People who self-harm: rapid evidence review and survey of practitioner perspectives

Appendix 3: Survey Questions

What type of organisation do you work for?

• NHS
• Private healthcare provider
• Charity/Non-profit organisation
• Local government
• Educational institution
• Emergency services (e.g. police, ambulance)
• Other

What is your job role?

• Doctor
• Service manager
• Social worker
• Administrative staff
• Peer practitioner
• Educational staff
• Nurse
• Other clinical/NHS staff
• Police
• Other emergency services staff
• Support worker
• Other

How long have you been working in your current role?

• Less than 1 year
• 1–3 years
• 5–10 years
• More than 10 years

Which categories of people who self-harm do you support? (Select all that apply)

• Children (under 18)
• Adults (18–64)
• Older adults (65+)
• Men only
• Women only
• People with disabilities
• Racialised communities
• LGBTQ+ individuals
• Neurodivergent individuals
• Care-experienced children and young people
• Prisoners
• Other

Have individuals who you support who self-harm reported experiencing barriers to accessing support or services?

• Yes
• No

Which types of services have individuals you support who self-harm experienced barriers in accessing? (Select all that apply)

• Mental health services
• Counselling services
• Out of hours services
• Education (school, higher and further education)
• Emergency services
• Addiction services
• Housing support services
• Employment support services
• Benefits/Financial support services
• Physical healthcare services
• Educational support services
• Other

Which of the following barriers have individuals you support who self-harm experienced? (Select all that apply)

• Stigma or discrimination from service providers
• Fear of stigma, discrimination or judgement from service providers
• Self-stigma (e.g. concern about seeming “attention-seeking”)
• Concern about receiving a psychiatric diagnosis/misdiagnosis
• Family beliefs/cultural barriers
• Negative past experiences accessing support
• Lack of awareness of available support
• Concerns around confidentiality/data sharing
• Other

What types of service barriers have individuals you support who self-harm experienced? (Select all that apply)

• Exclusion through policy criteria (e.g. ineligible for a service due to being a risk to oneself)
• Self-harm contracts (e.g. having to sign an agreement not to engage in self-harm)
• Long waiting times
• Inadequate availability of specialised services
• Inflexible service hours
• Lack of culturally sensitive services
• Poor accessibility (e.g. lack of interpreter or disability provisions)
• No choice regarding gender of practitioners
• Undesirable delivery method of support (e.g. preference for online/in-person support)
• Geographic location
• Lack of reminders for appointments or support to attend
• Removal from waiting lists following non-attendance to appointments
• Other

What types of structural barriers have individuals you support who self-harm experienced to accessing services? (Select all that apply)

• Financial barriers (e.g. cost of accessing services, cost of transport)
• Lack of transport to attend appointments (e.g. lack of availability of public transport or private transport)
• Caregivers unable to bring children or other dependents with them to appointments
• Digital barriers - inability to interact with online services due to lack of access to technology or digital literacy
• Other

What are the potential mental health implications for individuals who self-harm when facing barriers to accessing support? (Select all that apply)

• Increased severity or frequency of self-harm
• Increased risk of suicidal ideation
• Receiving a potentially unwanted diagnosis (e.g. personality disorder)
• Worsening underlying mental health condition
• Increased feelings of hopelessness or helplessness
• Increased social isolation
• Difficulty engaging in alternative coping strategies
• Ongoing unmet mental health needs
• Enduring self-stigmatisation
• Other

What are the potential social implications for individuals who self-harm when they face barriers to accessing support? (Select all that apply)

• Strained relationships with friends or family
• Difficulty in maintaining employment/education
• Disengagement with support (formal and informal)
• Not re-presenting for treatment following negative past experiences
• Increased financial stress
• Housing instability
• Legal issues
• Decreased ability to engage in daily activities
• Other

What are the potential physical health implications for individuals who self-harm when they face barriers to accessing support? (Select all that apply)

• Increased risk of physical injury or complications
• Not seeking help for physical health concerns due to anticipated self-harm stigma
• Chronic pain
• Neglect of physical health needs unrelated to self-harm
• Physical health implications of increased substance use or dependency
• Other

Have you observed any systemic issues impacting support services that contribute to barriers for individuals who self-harm? (Select all that apply)

• Insufficient funding and resources
• Lack of communication between different services
• Service providers experiencing burnout
• Fixed service criteria and eligibility requirements
• Lack of cultural inclusivity or sensitivity (e.g. failing to reach marginalised groups)
• Insufficient knowledge or training in self-harm
• Challenges around transitioning between services (e.g. child to adult services)
• Other

What can be done to overcome barriers to accessing support for individuals who self-harm? (Open text response)