The impact of interpersonal and intersubjective factors on engagement with psychological services in individuals who repeatedly display deliberate self-harm (DSH) behaviour

This thesis focuses on the relationship between individuals who repeatedly self-harm and healthcare services. It investigates potential barriers within this relationship that limit the access of service users to psychological therapies for self-harming behaviour available in the NHS. As repeated self-harm has a substantial economic burden, Part 1 presents a review of economic evaluations of psychological treatments for people diagnosed with Emotionally Unstable Personality Disorder, who often use deliberate self-harm as coping mechanisms. Twenty studies were included following a systematic search of the literature. Overall, Dialectical Behavioural Therapy has the highest chance to be considered as cost-effective, followed by Schema Focus Therapy and Mentalisation Based Therapy. Part 2 presents a qualitative study where semi-structured interviews were conducted with service users who repeatedly self-harm, and mental health professionals working in Accident and Emergency (AE a summary of the contributions of each author to this study is given in Appendix A.