Abstract

There is a dearth of research exploring pathways to episodes of deliberate self-harm (DSH) as experienced by mentally ill men within high-secure hospital settings. The principal aim of this study was to explore the causal pathway(s) to episodes of self-harm experienced by mentally ill men within a high secure hospital. With a secondary aim of developing a conceptual understanding of the development and function of this phenomenon within this often ignored population. Seven men with a history of repetitive DSH participated in audiotaped semi-structured interviews in which they recalled antecedents and functions of typical episodes. Transcribed interviews were analysed and coded using grounded theory methods. Two pathways to episodes of DSH emerged and were subsequently termed, the Relief and the Response to Mental Health Problems Pathways. The Relief Pathway consisted of two inter-related functions; relief and an expression of self-hatred. Within the Response to Mental Health Problems Pathway, episodes of DSH were directly influenced by auditory hallucinations and delusional beliefs. Participation within a dyadic suicide pact emerged as a wholly unexpected theme. Further research is required to substantiate the two-pathway aetiology to episodes of DSH proposed within this study.