May 17, 2018

Accessible Summary: Working with men who self-harm in a learning disability secure unit

Rebecca Fish and Hannah Morgan


Some research from Canada and the US says that more young men are self-harming.  There is a small amount of research from the UK. This says that when men self-harm, their injuries are usually more violent and can be seen as accidental.

Some of the research talks about UK prisons. More men in prison are self-harming. Some prisoners reported that staff can show bad attitudes towards their self-harm. Prison staff said they need more help to deal with male self-harm.

We talked to staff who work with men with learning disabilities in a secure unit. We wanted to find out what it is like to work with men who self-harm.


This work was paid for by Mersey Care NHS Foundation Trust. We were given approval to do this study from Lancaster University.

We interviewed nine staff members in a secure NHS learning disability unit in England. The staff were one psychiatrist, two therapy staff and six direct care staff.

The questions were:

  • How do staff work with men who self-harm?
  • Is male self-harm changing?
  • What helps?


Types of self-harm

The staff told us the types of self-harm that they had seen. They said men self-harm by causing fights, cutting or tying ligatures.

They also said men use less risky self-harm like picking and scratching. One person said that men swallow risky things.

Is the type of self-harm changing with this user group?

Three staff said that self-harm is changing:

Whereas one time, you know it might just have been a cut or a graze, or a bruise where someone’s rubbed their skin.  Now it seems to be you’ve got to reach for the sky and, do something that will really shock. (Int 41)

One person said that men are self-harming more because of moving plans:

It is increasing, and it started to increase because resettlement’s on the cards now.  And I think that’s around anxiety levels and they way they’re feeling. (Int 42)

Meanings of self-harm

Some staff think the men self-harm because they are bullied.  Some think it is because they are told what to do.

Other staff said men self-harm to show they are distressed, because they can’t talk about it.  Many staff said that that men self-harmed to start or stop ward moves.

Working with men who self-harm

Some staff said men hide their self-harm.

It is hard for some men to talk about their feelings, to say why they are feeling worried and why they have self-harmed.

Staff feel upset and sad when men self-harm.

Good ways to work with men who self-harm

Staff said these things helped:

  • Building up trust and relationships with the men.

  • Learning about men’s pasts.

  • Supporting friendships and family relationships.

  • Talking about men’s strengths and making them feel good about themselves.

  • Art therapy and CBT therapy can help men to stop self-harming.

  • Men need support when they are moving.

Staff support

It is difficult for staff to deal with self-harm. It is important to remember what the person has been through in their life.

Staff said they try to keep positive. Good relationships are important. Staff need help from managers as well as work mates.

Rebecca and Hannah would like to say thank you to all the staff who helped with this research. We would like to credit Mersey Care NHS Foundation Trust for paying for this work.

All images from CHANGE