Challenges encountered by frontline professionals in care for adolescents who self-harm. A qualitative study conducted on an inpatient unit implementing Adolescent Mentalization-Based Integrative Treatment (AMBIT)

Research: The prevalence rate of self-harm among adolescents is high and rising. This is a worrying trend, considering that self-harm is associated with poor mental health and an increased risk of suicide. However, research literature suggests that adolescents rarely seek help and that caring for them is a complex task. Furthermore, the existing research indicates that healthcare professionals’ views and responses to working with this patient group may be influenced by interplay of individual, interpersonal and institutional processes. Those working on the frontline in inpatient settings seem to be most affected by these processes. It was proposed that to support frontline healthcare professionals in caring for this patient group theory-driven therapeutic models need to be developed. It was also proposed that psychoanalytic theories were best positioned to manage the impact of the processes posing challenges to care for adolescents who self-harm. Research aims: This thesis aimed to investigate the challenges experienced by frontline professionals caring for adolescent patients who self-harmed whilst being treated on an inpatient unit, and frontline professionals responses to these challenges, including their use of Adolescent Mentalization-Based Integrative Treatment (AMBIT), a psychodynamically-oriented approach to care for adolescents with complex needs. Method: Qualitative methods were employed in this study. Twelve participants were recruited from an adolescent inpatient unit implementing AMBIT. Data were generated with semi-structured interviews and analysed with descriptive inductive thematic analysis. Findings: Four overarching themes were generated. The first three themes informed on the challenges in care for adolescent patients associated with patients’ and frontline professionals’ unhelpful relationships on the unit; and the impact of frontline team professionals’ responses to self-harm on their practices. The fourth theme elucidated frontline professionals’ use of AMBIT. Discussion: The findings provided new insights into the processes influencing frontline professionals’ work with adolescent patients who self-harmed whilst being treated on an inpatient unit. The opportunities and challenges related to the frontline professionals’ use of AMBIT were discussed.