title: Health services, suicide, and self-harm: patient distress and system anxiety.
abstract: Patients often become distressed in health settings, and provision of emotional support is a routine part of clinical care. However, in some situations, patient distress can become disturbing to both clinicians and patients, and can affect ordinary therapeutic engagement. We argue that health systems that support people presenting with suicidal acts and self-harm are particularly at risk of providing maladaptive responses, which we have termed dysregulation. If health systems become dysregulated, staff and patients might find it difficult to think clearly and respond adaptively. We describe some common characteristics of dysregulation, including negative feelings about patients, an inappropriately narrow focus on diagnosis and risk assessment, and ad-hoc, abrupt, and inconsistent decision making. These dysregulated responses might impair more adaptive responses such as containment of distress, safety planning, and negotiated responsibility with patients and carers. We discuss the main drivers of dysregulation and the implications for clinical practice in the management of self-harm and suicide risk.
authors.affiliation: Mental Health Services, NHS Greater Glasgow and Clyde, William Street Clinic, Glasgow, UK. Electronic address: michael.smith2@ggc.scot.nhs.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Mental Health Services, NHS Greater Glasgow and Clyde, William Street Clinic, Glasgow, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Bouch
authors.affiliation: Scottish Recovery Network, Glasgow, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bradstreet
authors.affiliation: Mental Health Services, NHS Greater Glasgow and Clyde, William Street Clinic, Glasgow, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Lakey
authors.affiliation: Retired Consultant, Paisley, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Nightingale
authors.affiliation: Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Rory C
authors.initials: RC
authors.lastname: O'Connor
mesh_terms: D001007:Anxiety / Q000523:psychology*; D006296:Health Services; D006801:Humans; D011369:Professional-Patient Relations; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000517:prevention & control* / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D013405:Suicide / Q000523:psychology*