The Swedish National Self-Injury Project

Hem/The Swedish National Self-Injury Project
The Swedish National Self-Injury Project 2018-03-14T09:26:21+00:00

The National Self-Injury Project – our assignment

In an agreement between the Swedish Association of Local Authorities and Regions (SALAR) and the government from October 2011, the parties have agreed upon an initiative aiming at developing and coordinating activities in order to decrease the number of young with self-injurious behaviour: the National Self-Injury Project.

The goal of the agreement is to develop and coordinate activities in order to decrease the number of young with serious self-injurious behaviour, and to create a better early stage care through a structure that provides for proper care for these persons. The overall goal is thus to decrease the number of people that are taken into professional care within inpatient units, and to decrease the number of involuntary and coercive measures.

SALAR has agreed with Psykiatri Skåne:

  • To carry out a pre-study and then spread it on a national basis. The study should contain a compilation of current knowledge within the area, nationally as well as internationally. In addition to that, the study should contain a report on the resources that are available currently in terms of clinics and competent personnel in both institutional and non-institutional care, and units of potential collaboration partners that supply care within this area. The study should also contain an inventory of current development activities in the area, and the financing of those activities.
  • To assemble and coordinate the regions that in this context form nodes to a national network.
  • To carry out common national activities within the area.
  • To continuously report to SALAR regarding the progress of the assignment.

SALAR assigns to Psykiatri Skåne, the Region Västra Götaland and Stockholm County Council:

  • To create a regional node of competence in which the region’s own resources within the area and resources in other county councils that wish to join and engage themselves in the appropriate node are linked together in order to enable exchange of experiences and creation of new, shared knowledge in the area.
  • To create and engage in a national network within the area that includes all of Sweden.
  • To collect all the experience and practice that is to be found on a local level concerning preventive efforts, early efforts and efforts aimed at the very most ill.
  • To create structures that enable spreading of knowledge and give guidance, advice and support in individual cases.
  • Collect and produce data that can serve as basis for comparative studies, which can then lead to an improved follow up and evaluation of what gives good results.
  • Work out measurable goals for the project that will then be followed up and accounted for in the final report that SALAR will hand in to the Government Offices of Sweden (the Ministry of Health and Social Affairs).
  • To collaborate with other organizations.
Since the beginning of the project and in all activities we do, we have a close collaboration and exchange with SHEDO. This cooperation, in which the care users’ perspective pervades everything we do, has largely contributed to and enriched our work in the project.
How common is it for patients in psychiatric care to injure themselves? Does the occurrence vary in different ages, between different types of care units, and are there regional differences? To what extent do patients injure themselves occasionally compared to repeatedly? Are there patients that hurt themselves without having had a suicidal intention? Are there patients that have attempted suicide without ever having injured themselves?

We need to learn more about how common self-injurious behaviour is with patients in psychiatric care. To increase our knowledge and to be able to answer these and more questions we are carrying out a national inventory. During the fall of 2013 all patients above the age of 12 at a representative selection of child and adult psychiatric clinics in Sweden were asked to answer a questionnaire regarding self-injurious behaviour. The survey was carried out by researchers Mia Ramklint and Charlotta Odelius at the Institute for Neuroscience at Uppsala University. The result was presented in 2014.

The web based training aims at increasing the competence among people that encounter self-injurious behaviour in their professional role but also in private life, may it be in the role of being afflicted yourself or in being a relative or otherwise close to someone afflicted by self-injurious behaviour. The training consists of a mix of text modules, filmed interviews with researchers in the field, and short movies that serve as examples of different ways of interacting with and responding to someone with this behaviour.

Emotion Regulation Group Therapy (ERGT) is a promising therapy that is specifically aimed at working with self-injurious behaviour and other impulsive destructive behaviours. ERGT runs during 16 weeks, with 90−120 minutes weekly sessions in a group format. So far three studies of ERGT have been run within the project. The studies have shown very promising results. ERGT has not been studied in Sweden before.

The ERGT manual has been translated into Swedish and the creators of the method, Kim Gratz and Matthew Tull, have delivered training sessions in Sweden. The interest in testing and using the therapy in Sweden is large, and the National Self-Injury Project have so far trained around 150 therapists.

An adjusted and modified version of ERGT has been developed for children and adolescents: Emotion Regulation Individual Therapy for Adolescents, ERITA. This version is mainly internet based, and also includes a module for parents/care givers. ERITA is being tested during 2016−2017.

Within the project a large number of personnel within different levels of psychiatric care and health care related personnel have been trained through a wide range of training activities. A shared focus is put on the value and importance of a good way to respond and interact with people afflicted by self-injurious behavior.
A number of national and local conferences are arranged and held with the aim of spreading and sharing different aspects of knowledge regarding self-injurious behavior.