ABSTRACT
Patients with NSSI may require hospital treatment during a crisis period due to the severity of their self-injury or their psychiatric condition in general. Unless the patient is suicidal or psychotic or has other severe psychopathology in addition to NSSI, the stay should be as brief as possible, and from the outset, the goal should be to transition to outpatient treatment. Prevalence of NSSI among psychiatric patients is high, and studies show that hospital staff often have negative attitudes towards patients who self-injure. During a hospital stay, a malign dynamic often emerges, where the structure at the ward and the loss of autonomy will cause patients to regress, including resorting to self-injury. The hospital staff’s response to a patient’s self-injury is generally to act to protect the patient. This in turn is often perceived by the patient as further control and a restriction of autonomy. Action leads to action, and a ‘tacit dialogue’ may emerge, where the escalating process is not verbalized. This may exacerbate the self-injurious behaviour, and the staff may in turn restrict the patient’s autonomy further. Hence I advocate for a non-confrontational culture and propose a procedure for handling incidents of self-injury in the ward.
