Assessment and Treatment of Self-injury with a Man with a Profound Learning Disability

Authors

  • Gerry Carson,

    1. Services for Adults with Learning Disabilities, Lifespan Healthcare NHS Trust, Cambridge
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  • Isabel C. H. Clare,

    Corresponding author
    1. Services for Adults with Learning Disabilities, Lifespan Healthcare NHS Trust
    2. Department of Psychiatry (Section of Developmental Psychiatry), University of Cambridge
      Department of Psychiatry (Section of Developmental Psychiatry), University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 2AH
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  • Glynis H. Murphy

    1. Tizard Centre, University of Kent at Canterbury
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Department of Psychiatry (Section of Developmental Psychiatry), University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 2AH

Abstract

Despite developments in the research literature on the functional analysis of self-injury, relatively few accounts are available of its application to clinical practice with adults living in ordinary health or social care settings. We describe work with a man with a profound learning disability, very limited skills, and chronic self-injurious behaviour, living in a barren long-stay hospital. Functional analysis identified physical discomfort, lack of sensory stimulation, and social/physical isolation as factors contributing to his self-injury. Based on LaVigna et al.'s (1989) organisational framework, a package of non-aversive interventions was introduced. The service-user's self-injury decreased markedly. However, this improvement was not maintained after he moved to ‘mainstream’ community-based social care where, unexpectedly, there were fewer opportunities for participation in purposeful activities. The outcome illustrates the importance of competent social care provision in supporting any benefits gained through intensive assessment and treatment.

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