Quantitative Evidence for Relational Care Approaches to Assessing and Managing Self-Harm and Suicide Risk in Inpatient Mental Health and Emergency Department Settings: A Scoping Review

There is an over-reliance on structured risk assessments and restrictive practices for managing self-harm and suicidality in inpatient mental health and emergency department (ED) settings, despite a lack of supporting evidence. Alternative “relational care” approaches prioritising interpersonal relationships are needed. We present a definition of “relational care,” co-produced with academic and lived experience researchers and clinicians, and conducted a scoping review, following PRISMA guidelines. We aimed to examine quantitative evidence for the impact of “relational care” in non-forensic inpatient mental health and ED settings on self-harm and suicide. We identified 29 relevant reviews, covering 62 relational care approaches, reported in 87 primary papers. Evidence suggests some individual-, group-, ward- and organisation-level relational care approaches can reduce self-harm and suicide in inpatient mental health and ED settings, although there is a lack of high-quality research overall. Further co-produced research is needed to clarify the meaning of “relational care,” its core components, and develop a clear framework for its application and evaluation. Further high-quality research is needed evaluating its effectiveness, how it is experienced by patients, carers, and staff, and exploring what works best for whom, under what circumstances, and why.尽管缺乏相关支撑证据，但目前精神科住院与急诊（ED）场景中，针对自伤与自杀意念的管理过度依赖结构化风险评估与限制性干预措施。亟需优先聚焦人际互动的替代性“关系照护（relational care）”干预模式。本研究联合学术研究者、亲历自伤与自杀经历的研究者与临床医护人员共同界定了“关系照护”的内涵，并遵循PRISMA指南开展了范围综述（scoping review）。本研究旨在探讨非司法精神科住院与急诊场景中，“关系照护”对自伤与自杀行为影响的定量证据。本次综述共纳入29篇相关综述文献，涵盖62种关系照护模式，相关研究发表于87篇原始论文中。现有证据表明，部分个体层面、团体层面、病房层面与机构层面的关系照护模式，可在精神科住院与急诊场景中降低自伤与自杀行为发生率，但整体而言高质量研究仍较为匮乏。亟需开展进一步的联合研究，以明确“关系照护”的内涵与核心构成要素，并构建清晰的应用与评估框架。此外，还需开展更多高质量研究，评估其实际效果，探讨患者、照护者与医护人员对其的体验，并明确何种场景下、针对哪些人群该模式效果最佳及其背后的作用机制。