A ‘cut too deep’; creating a context for change in the family and community of practice for the management of self-harm

Ireland, Sara (2019) A ‘cut too deep’; creating a context for change in the family and community of practice for the management of self-harm. [Doctorate by public works]


Self-harm is prevalent in young people in escalating proportions. Research into its causes and treatments is on-going. Significant numbers of young people are treated in primary care without the medical diagnosis of mental health conditions. Whilst most self-harm happens in bedrooms at night, the family and parents in particular are not always involved in the safety and the support planning of their children. The impact of providing parental care in these circumstances is challenging and can be to the detriment of family members’ health too.

The account follows a reflexive journey through a multi-agency project, to deliver two outputs – firstly, the improvement of the management of self-harm in the family and community and secondly, the illumination of the developing model of multi-agency work in this Early Help context. These two domains of exploration interweave and alternate through the thesis. Theories from different psychological and therapeutic domains are considered within the Deleuzian philosophical framework to illuminate the processes that distilled the works.

The original reported evidence (upon which this reflexive audit is based) employed mixed methodologies, founded in action research, action learning and grounded theory including qualitative data audits of the mental health context and the impact of self- harm according to parents (134 coded cases reviewed), semi-structured interviews with young people in focus groups, case work and case studies, impact of training programmes and workshops for parents measured through questionnaires and on-line surveys, pre and post intervention scaling, semi- structured interviewing and focus groups in the final phase of work.535 participants from the wider network of practice, families and young people participated in the process.

The project reported that a family focused approach is important in the management of self-harm and the helping network struggles to work seamlessly around the family. A relational frame, safety planning, social prescribing to Parent Support programmes and Co-ordinated Circles of support interventions assist at the level of the family. Clinical supervision and GP family focused consultation techniques improve the experience of help and support a context for family recovery. The relationships between the helping partners require attention. Project partners value a model of non-hierarchical collaboration underpinned by shared values within a light-touch framework where the ‘lived experience of the family and network’ is at the core of the developing ideas to improve practice. This model of multi-agency working is optimised when learning is at the centre of partner collaboration and when conditions such as stigmatisation, complex issues, risk management and historical difficult relationships with help are present.

SIreland thesis.pdf - Accepted Version

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