The impact on mental health professionals of working with individuals who self-harm.

A thesis was completed as part of the requirements of the Doctorate in Clinical Psychology. Having previously worked with young people who self-harmed, the author was interested in the impact of work on professionals. When reading around the subject, it was possible to identify that whilst a wealth of research has been undertaken into healthcare professional attitudes towards self-harm, few studies have explored the impact of such work on staff. The impact of work with self-harm on professionals is an important area of enquiry as it is acknowledged that mental health workers are vulnerable to compassion fatigue (Figley, 2002) and vicarious traumatisation (McCann & Pearlman, 1990) through their empathy with those who are suffering. This impacts on staff well-being and morale, as well as service users’ experience and outcomes. A review of the literature was conducted in order to ascertain what was already known and where gaps existed. Nine studies were identified and evaluated. Working with self-harm had both an emotional and cognitive impact on professionals, with work eliciting strong emotions and some staff describing responses such as sleep disturbance and relational conflict that were consistent with compassion fatigue (Bride, 2004). Most research had been carried out with qualified staff working with adults who self-harmed. Therefore, a gap was identified around unqualified staff experience of working in inpatient settings with adolescents who self-harm. Since the aim was to explore staff experience, a decision was made to use Interpretative Phenomenological Analysis to explore the experience of healthcare support workers (HCSWs) in an inpatient unit. Six HCSWs were interviewed using a semi-structured format. Four superordinate themes were found: trying to make sense of self-harm, emotional impact, relationships, and HCSW role. Participants’ responses were reflective of components of compassion fatigue and vicarious traumatisation, highlighting the profound impact of such work and the need for structured training and support. Findings were supported by research with qualified staff. However, existing knowledge was extended by providing detail of the meaning of experience for HCSWs. The thesis concludes with the author’s reflections on her own experience of working on an inpatient unit with adolescents who self-harm.