Shafti, Matina, Taylor, Peter, Forrester, Andrew, Robinson, Louise, Mathews, Sandeep and Pratt, Daniel (2025) ‘If one doesn’t happen, the other will’: forensic mental health service patients’ experiences of co-occurring self-harm and aggression. BJPsych Open, 11 (1):e20. pp. 1-8. ISSN 2056-4724 (Online) (doi:10.1192/bjo.2024.834)

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Abstract

Background
Co-occurring self-harm and aggression (dual harm) is particularly
prevalent among forensic mental health service (FMHS) patients.
There is limited understanding of why this population engages in
dual harm.
Aims
This work aims to explore FMHS patients’ experiences of dual
harm and how they make sense of this behaviour, with a focus
on the role of emotions.
Method
Participants were identified from their participation in a previous
study. Sixteen FMHS patients with a lifetime history of dual harm
were recruited from two hospitals. Individuals participated in
one-to-one, semi-structured interviews where they reflected on
past and/or current self-harm and aggression. Interview transcripts were analysed using reflexive thematic analysis.
Results
Six themes were generated: self-harm and aggression as emotional regulation strategies, the consequences of witnessing
harmful behaviours, relationships with others and the self,
trapped within the criminal justice system, the convergence and
divergence of self-harm and aggression, and moving forward as
an FMHS patient. Themes highlighted shared risk factors of dual
harm across participants, including emotional dysregulation,
perceived lack of social support and witnessing harmful behaviours. Participants underlined the duality of their self-harm and
aggression, primarily utilising both to regulate negative emotions. These behaviours also fulfilled distinct purposes at times
(e.g. self-harm as punishment, aggression as defence). The
impact of contextual factors within FMHSs, including restrictive
practices and institutionalisation, were emphasised.
Conclusions
Findings provide recommendations that can help address dual
harm within forensic settings, including (a) transdiagnostic,
individualised approaches that consider the duality of self-harm
and aggression; and (b) cultural and organisational focus on
recovery-centred practice.

Item Type:	Article
Uncontrolled Keywords:	self-harm, aggression, co-occurrence, suicide, forensic mental health
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Inequalities Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Mental Health Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	19 Mar 2025 11:28
URI:	http://gala.gre.ac.uk/id/eprint/50079

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