Self-harm: from risk management to relational and recovery-oriented care Jean Morrissey, Louise Doyle and Agnes Higgins Abstract Purpose – The purpose of this paper is to examine the discourses that shape nurses’ understanding of self-harm and explore strategies for working with people who self-harm in a relational and a recovery-oriented manner. Design/methodology/approach – Self-harm is a relatively common experience for a cohort of people who present to the mental health services and is, therefore, a phenomenon that mental health nurses will be familiar with. Traditionally, however, mental health nurses’ responses to people who self-harm have been largely framed by a risk adverse and biomedical discourse which positions self-harm as a “symptom” of a diagnosed mental illness, most often borderline personality disorder. Findings – This has led to the development of largely unhelpful strategies to eliminate self-harm, often in the absence of real therapeutic engagement, which can have negative outcomes for the person. Attitudes towards those who self-harm amongst mental health nurses can also be problematic, particularly when those who hurt themselves are perceived to be attention seeking and beyond help. This, in turn, has a negative impact on treatment outcomes and future help-seeking intentions. Research limitations/implications – Despite some deficiencies in how mental health nurses respond to people who self-harm, it is widely recognised that they have an important role to play in self-harm prevention reduction and harm minimisation. Practical implications – By moving the focus of practice away from the traditional concept of “risk” towards co-constructed collaborative safety planning, mental health nurses can respond in a more embodied individualised and sensitive manner to those who self-harm. Originality/value – This paper adds further knowledge and understanding to assist nurses’ understanding and working with people who self-harm in a relational and a recovery-oriented manner. Keywords Engagement, Risk, Self-harm, Recovery Paper type Conceptual paper Introduction Contemporary mental health policies articulate the need for services to be driven by the principles of quality and safety (Higgins et al., 2016). In the context of safety and risk, self-harm has become a major health issue and a cause of concern internationally (Fleischmann and Shekhar, 2013). Mental health nurses are at the frontline of service provision and are likely to encounter in almost every practice setting people who may have thoughts of self-harming and/or engaged in self-harming behaviour. They are therefore in a pivotal position to utilise their knowledge and skills to support people who present with self-harm and as such have an important role to play in self-harm prevention, reduction and harm minimisation. People who self-harm experience many needs and challenges related to their emotional distress. A positive and open attitude by nurses is critical, if they are to engage with the person in a manner that supports and promotes the person’s safety and recovery (Morrissey, 2015). However, how nurses conceptualise and think about self-harm strongly influences their action, interactions and the strategies they use to support people (Higgins et al., 2015), which in turn impacts on the person’s treatment, recovery and safety outcomes. This paper aims to examine the discourses that shape nurses’ understanding of self-harm and explores strategies for working with people who self-harm in a relational and recovery-oriented way. Received 15 March 2017 Accepted 14 June 2017 Jean Morrissey is an Assistant Professor, Louise Doyle is an Assistant Professor in Mental Health Nursing and Agnes Higgins is a Professor in Mental Health Nursing, all at the School of Nursing & Midwifery, University of Dublin Trinity College, Dublin, Ireland. PAGE 34 j THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE j VOL. 13 NO. 1 2018, pp. 34-43, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-03-2017-0017