ArticleBorderline personality disorder and emotion dysregulation2026
Does changing clinicians' attitudes toward self-harm reduce coercive interventions in mental health inpatient settings? A quasi-experimental study of staff training.
Article in Borderline personality disorder and emotion dysregulation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStaff education may improve clinicians' attitudes toward self-harm, but whether this translates into reduced coercion is unclear. We evaluated a regional strategy to improve care for self-harming patients and its impact on staff attitudes and coercive interventions across services.
methodsQuasi-experimental dual design: (a) interrupted time-series of registry data on coercive interventions (Jan 2021-Dec 2024) and (b) three-wave pre-post surveys using the revised 17-item Self-Harm Antipathy Scale (SHAS-DR) at baseline, 2 months, and 8 months post-training. Change points: June 2022 (strategy announcement) and June 2023 (training implementation).
resultsIn registry data, coercive interventions declined after the strategy announcement (level IRR 0.39, 95% CI 0.21-0.73) with no subsequent trend change. A temporary increase occurred at the training point (level IRR 2.58, 95% CI 1.57-4.25), consistent with implementation disruption. Reductions were largest for mechanical restraints, particularly among self-harming patients, while rapid tranquillization remained most frequent. Annual coercive episodes fell from 1,280 (2021) to 409 (2024). Staff attitudes improved and were sustained. Mean SHAS-DR decreased from 40.0 (SD 10.8) at baseline to 34.8 (SD 7.4) at 2 months and 35.4 (SD 8.2) at 8 months; baseline-to-follow-up changes were significant (p ≤ 0.001).
conclusionsThe strategy coincided with an immediate reduction in coercion and a transient rise during training, while staff attitudes reflected reduced antipathy toward people who self-harm. Sensitivity analyses suggested changes were not driven by high-frequency patients. Sustained reductions likely require continued organizational and relational supports.
trial registrationNot applicable.
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