Lifetime prevalence of self-harm (self-poisoning or self-injury) is 5–6% in the UK adult population. Rates are increasing especially among young women, where lifetime prevalence is now 25%. The commonest immediate causes are social and interpersonal problems. The most commonly associated mental health problems are mood disorders and alcohol misuse. Assessment involves careful characterisation of the act of self-harm, the person who self-harms and their social circumstances, but should not entirely be focussed on risk. It should identify needs in mental health or physical health, social needs and psychological needs, and should be a therapeutic experience for the person who has self-harmed. The assessment itself may be helpful for some. Research into cost-effective treatment is limited, but even so it is reasonable to offer brief psychological therapies to everybody and longer-term therapies to those with severe repeated self-harm. Quality improvement activities should aim to improve the experience for people making contact with mental health and to increase the availability and accessibility of therapeutic interventions for self-harm.

This chapter explores the legal and ethical factors that inform mental health nursing, from multiple perspectives. The chapter proposes a legal and ethical framework that promotes human connectedness between the practitioner and people with mental health conditions and their families and whānau. The chapter includes theoretical and practical aspects of working within a legal framework and provides several narratives to bring to life what it means to experience compulsory treatment. It concludes by discussing proposed alternatives to compulsory treatment and a potential future legal framework that embraces a person’s autonomy and human rights. New Zealand – and each Australian state and territory – has its own mental health legislation. Although there are differences between them, they share the essential features of providing for treatment without consent, criteria of danger or risk to self and others, and certain procedural protections. Throughout this chapter we use the term ‘mental health legislation’ to refer to common aspects of the legislation in different jurisdictions.

This chapter explores the legal and ethical factors that inform mental health nursing, from multiple perspectives. The chapter proposes a legal and ethical framework that promotes human connectedness between the practitioner and people with mental health conditions and their families and whānau. The chapter includes theoretical and practical aspects of working within a legal framework and provides several narratives to bring to life what it means to experience compulsory treatment. It concludes by discussing proposed alternatives to compulsory treatment and a potential future legal framework that embraces a person’s autonomy and human rights. New Zealand – and each Australian state and territory – has its own mental health legislation. Although there are differences between them, they share the essential features of providing for treatment without consent, criteria of danger or risk to self and others, and certain procedural protections. Throughout this chapter we use the term ‘mental health legislation’ to refer to common aspects of the legislation in different jurisdictions.