Quantitative evidence for relational care approaches to assessing and managing self-harm and suicide risk in inpatient mental health and emergency department settings: a scoping review

Abstract

There is an over-reliance on structured risk assessments and restrictive practices for managing self-harm and suicidality in inpatient mental health and emergency department (ED) settings, despite a lack of supporting evidence. Alternative ‘relational care’ approaches prioritising interpersonal relationships are needed. We present a definition of ‘relational care’, co-produced with academic and lived experience researchers and clinicians, and conducted a scoping review, following PRISMA guidelines. We aimed to examine quantitative evidence for the impact of ‘relational care’ in non-forensic inpatient mental health and ED settings on self-harm and suicide. We identified 29 relevant reviews, covering 62 relational care approaches, reported in 87 primary papers. Evidence suggests some individual-, group-, ward- and organisation-level relational care approaches can reduce self-harm and suicide in inpatient mental health and ED settings, although there is a lack of high-quality research overall. Further co-produced research is needed to clarify the meaning of ‘relational care’, its core components, and develop a clear framework for its application and evaluation. Further high-quality research is needed evaluating its effectiveness, how it is experienced by patients, carers, and staff, and exploring what works best for whom, under what circumstances, and why.