Gray, Emma
(2024)
An investigation into the psychological wellbeing of staff working with self-harm in forensic settings.
DForenPsy thesis, University of Nottingham.
Abstract
The relationship between witnessing or experiencing distressing events and acquiring symptoms of trauma is well established. This thesis is concerned with the psychological wellbeing and trauma symptoms of individuals who work in forensic settings, who are regularly exposed to self-harming behaviours. A range of methods were used to explore this. Following an introduction in Chapter One, Chapter Two contains a systematic review investigating the psychological and emotional responses of staff working in prisons and forensic psychiatric hospitals, who are witness to and/or are exposed to regular self-harming behaviours. The review highlights that across the 10 included studies, staff report different immediate and prolonged emotional and psychological responses to managing self-harming behaviours of those in their care, some of which consistent with trauma responses. Findings from the review suggest that those working in prison settings are more likely to report desensitisation and detachment from emotions than those in secure psychiatric hospitals.
Chapter Three, a case study of a woman detained in a medium forensic mental health hospital, explores the impact of Dialectical Behaviour Therapy (DBT) Skills Training and staff perceptions of her self-harming behaviours. This case study identifies the function of her self-harming behaviours and reports a reduction in self-harm following administration of one DBT module. Staff views identify some negative attitudes towards self-harm, highlighting some confusion relating to the function of self-harm, and that further training may be required.
This leads to Chapter Four, an empirical study using four multiple linear regression analyses, and three analyses of variances to explore the impact of attitudes towards self-harm (using the Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ)) and knowledge of self-harm (using the Knowledge of Self-Harm Questionnaire (KSHQ)) on self-reported trauma symptoms (using the Trauma Symptom Checklist-40 (TSC-40)) of those working in prisons and forensic psychiatric hospital settings, who are regularly exposed to self-harming behaviours. The regression model highlighted that reported anxiety and depression symptoms were significantly predicted by the subscales of the ADSHQ and KSHQ, with coping ability found to be a significant unique predictor. Significant differences were found between those who have and have not attended training on self-harm, on effective ability and coping ability. Significant differences were also found between prison staff and forensic psychiatric hospital staff on perceived confidence and effective ability scores. Interpretations, limitations, and comparison to existing literature are discussed.
Chapter Five consists of a critical evaluation of the TSC-40 (Elliott & Briere, 1992) exploring the psychometric properties and discusses its use. Overall, the Trauma Symptom Checklist-40 was found to be a reliable and valid tool to measure general symptoms of trauma, in line with the DSM-5's definition of post-traumatic stress disorder (American Psychiatric Association, 2013). The final chapter summaries the key findings across the thesis, the limitations of the methods used, and the implication of the findings.
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