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.
Subject(s)
Anxiety/psychology , Health Services , Professional-Patient Relations , Self-Injurious Behavior/prevention & control , Self-Injurious Behavior/psychology , Stress, Psychological/psychology , Suicide/psychology , Humans , Risk Assessment , Social SupportABSTRACT
This paper describes the initial development and implementation of the Starting Well Health Demonstration Project, Scotland's national child health demonstration project. The Project, initially launched in 2000, aims to demonstrate that child health can be improved by a program of activities that both supports families and provides them with access to enhanced community-based resources. Early process outcomes will be presented and policy implications arising out of the Project to date will be explored.