Reducing the risk of self-harm in inpatient mental health settings

Summary

This blog explores the ever-present risk of self-harm in inpatient mental health settings and looks at ways to reduce this risk. 

Content

Inpatient mental healthcare is intended to offer refuge. In theory, these are places where an individual in (mental health) crisis can step out of the chaos and venture into a structured environment that’s designed to stabilise and guide them back to balance. But for those struggling with self-harm, the reality of inpatient care is often far more complex: rules intended to keep these patients safe may suddenly become triggers.

Research studies are unanimous: patients who rely on self-harm as a way to manage the intensity of their feelings can find inpatient spaces challenging. Deprived of a familiar coping mechanism, they might feel isolated or even punished (a situation that prompts an escalation of distress rather than relief). This paradox—the push and pull between patient safety and autonomy, control and compassion—makes managing self-harm in inpatient mental health settings a hefty ordeal.

Self-harm in inpatient treatment: what do the studies reveal?

One research study published in the Journal of Psychiatric and Mental Health Nursing has, among other results, concluded that, for some patients, the inpatient environment temporarily reduces the incidence of self-harm simply by making it physically more challenging to do so. Yet, the study underlines this sense of enforced security is fragile. For patients who have come to rely on self-harm as a form of release, removing that outlet without addressing the underlying pain can magnify feelings of helplessness. That also makes things difficult for the staff: they’re aware that while restrictions can reduce harm, they also risk pushing patients into more dangerous or desperate forms of self-harm.

How to reduce the risk of self-harm in inpatient mental health settings

Reducing self-harm risk in inpatient mental health settings requires a shift away from containment and toward a model that promotes healing through connection, trust and empowerment.

Build authentic trust

Safety isn’t simply about restrictions or even vigilance. Safety, in a setting meant for healing, is about creating trust. A staff member trained to listen without judgment and to approach the patient with calmness and empathy is often the first line of defence against self-harm. When patients feel they can freely communicate about their urges without the discouraging fear of punishment, it can reduce the compulsion to self-harm in secrecy. 

Offer practical coping tools

Patients who self-harm typically do so because it serves as a reliable, although harmful, way to manage emotions they simply can’t handle. In an inpatient setting, replacing self-harm with skills like grounding techniques, mindful breathing, meditation or yoga, and keeping an everyday diary can be more than helpful. Introducing these skills as an alternative to self-harm will require time, practice and encouragement. Staff who guide patients through these techniques will be an important link; they’ll help patients see and feel that self-control, and not self-harm, is achievable.

Provide plenty of safe outlets

Patients frequently injure themselves because they don't have safe ways to express the overwhelming emotions they're experiencing. Establishing specific areas and times for patients to express themselves via art, journaling or group conversations provides a healthy means of processing challenging emotions. These kinds of therapeutic channels can lessen the urge for self-harm as a release mechanism while also making patients feel heard and understood.

Collaborative care

Involving patients in creating their treatment plans can foster a profound sense of agency they feel they lack. When patients participate in defining their goals and strategies, they are more likely to engage meaningfully with their treatment. Collaborative care doesn’t just manage symptoms—it affirms the patient’s role in their recovery. By involving patients as partners, we validate their insight and resilience, helping to counteract feelings of powerlessness that can trigger self-harming behaviours.

Support staff resilience

Working in mental healthcare, especially in crisis settings, demands both emotional endurance and self-care. In facilities where staff face constant pressure to prevent self-harm, the emotional toll can lead to burnout. A burnt-out staff member may unintentionally create a tense atmosphere that patients can sense. Facilities that invest in support systems—counselling, peer supervision or regular team check-ins—enable staff to maintain the compassion and resilience needed to connect with patients. When staff feel cared for, they can care more effectively, healing the inpatient environment.

Conclusions

Inpatient mental health settings face an immense challenge: to protect individuals from self-harm while also supporting the emotional work that is essential to recovery. Research underscores that while restrictions on self-harm may reduce immediate risk, they cannot address the pain that drives these behaviours. Without a shift in approach, the risk of self-harm in inpatient mental health settings remains. A treatment model that combines empathy with skill-building, collaborative care and staff support creates a space where healing can occur on a deeper level.

About the author

Danny Mills II is the Chief Marketing Officer at Time Wellness Arkansas, a provider of mental health services. With a passion for raising awareness, he draws from personal experience to shed light on overlooked aspects of mental healthcare. When he’s not leading marketing efforts, he’s dedicated to writing and advocating for greater understanding in the mental health field.