Self-harm strategy development: qualitative evidence

Conclusion

This meta-ethnography of qualitative studies with people who have self-harmed has sought to synthesise and discuss a rich and varied literature, offering support to those seeking to draw on ‘lived experience’ to inform policy and practice responses to self-harm. We have demonstrated that self-harm is a diverse practice, incorporating multiple methods and multiple meanings, which are deeply entangled with social and cultural contexts.

There is still much that is not known about self-harm. In particular, we identified a significant paucity of qualitative studies which engage with Black and minority ethnic people. Indeed, many studies simply did not report on ethnicity. While there are understandable concerns about self-harm among young women, it is vital that self-harm is understood as a practice that many different social groups – and age groups – engage in.

Our review was particularly concerned with identifying the relationship between self-harm and social or contextual features. It is important to note that these were not always the focus in the studies we reviewed. While our review has certainly demonstrated the importance of immediate and more distal social factors – from relationships, bullying, institutions, to queerphobia and poverty – in making sense of self-harm; we also noted that many studies had less focus on such social factors. An example here is the surprisingly limited attention paid to exploring the relationship between gender and self-harm in the studies we reviewed. This is despite self-harm frequently being understood as more common among young women, and many studies focusing on largely female samples. Studies which engage more deeply with social factors – proximal and distal – in how self-harm is understood and experienced would be welcome, and may offer fruitful ways forward in making recommendations for policy and practice.

Our review has some limitations. Firstly, the review was conducted with specific keywords, date restrictions, and a focus on the UK. This approach was developed to manage the number of included papers to ensure they were manageable, whilst still allowing sufficient breadth. This is inevitably an approach that means some potentially useful studies will have been omitted. Additionally, with some exceptions, the review focused on peer-reviewed articles, and not books. We are aware that this excludes several key contributions, and in particular some texts which – in part due to their length – are better able to engage with some of the omissions regarding social factors we noted above. Finally, and as we indicate above, it is important to reiterate that studies with those who have self-harmed have tended to focus on relatively similar samples. As such, our studies draw on samples that are more often female, more often younger, and more often involving relatively educated participants.