How can I effectively engage with patients who are reluctant to discuss their self-harm behaviors?

To effectively engage with patients reluctant to discuss their self-harm behaviors, it is essential to treat them with respect, dignity, and compassion, while being culturally sensitive. Establish a trusting and collaborative therapeutic relationship by using a non-judgmental and empathetic approach.

Use alternative communication methods if the patient finds it difficult to vocalize distress, such as non-verbal language, letters, emotional wellbeing passports, or agreed safe words and phrases. This supports patients who may struggle to express themselves verbally and helps build rapport.

Conduct a psychosocial assessment that explores the person’s social, psychological, and motivational factors surrounding self-harm, including any suicidal intent or feelings of hopelessness. This assessment should be done sensitively and may be carried out in primary care by trained staff if specialist referral is not immediately possible.

Engage in shared decision-making, involving the patient in discussions about their care, safety planning, and the involvement of family or carers as appropriate and with consent. This collaborative approach helps empower the patient and respects their autonomy.

Identify and discuss coping strategies, social supports, and safety plans that include removing or restricting access to means of self-harm, tailored to the patient’s preferences and needs. This can help the patient feel safer and more supported.

Be aware of safeguarding concerns and address these sensitively, ensuring the patient feels safe and supported throughout the process.

Maintain continuity of care and ensure that staff are visible and accessible to encourage interaction and trust.