Attitudes towards clinical and non-clinical services among individuals who self-harm or attempt suicide: A systematic review

The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. We reviewed research papers published since then until July 2022 to examine contemporary attitudes towards clinical and non-clinical services among individuals who self-harm and their relatives. We identified 29 studies meeting inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes towards clinical management and organisational barriers across services. Generally, more positive attitudes were found towards non-clinical services providing therapeutic contact, such as voluntary sector organisations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centred and compassionate care and deliver more effective, acceptable and accessible services.