Critically discuss the main difficulties working psychologically with people who self-harm or who are suicidal, with reference to best practice and research in counselling and forensic psychology. What thoughts and feelings could be brought up in you when working with clients who self-harm?

Listen to an interview with Fiona McCauley, a TESS (Text and Email Support Service) coordinator at Self-Injury Support in Bristol.ONLINE !!!!! Expain as per below: definition of self harm and suicide, and fact/ figures

so whats is best practice what research tells us Logan(2013)argues that paper exercise approach taken to risk assessment death in custody Logan 2013- each person needs to be assessed as a unique individual

study of self harm prevalence by Hawton et al. 2014

A simple definition provided by the NHS describes self-harm as any 'intentional damage or injury that we cause to ourselves. It is usually a way of coping with or expressing overwhelming emotional distress' (NHS Choices, 2017a).

Self-harm, very complex behaviour that can hold a number of different meanings- James and Samuels, 2018 Most common reason for self harm is to manage emotions Best practice -needs to be seen as coping strategy with personal meaning not seen as mental illness ( James and Saumuels, 2018) All Logan , 2013- sudden changes in circumstances can be a trigger

much suicidal behavior is driven by anger as much as despair- by Pilgrim, 2023

the most high risk clients are dual diagnosed with severe mental problems and substance use disorder - by Logan, 2013

Self harm is linked to problematic anger management and impulse control by james and Samuels , 2018

The World Health Organisation (WHO, 2016) defines suicide as, 'the act of deliberately killing oneself', while De Leo et al. (2006, p. 12) offer a definition as 'an act with fatal outcome, which the deceased, knowing or expecting a potentially fatal outcome, has initiated and carried out with a purpose of bringing about wanted changes'.

Reeves (2013) offers a summary of the key aspects of self-harm/injury that capture a broader array of behaviours. Self-harm/injury can:

be directed against the body (e.g. cutting, burning), which might be termed as self-injury include behaviours without immediate impact, such as eating disorders, risky sexual behaviour be planned and form part of a habitual pattern, or may be unplanned and spontaneous be about coping, living, surviving and self-worth have a relationship with suicide potential, particularly in the context of other risk factors.

Cohen (1985), have argued that medical interventions can lead to the very real risk of unintended consequences occurring, such as increased stigmatisation and unnecessary compulsion/treatment under mental health legislation

Lorentzon (2005) point out that conversely the act of suicide can also be conceived as an act of taking control amid a life that is experienced as out of control. Indeed, scholars such as Thomas Szasz (see, for example, Szasz, 1997) have opened rich debates on the territorial parameters of psychiatric and medical power, while at the same time actively working as a psychiatrist.

In the UK, suicide was decriminalised in the 1961 Suicide Act and while there is not a general duty to report concerns of potential suicide,

2005 Mental Capacity Act in England and Wales and the 2000 Adults with Incapacity Act in Scotland) concerning capacity that informs practitioner decisions concerning risk. These Acts are based on the principle that adults have the right to self-determination, including the right to die through suicide, if they have the capacity to do so. However, practitioners can act to protect the well-being of the client if a contract with a client is established at the outset of therapy, which limits confidentiality with regards to the risk of suicide

Bond and Mitchels (2014) offer some helpful guidance (see Information box 18.1).

However, it must be noted that NICE state the following regarding the scales involved in such risk assessment: 'The sensitivity and specificity of these scales are, at best, modest' (NICE, 2011, p. 29).