Suicide, Self Injury and Hospitalization: Can your therapist have you hospitalized?

Allan N. Schwartz, LCSW, Ph.D.

Suicide, Self Injury and Hospitalization:
Can your therapist have you hospitalized?

Posting:

On March 7, 2009 someone posted this comment entitled:

"Distrust of Therapists"

http://www.mentalhelp.net/poc/view_doc.php?type=advice&id=3138&at=2&cn=91&ad_2=1&submit=I+Agree#ad8903

"I was hospitalized for self-injury and thoughts (not plans) of suicide and while the increased medication and enforced hospital stay did not help, I am now very afraid to report my true feelings to anyone and have actively avoided therapy, leaving me with no one to trust.

In the US, ethics usually doesn't have anything to do with it: as my callous former therapist explained to me, he was having me hospitalized because federal liability laws encouraged him to do so. These laws permit relatives of suicides to sue mental health care workers for neglect, and that's why you see rampant over hospitalization of patients in America."

______________________________________________________________

The anonymous writer of the posting cited above raises an interesting moral, ethical and practical dilemma for patients and their psychotherapist. The dilemma has to do with the question of when it is or is not proper to have a patient sent to the hospital emergency room?

Whether the therapist is a Licensed Clinical Psychologist, Licensed Clinical Social Worker, Psychiatrist or Licensed Marriage and Family Therapist, there is an obligation on their part to intervene under certain types of circumstances. By "intervene" is meant that they must report that someone is in imminent danger. This obligation overrides laws of confidentiality. The reason for this is that, under these circumstances, it is clear that a patient is in danger of committing suicide or homicide. If there is clear evidence that a child is being abused, the therapist must report this, as well. Outside of suicide, homicide and child abuse, the laws of confidentiality hold sway.

How does "reporting" really work?

In the case of a patient whom the therapist is convinced is in danger of suicide, a call can be made to 911 to report the suicide and have them go to the patient's home. In all of my years of practice there was one occasion where I asked 911 to come to my office and pick up the patient. I had to cancel my afternoon schedule to get this accomplished.

Other steps that can be taken are to call family, friends or neighbors and have them take the patient to the emergency room. One last possibility is to get the patient to go voluntarily go. The problem here is that, if someone is really suicidal and they are left to their own devices there is a good chance that they will attempt suicide.<>

Once sent to the emergency room of a hospital, there is absolutely no guarantee that a patient will be hospitalized. Instead, the hospital emergency room will do one of two things depending on where you live: 1. They will transfer the patient to a psychiatric hospital for evaluation or, 2. They have their own psychiatric emergency room and will do an evaluation right there.

In doing the evaluation, a group of psychiatrists, psychiatric nurses and clinical social workers, will decide whether or not the patient is truly suicidal and in need of hospitalization. Contrary to what the anonymous writer states above, it is not easy to be admitted to a psychiatric hospital. This is the reason why there is no such thing as "over hospitalization" in the United States. I have seen, on numerous occasions, where patients, brought to the hospital emergency room by 911 the emergency response team, were sent home.

In order to further elaborate on just how difficult it is to accomplish a psychiatric hospitalization, even if 911 is sent to the patient's home, the emergency response team does an immediate evaluation and can decide that a trip to the ER is not necessary.

In my opinion, the writer of the note above, was admitted to the hospital because she was deemed to be dangerously suicidal.

I cannot and will not defend the actions of every therapist because I do not know who they are or how well trained and experienced they may be. However, in the case of those therapists I have known, from New York to Colorado and California, the only time they will call 911 is when the fear for the safety of the patient.

What about self injury?

There are too many people, both male and female, who injure themselves. The most common type of self injury is probably self cutting, often with a razor. The cuts usually leave scars that bear witness to the self cutting. As a result and in order to hide the scars, people wear long sleeves even during the summer and long pants. Cutting occurs on the arms, legs and other parts of the body.

The goal of self mutilation is rarely connected to suicide. Instead, the strategy is to feel the sense of calmness that is followed by an episode of cutting. It is speculated that this calmness stems from endorphins that create a almost a euphoric state.

Therefore, it is unlikely that a therapist will feel impelled to report self cutting. Of course, there can be exceptions as for example, if it is believed that suicide is the intention. Just to repeat, suicide is very rarely the goal of self cutting. It should go without having to say it that there is always the risk of cutting in the wrong place, hitting an artery and causing a deadly bleed out. In my individual experience I have not come across or read about such an occurrence.

In by opinion, a psychiatric hospital will not admit a patient for self cutting unless the evaluating team lead by the psychiatrist, determine that the individual is suicidal. This even happens in cases of Anorexia Nervosa in which a patient will not be admitted unless the body weight places them in danger of death.

In an age where hospital and medical costs continue to surge and in which health insurance companies are reluctant to reimburse, it is unlikely that anyone will be admitted for frivolous reasons.

Trust:

It is true that trust is a key element to the successful completion of a psychotherapy. There are those times where a therapist may decide that a visit to the emergency room is important for a patient. In my experience, that happens with mutual cooperation between therapist and patient. Even in the case where I asked 911 to come to my office, the patient was cooperative, In fact, that individual was admitted and remained for quite a lengthy period (by today's standards, one week) and was not angry upon returning to treatment.

Trust is important because only with trust, can a person be willing to talk about all that they are thinking about and feeling.

Conclusion:

To answer the question within the title of this essay, a therapist can attempt to have you hospitalized if he has determined that you are in danger of attempting to kill yourself. However, in no way does that mean that, after being taken or going to the emergency room, will you be admitted. Only if you prove to the emergency room team and even the emergency response team, that you are suicidal, will you be admitted.

Your comments are encouraged.

Allan N. Schwartz, PhD

Source: MentalHelp.Net

Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Bipolar Disorder Self Injury: Why You Must Be Concerned

In bipolar disorder, there is often concern about bipolar disorder self injury. It is usually serious, and comes in different forms.

A form of bipolar disorder self injury that’s coming most lately into the general public consciousness is self mutilation, or “cutting”. This practice is found in folk with other diagnoses, too. In reality, only a fraction of those who self injure are bipolar.

Cutting, burning or other self hurting behaviors are often seen in adolescent girls and others, even in men. A lot of this is a part of bipolar disorder self injury.

These acts aren’t suicide attempts, whether or not the people who do them are depressed or suicidal. They’re often desperate acts of anger, worthlessness, and loss of control. This is often a case of bipolar disorder self injury, and it’s not surprising when the symptoms are similar.

Suicide, naturally, is the most extreme form of bipolar disorder self injury. There will be plans and attempts before an individual commits suicide. In any case, all threats of bipolar disorder self injury should be regarded seriously.

Suicidal thoughts may cloud the thinking about a depressed person to the limit that he or she will be able to think about nothing else. It may appear the world would be better off without them, or that they can prove to others that they should have been treated better. At this time there is concern of bipolar disorder self injury, but the concepts are just at a low heat.

The danger becomes more imminent when the person starts to make plans. A person may make elaborate plans for some years. Another person may only think about a plausible way to go about it. The difficulty is that either of these folk may at any point basically commit suicide. It isn’t easy to predict the chance of bipolar disorder self injury.

Many times a person’s suicidal bents will not be spotted unless an attempt is made. A sensible person should treat all attempts seriously, though some may seem more serious than others. More significant attempts could be identified when the result was more certain compared to other attempts, or a note was found. Bipolar disorder self injury is always possible in these scenarios.

There’s always the possibility that a person is serious, in any case what type of attempt was employed. Statistics show that people who have never tried to commit suicide during the past are 40 times less sure to be successful than people who have.

Suicide may be on a person’s mind if he starts to set his affairs in order or make last agreements. It could be so simple as giving away possessions, or as complicated as making monetary arrangements. If this is suddenly seen in a bipolar individual, it should be determined whether that person is in danger of bipolar disorder self injury.

Many thoughts, plans, or attempts actually do end in suicide. 11 percent of deaths in the States are as a result of suicide. Roughly eighty percent of suicide deaths are by males, although more ladies attempt it. Every year, more and more teens are committing suicide. Bipolar disorder self injury, then, is a definite and increasing issue.

The disease’s physical, social, and affective consequences are tricky enough to handle. Self harm and suicide make attention to bipolar disorder self-mutilate most necessary.

Source: Unknown

Wordless Wednesday

Source

Tell them to remember hope. We have hope."

-renee yohee,
the story and inspiration of to write love on her arms,
my biggest hero.


we are only asked to love,
to offer hope to the many hopeless.
we don't get to choose all the endings,
but we are asked to play the rescuers.
we won't solve all mysteries,
and our hearts will certainly break in such a vulnerable life,
but it is the best way.
we were made to be lovers bold in broken places,
pouring ourselves out again and again,
until we're called home.


the vision is that community and hope and help would replace secrets and silence.

the vision is people putting down guns and blades and bottles.

the vision is that we can reduce the suicide rate in America and around the world.

the vision is that we would learn what it means to love our friends, and that we would love ourselves enough to get the help we need.

the vision is better endings.

the vision is the restoration of broken families and broken relationships.

the vision is people finding life, finding freedom, finding love.

the vision is graduation, a Super Bowl, a wedding, a child, a sunrise.

the vision is people becoming incredible parents, people breaking cycles, making change.

the vision is the possibility that your best days are ahead.

the vision is the possibility that we're more loved than we'll ever know.

the vision is hope, and hope is real.

you are not alone, and this is not the end of your story.

-jamie tworkowski,
founder of to write love on her arms.
Source: Ashley Rosex

I Think ...

Definitions of suicide and self-harm behavior in an Australian Aboriginal community

Farrelly T, Francis K (2009)
Definitions of suicide and self-harm behavior in an Australian Aboriginal community.
Suicide and Life-Threatening Behavior;39(2):182-189

Journal Article

Source: Australian Indigenous Health Bulletin

View abstract: PubMed
View website: PubMed

Three out of 10 students in study intentionally harm themselves

Three out of 10 students surveyed for a York University study acknowledged engaging in acts of deliberate self-harm, such as skin cutting, burning and using drugs or alcohol to excess.

The study evaluates the responses of 319 first-year university students who volunteered to answer a questionnaire that assessed their personality and personal history, and that asked whether they had ever intentionally engaged in 22 self-harm behaviours.

Of the 94 students who indicated they had, women were no more likely to self-harm than men, contrary to previous studies which suggest it is a predominantly female phenomenon.

There were, however, some clear differences in the type of self-harm acts engaged in by women and men.

Right: Cutting is one form of self-harm as seen in this photo of a person's arm

Among those who engaged in self-harm, the women surveyed (45 per cent) were more likely to report cutting the wrists, arms or other areas of the body, while men (23 per cent) were more likely to report engaging in gang activity or other forms of physical violence with the intention to harm themselves. The most frequent forms of self-harm were cutting, entering into risky situations, carving, scratching and the use of substances with the intent to self-harm.

The life circumstances of the participants are relevant to the study’s findings, says Gordon Flett, Canada Research Chair in Personality & Health at York, who co-authored the study with Abby Goldstein, (MA '00, PhD '05) now an assistant professor at the Ontario Institute for Studies in Education.

The average age of the participants was 19 years old and the majority (68 per cent) had just finished high school and were living with their parents (64 per cent). The sample was evenly split between Canadian-born students and those born outside of Canada.

“In many cases, these young people are throwing themselves into the student role as a way of overcompensating for some other emotional and relationship issue,” Flett says. “If they do well in university, that might get them over the hump, but if they don’t, they may be at risk for some more extreme behaviours.”

The latest clinical research suggests that self-harm may be a response to emotional pain that cannot be resolved in a more functional way. Goldstein hopes this information will begin to remove some of the secrecy often associated with self-harm.

“These findings suggest that a significant percentage of college students have engaged in an act of deliberate self-harm at some point in their lifetime,” Goldstein says. “Unfortunately, many people hide these acts or their intentions from others, which can often lead to isolation and greater suffering.”

By assessing the personality traits and personal history of the participants, the study was also able to identify factors which may help predict which students may be vulnerable to deliberately harming themselves.

“Some of these kids come from middle-class or affluent families but that’s no protection when the issue at hand is self-image,” Flett says.

"Personality, Child Maltreatment and Substance Use in Deliberate Self-Harm Among College Students" will be published in the Canadian Journal of Behavioural Science in October.

The study was supported by funding from the Canadian Institutes of Health Research.

Source: York files

Shelved report keeps suicide prevention reforms at bay

RUTH POLLARD INVESTIGATIONS EDITOR

August 22, 2009

A HERALD INVESTIGATION

AN EVALUATION of Australia's main suicide prevention program - which found there was little evidence the strategy had reduced rates of suicide and self harm - has been kept secret for three years, stalling much needed national reforms.

The 2006 evaluation reveals the Howard government was urged to review the National Suicide Prevention Strategy to ensure that funds were better targeted to those in greatest need. ''The current goals and objectives … are too broad to provide sufficient guidance,'' it concluded.

And while the national program floundered, suicide rates remained at historically high levels. The Herald revealed yesterday that the national suicide statistics had been undercounted, and the toll could be as high as 3000 a year, rather than the 1800 reported by the Australian Bureau of Statistics, without any corresponding increase in funding to prevent further deaths.

The Federal Health Minister, Nicola Roxon, said the Government was working with the Australian Suicide Prevention Advisory Council to develop ways to improve the data and respond to the needs of people at risk. ''I'm concerned by these reports,'' Ms Roxon said.

To make progress, access to quality mental health services must be improved and structures developed to co-ordinate a new national response, said John Mendoza, the chairman of the Federal Government's National Advisory Council on Mental Health.

''We have seen our governments … implement an assertive response to swine flu [and] now we have had 121 deaths since the outbreak and … 460 people are … in hospital from H1N1.

''In the same period we have had at least 10 times the number of suicides and … 20,000 hospital admissions for self-harm. This is the scale of the problem, and it's time we addressed it.''

Training GPs and other health care providers in recognising the warning signs for self harm and suicide, as well as reducing access to the means of suicide and investing in self-help services would go a long way to reducing risk, Professor Mendoza said.

The chairman of Suicide Prevention Australia, Michael Dudley, said: ''We have absolute evidence that putting barriers around jumping points makes a huge difference - people do not automatically go and try something else, and it is the same with reducing access to firearms, medications and other methods.

''Maintaining a social connection can make a difference - we should be following people … after they have had contact with health services, because we know they are very much at risk.''

Lifeline: 131 114

Source: The Sydney Morning Herald

Brisbane Times

Young people's distress is a wake-up call

The rise in self-harm points to something seriously askew in our priorities as a country

PARENTING INVOLVES an awful lot of stumbling along in the dark, hoping to God that you are doing something right. Every so often, parents are presented with situations that seem to confirm their worst fear: that they are actually doing everything wrong. As vividly illustrated by the two case studies written about by Sheila Wayman in the Healthplus supplement recently (August 11th, 2009), there is a particularly visceral feeling experienced by parents, like being punched hard in the stomach, when they discover that their child is harming him or herself.

Not unnaturally, most parents react with shame and panic, and become desperately worried about exacerbating the situation. The idea that a child would be so distressed that swallowing tablets or cutting oneself would constitute some kind of relief horrifies parents.

Levels of distress are clearly rising among young people, but that does not mean that parents are justified in shouldering all the blame. Young people resort to self-harm for complex reasons. For example, while it is more common in families where there are difficulties of one kind or another, it can also happen in so-called “good” families.

While no family is perfect, most families can learn to cope. Dr Keith Holmes, a consultant child psychiatrist in the Lucena Clinic, says that “the sign of a well-functioning family is not that bad stuff never happens, but that when it happens, it is dealt with well”.

Families who have kept the lines of communication open have an advantage when a crisis happens. Dr Holmes talks about how impressive it is that many families manage to get over the initial denial and sense of failure, and begin to do all that they can.

Even where things have gone awry, perhaps because of a messy and acrimonious breakdown, it is more than possible to help a child, if the parents can manage to retrieve enough of their relationship to make the welfare of the child a priority. Parents need to be parents more than ever, he says. They need to re-establish lines of communication, and healthy levels of discipline.

Many parents worry that something like cutting will lead to suicide attempts. Prof Carol Fitzpatrick of Children’s University Hospital, Temple Street, says it is important to realise that even though the risk of suicide is greater among people who self-harm, only a small minority will go on to die

by suicide. Some young people will have only a few incidents. Others will respond positively to parents’ willingness to listen and to help, and may not need further intervention.

However, if there are signs of deeper distress, or increasing isolation and depression, parents should seek help. Her advice to parents is to “trust your gut feeling”. Parents can go to their GP for a referral to child and adolescent mental health services for their child. It is a national scandal that so many of them will go on a waiting list for anything from six weeks to three years, depending on where they live.

A dedicated deliberate self-harm team was set up in Temple St some years ago, and while initially focused only on the young people, the need to provide support to parents soon became evident. The Space programme resulted. Initially only available on referral, a new course is available free to parents of children under 18, due to sponsorship by the ESB workers’ charity, Electric Aid.

The next course is being run in Wynn’s Hotel on Tuesdays, in October and November. It is important to register, as places are limited, by contacting Lorna Power, tel: 01-7166321 or e-mail Lorna.Power@cuh.ie.

The National Suicide Research Foundation suggests that the rise in unemployment may be a factor in the rise in self-harm among young men. Ironically, before the recession we blamed consumerism and conspicuous consumption instead.

Clearly, something deeper is going on. Why are people less able to deal with the challenges that life throws at them, or at least more likely to resort to self-harm as a deeply flawed way of trying to cope?

Ireland of the past was in many ways a dark and repressive place. However, we also have to face the fact that when we threw off the shackles of that time, we also inadvertently weakened societal constraints that helped to make self-harm and suicide much more rare.

While there is much greater openness in society, that same openness means that the idea of self-harm occurs to far more young people. It is one of the paradoxes of our age that we have never had so many means of communication, but more fundamental levels of communication, such as those between parents and children, have become much more difficult.

As Prof Kevin Malone of UCD has pointed out, many young people can live in a virtual cocoon, frantically interacting with peers, while parental influence is greatly diminished or even excluded. Behaviours such as cutting can even be become tacitly acceptable as a result.

Self-harm is not the only dysfunctional coping mechanism to which people resort. Our society has long had a problematic relationship with alcohol, while “workaholism” is often just a more acceptable way for adults to evade difficult emotions or situations.

Our young people’s distress is further evidence that something is seriously askew in our priorities as a country and a culture. It is an overt sign from our upcoming generation that all is not well, and perhaps we should pay more heed.

This article appears in the print edition of the Irish Times

Wordless Wednesday

Janes, 'Free From Harm' website

Mental health drive to help gay people

Published Date: 31 August 2009

A NEW mental health programme for lesbian, gay, bisexual and transgender people will aim to help tackle high levels of depression, anxiety, self-harm, suicide and attempted suicide.

The LGBT Centre for Health and Wellbeing in Edinburgh's Howe Street says prejudice and discrimination contribute to a rate of mental ill-health among the LGBT community three or four times that of the mainstream population.

Its autumn Mind Matters programme will include sessions on issues such as self-harm, support for carers, domestic abuse, safe alcohol use and parenting.

All the events are free of charge. For further information, contact the centre on 0131 523 1100, visit www.lgbthealth.org.uk or e-mail admin@lgbthealth.ord.uk

The full article contains 124 words and appears in Edinburgh Evening News newspaper.

Page 1 of 1

• Last Updated: 31 August 2009 9:42 AM
• Source: Edinburgh Evening News
• Location: Edinburgh

Cutting and other self-harm- part 1

In the 1990s an epidemic spread throughout many American homes as a new fad erupted. With the emergence of the “Goth” scene, it was suddenly popular to be miserable. (How many of you can remember back to SNL’s famous “Goth Talk” skit?) You weren’t “cool” unless you had some kind of abuse at home to deal with…and one of the most popular ways to show-boat this was self-mutilation.

Unlike most fads, this one piggy-backed on a real problem, and while the fad may have faded, the problem still exists. Teens are still mutilating themselves, only now-a-days they are doing it in secret.

The most common reason, one that this writer cannot disclaim, is that the physical pain the mutilation provides masks the emotional pain the teenager cannot deal with. Even deeper, the teen has no control over the deliverance and intensity of the emotional pain, but is in control over the extent to which they inflict the physical pain on themselves.

Unfortunately, to what extent the emotional pain would have to be in order to cause this reaction can not be measured. There are too many factors to be able to give parents of this issue a clean-cut answer:

Whatever the initial emotional trigger, the Cutting is a tell-tale sign of what your teen needs in order to recover from whatever ails them.

1. Cutting and self-mutilation is a cry for help. Whatever it is that is plaguing your adolescent is too much for him or her to handle on their own. It is time for you to step in and go against their wishes of “leaving them alone”.
2. Cutting and self-mutilation can also be a method of attention seeking. While closely related to a cry for help, this is the one that many people ignore. You’ve heard the advice when your children were younger and threw a temper tantrum: “ignore them, when they realize you are not paying attention, they’ll stop”.

While cutting and self-mutilation may be a grandiose “temper-tantrum”, this one will not stop when ignored. If ignored, what may have started out as an attention-seeking tactic, will grow into a deep despair, and could transform into suicidal thoughts and tendencies.

To be continued…
Source
August 3, 9:35 AMHouston Teen Issues ExaminerJennifer Korenek

Violent cry for help all too common

For many years, the wounds she inflicted on herself were her only way of communicating the pain she felt on the inside. Jess Senior talks about how she stopped self-harming.

The first time it happened, she was 13.

"I was in a lot of distress and everything just felt overwhelming ... I didn't remember doing it but became aware I was bleeding. I guess I was still in shock, I thought, 'How the hell did that happen?' "

For the next few years, self-harming became her main coping strategy for dealing with distress and depression. Even in summer, she would wear long sleeves, trousers and tights to hide the cuts.

It's hard to understand how someone could feel "helped" by such self-destructive behaviour, but Jess felt she had no other way to communicate what was happening to her inside.

"There's pain and with that you get a certain amount of adrenaline and endorphins, which is quite addictive and why people turn to it again and again.

"For a long time, I didn't have the language to articulate what was happening for me . . . I felt so out of control."

Despite the involvement of mental health services in her life from birth - because of her mother's serious mental illness - the pattern of hurting herself started very early. Her father remembers that as a preschooler, Jess would scratch herself in her sleep till she bled.

Her mother took her own life when Jess was 9, and for many years, she felt fated to follow the same tragic path. Admitted to hospital at 14 after a suicide attempt, she came under the formal care of mental health services, for better - and occasionally - worse.

Her father, who had won custody of her when she was four, has been a great source of strength and stability throughout her life. "It must have been really confusing and frightening for him . . . He once told me he had thought I would die by suicide. I thought that myself for a long time, but to hear your dad say that was really scary."

She tried to cover up the self-harm, telling "ludicrous stories" to her father and stepmother. "Of course they knew, parents aren't stupid. I made up lame excuses to friends about why I couldn't go swimming and why I dressed for winter year round."

However, chronic self-harming like Jess' would not show up on any of the official statistics. She never sought medical help, though she "probably should have".

"I know heaps of people who go into the emergency department or their GP, get stitched up and sent home in well under 48 hours, so they don't get recorded.

Despite failing seventh form "pretty miserably", she managed to get into university with a provisional pass. "I did pass one psychology paper. I loved it, and it was all pretty familiar territory to me . . . but I couldn't cope and dropped out."

After a couple of psychotic episodes, she was admitted to the regional Rangatahi (adolescent) inpatient unit. She had not been self-harming for some time, but within two days of being admitted, she started again.

"There were some benefits [to being an inpatient] - I stayed alive - and some of the other people in there are now my best friends . . . But for me, it was not a good place to be. While I was there, another patient suicided, which brought me massive secondary or cumulative trauma."

Thanks to her having a supportive family and psychiatrist, she was discharged relatively quickly.

The turning point for her on self-harm was being "told off" by a community psychiatric nurse. "I was outraged at the time and got all righteous, 'How dare she speak to me like that?' etc.

"But gradually I came to accept that she was right when she said it was in my power to do something about it . . . rather than me falling back on the excuse that I was dissociated, I didn't mean to.

"She wouldn't even let me off the hook when I was psychotic. She said, 'You know when your anxieties are getting bad and you can choose to do something about it before you get to that point. She put the responsibility back in my hands."

It took some time to be able to give up completely, but the clincher was when her favourite "coping strategy" stopped working. "On the few occasions where I thought 'F. . . it, I'm just going to do it', it didn't work for me because my headspace had changed. I just felt, 'What was the point of that? I don't feel any better'."

Then there was the moment when she threw out all her disposable razors. "A bit like an alcoholic tipping the whisky down the sink. It felt great."

Another big factor in her recovery was meeting her partner. They have been together seven years. "It's harder to hide what's going on when someone can see you."

It hasn't been easy for him either. "For both him and my dad, it must be really, really hard to see someone you love hurt themselves. They have both got frustrated and angry at times, but I know they are always there for me."

Her partner also lost his mother at a young age, which made it particularly difficult for him to understand her suicidal behaviour. One day, he came home to find her bleeding and distraught. "He got really mad and said, 'How can you do this to yourself? My mother wanted to live and she couldn't. You are perfectly healthy and you're throwing it away'.

"I felt really guilty, but at the same time I felt he didn't know what it was like."

Another turning point for her was becoming involved with Wellink's peer support helpline Warmline five years ago.

"It was fantastic to meet all these people who shared similar experiences. I didn't want my life to turn out like my mother's, but I thought I had no choice. Then I met all these amazing people living really great lives and doing amazing work and it opened my eyes to the possibilities. Instead of feeling like I was a big burden on society and my family, I felt empowered."

Now 24, she works as a peer development co-ordinator with Wellink, consulting for a range of organisations providing mental health services.

She is deeply disappointed by Capital and Coast District Health Board's recent decision to defer plans for an innovative community-based crisis treatment service in partnership with Wellink.

For people in crisis, Te Whetu Marama - New Zealand's first Short Term Assessment and Recovery Service (Stars) - was to be an alternative to staying at home or being admitted to an acute admissions unit.

Instead, ward 27 has been enlarged and the new service is set to open next April - though Jess points out this is the fourth firm date they have been given since the first one of May 2007.

She feels an opportunity has been missed. Self-harm and suicidal behaviour are symptoms of deep psychological distress and can't be fixed with a quick visit to ED for stitches or a stomach-pump.

"We're lucky to have HeadSpace [youth crisis respite] in Wellington, which operates on the same principle with no lockdown and no seclusion and has stopped many people being admitted repeatedly to the inpatient unit.

"But we need more flexibility in services. It's still the case that young people with severe levels of self-harm are shipped out of Wellington to Ashburn Hall in Christchurch, away from their support networks.

"People need to feel comfortable and safe and have their whanau and friends around them."

SELF-HARM DATA TIP OF ICEBERG, MENTAL HEALTH WORKERS SAY

Fewer people are being admitted to hospit for intentional self-harm, but critics say the official figures fail to show the true scale of suicidal behaviour.

The Health Ministry's latest data on intentional self-harm cases in hospitals, issued in the past fortnight, shows teenagers aged 15 to 19 had the highest rates of intentional self-harm and females were twice as likely to need hospital care.

In 2007, 2678 people were admitted to hospital for more than 48 hours for intentional self-harm, compared with 3030 in 1996, a drop of more than 25 per cent.

However, an Auckland University study covering four district health boards, including Capital and Coast, has found the official figures, based on narrow definitions and "flawed" data collection, "substantially underestimate the size of the problem".

The ACC-funded study, the first to use direct observation, found the number of people treated at Waitemata for self-harm increased 31 per cent over four years.

Writing in The Australian and New Zealand Journal of Psychiatry, Simon Hatcher, from the Department of Psychological Medicine, and his team described how suicide attempts often went unrecorded.

For example, overdoses of paracetamol were sometimes logged as "abdominal pain". Furthermore, some hospitals recorded patients seen in emergency departments, but others counted them only if they were admitted to a ward.

In the four health boards - Capital and Coast, Waitemata, Counties Manukau and Northland - 1600 people were treated for self-harm incidents 2000 times over a year, which suggested about 6200 self-harm episodes involving 4900 people nationally.

Researchers said even this was likely to be an underestimate.

According to the New Zealand Mental Health Survey, 0.4 per cent of the population, or 16,000 people, attempt suicide in a year, but less than one-third go to hospital. The group wants monitoring sites in representative health boards to track the true rate of suicidal behaviour.

Mental health director David Chaplow agreed official figures were likely to be an underestimate. "Hospitalisations are a crude indicator, but you have to start somewhere and it does indicate a trend."

From July 1, health boards have been required to report every person discharged from emergency departments after receiving treatment for three hours or more, removing the major cause of inconsistency in the reporting of intentional self-harm.

Dr Chaplow said hospitals were trialling new ways of reaching people who may have slipped between the cracks, including visits, phone calls and postcards. "[When] people feel they have no value, that no-one cares about them, something as simple as a postcard asking if they are OK is sometimes enough to make a difference."

Under the 10-year suicide prevention action plan, several measures are under way to improve care and follow-up, increasing understanding about depression and targeted programmes for Maori and youth.

"New Zealand is right up there with prevention, but any suicide is a tragedy, and while we can celebrate the trend, we can't stop working until there are no more suicides."

Source: NZ Dominion Post

By RUTH HILL - The Dominion Post

Last updated 14:45 31/08/2009

Self-harm admissions drop by a quarter

Over 2500 people were hospitalised for more than two days after intentionally injuring themselves in 2007, with women almost twice as likely to do it as men, according to figures released today.

A report by the Ministry of Health called Intentional Self-Harm Hospitalisations 2007 (Provisional), showed that 2678 people spent more than 48 hours in hospital.

However, the results show the number decreased from 3030 in 1996.

Mental Health director Dr David Chaplow said this was consistent with the declining pattern over the past 11 years.

“Self-harm hospitalisation rates have dropped by 25.6 per cent for the total population and 40.1 percent for those aged 15 to 24 years old since 1996," he said.

For males, the highest rate was among the 35-39 year age group while women aged between 15 and 19 were the most at-risk group for females.

Maori, at 75.1 hospitalisations per 100,000 people, were more likely to self-harm than non-Maori, with rates of 61.6 per 100,000.

The Health Ministry said anti-suicide initiatives included better follow-up care, mental health awareness campaigns and addressing suicide rates among the Maori community in particular.

The data does not include those who harmed themselves but spent less than two days in hospital or readmissions less than two days after being released.

The Health Ministry said this was due to differences in the way District Health Boards recorded some of these events although this had now been addressed.

By removing the data, the ministry says it allowed them to make more accurate comparisons.

Source: NZ National Health

By Micahel Fox

Last updated 21/8/09

11% increase in male self-harm

Dara Gantly

dara.gantly@imt.ie

Last year saw a dramatic 11 per cent increase in male deliberate self-harm cases, the National Suicide Research Foundation has revealed. In total, 11,700 deliberate self-harm presentations involving 9,218 individuals of both genders were made to hospital emergency departments in 2008.

The Annual Report of the National Registry of Deliberate Self Harm, published on July 20, found the national person-based rate of self harm increased by 6 per cent, from 188 per 100,000 in 2007 to 200 per 100,000 last year. The strongest increase in self-harm was observed in men, with a rise of 11 per cent (180 per 100,000 in 2008 compared to 162 per 100,000 in 2007). This is the highest rate since the start of the Registry in 2002. Among women, the increase was 4 per cent.

The report revealed that almost half of presentations were by people under 30, with the peak rate for women in the 15-19 age group and for men in the 20-24 age group. An increase in self harm was also observed amongst those aged as young as 10-14 years.

The incidence of deliberate self-harm was highest in HSE Dublin/North East and lowest in HSE South. City rates generally exceeded those of the counties, particularly for men.

The proportion of deliberate self-harm patients who left the emergency department without admission had increased, with particular concern for those who used highly lethal methods, such as attempted hanging and drowning. The admission rates varied considerably across hospitals and HSE regions reflecting a ‘lack of uniform assessment procedures’ for this patient group, the report said.

Posted in Public Health on 28 July 2009

Suicide attempts and self-harm ‘by 5 year olds’

By Jennifer Hough

Wednesday, August 19, 2009

CHILDREN as young as five have been treated for suicide attempts and self-harm, according to a leading child and adolescent psychiatrist.

Professor Carol Fitzpatrick, a specialist in child psychiatry, said children as young as five and six have presented to Children’s University Hospital, Temple Street, Dublin, because of self-harm or suicide attempts.

She said that as adolescence approaches, the problem becomes more common.

Data from a special deliberate self-harm team at Temple Street also reflects the growing trend.

Prof Fitzpatrick said the figures for last year were up "very significantly".

She also said that, looking at the figures so far this year, it appeared as though they were set to increase again.

In seven years, the team has seen 566 cases of children aged 16 and under with self-harm or suicidal behaviour.

Paul Kelly, director of Console, a charity that supports those bereaved through suicide and promotes mental health in the community, said deliberate self-harm and suicidal ideation were growing problems in young people.

Console had seen children aged six and seven who were "at risk".

He said Console was hoping to increase its psychotherapy services to adolescents and younger children owing to the worrying trend.

According to latest figures from the National Suicide Research Foundation, published last month, an increase in self-harm was "observed" in the 10-14 age bracket.

An estimated one in 10 adolescents in Ireland resorts to self-harm. Hospitals reported 197 cases of girls self-harming and 63 of boys in this age group last year.

The report urged: "Considering the high rates of deliberate self-harm in adolescents and the increase in self-harm among those aged 10-14 in 2008, there is a need to prioritise evidence-based mental health programmes for children and adolescents as well as specialist mental health services."

Mr Kelly said Console was appealing for help resource counselling for young people at risk.

"We are all feeling the effects of the recession and know now is not the time to ask people to delve into their pockets to donate. Instead, we are doing all in our power to create events and services to continue to fund our work this year," said Mr Kelly.

He said the charity was seeking 1,000 people from across Ireland to pack bags in Dunnes Stores on Saturday, August 29, to raise essential funds for people devastated by the suicide of a loved one.

* Anyone wishing to help out on the day can contact 01-6102638 or email info@console.ie.

This story appeared in the printed version of the Irish Examiner Wednesday, August 19, 2009

Read more: http://www.irishexaminer.com/ireland/suicide-attempts-and-self-harm-by-5-year-olds-99012.html#ixzz0P0PalVQY

Self-harm in Northern Ireland

Researchers from Queen's University and the University of Ulster in Northern Ireland have been asking 941 sixteen-year-olds about self-harm. One in ten had self-harmed in the past year and another 14% had thought about it but had not done so. Girls were much more likely than boys to say that they had thought about harming themselves (18% vs 7%) or had actually done so (13% vs 5%). There were strong links between self-harm and high levels of stress, high expectations the youngsters felt they could not fulfil and experiences of bullying in school. 25% of the sample said that they had suffered from serious mental and emotional health problems in the past year for which they felt they needed professional help although only 9% had actually asked for it. Youngsters from less well-off backgrounds were significantly more likely to be affected by mental-health issues and to have self-harmed or considered self-harming.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/07/090730073921.htm

Screams

Does anyone really care if you hurt yourself. Are you sending out blatent messages that no one reads.

Do you scream 'what do I have to do'

do u beg for love and understanding that no one reads

Welcome to my world

Working with Self-harm – a One Day Workshop (Swansea)

Date:- Thursday 25th June 2009


Venue:- Maritime Museum, Oystermouth Road,
Swansea, SA1 3RD

This one-day workshop explores self-harm and is suitable for workers whose clients may be exhibiting self-harming behaviours. Participants will explore this complex subject that is often mistakenly seen as attempted suicide.

This workshop starts from the basic principles of understanding the issues leading to and surrounding destructive and harmful behaviours, the function of the behaviour(s) and appropriate responses. Self-harm is a relevant issue for all of those working with children and young people and is of grave concern.

The aims of this workshop are: To increase awareness and understanding of the reasons why young people may use destructive and harmful behaviours. To develop competence and identify relevant skills to enable professionals to respond confidently when presented with and in identifying self-harming behaviours.

To book contact:

Glyn Jones,
Network Manager,
Mid and West Wales CAMHS Commissioning Network

glyn.jones@wales.nhs.uk

Music, Self Harm & Slipknot

Corey Taylor defends the band's lyrics...

• by Daniel Melia
• Thursday, May 21, 2009
• Photo by: wenn.com / Carsten Windhorst

Vibrant Slipknot frontman Corey Taylor has hit out suggestions the band's music encourages children to self harm.

The band previously come under fire over the dark imagery in some of their song lyrics, but Taylor insists the tracks do not influence impressionable youngsters.

And he understands why angst-ridden teenagers feel depressed - he suffered the same problems in his youth.

Taylor says, "If you're setting out to hurt yourself, it's not the music that's causing it. There's something else wrong. We get a lot of kids that cut themselves but I go out of my way to try and stop it.

"It may feel artistic to carve our names in your arm but to us, it's just hurting yourself. As bleak as Slipknot can be, it's supposed to be positive in the long term and the last thing we want is for anyone to hurt themselves.

"I used to be one of those kids and I always try to explain to them that I know what it's like to feel like you're the last person on Earth. All you have to do is reach out and someone will be there."

Slipknot live in London

Slipknot fans @ Hammersmith Apollo

“I can actually talk to them now” – Educational intervention for nurses

Posted on June 1, 2009 by sjennings29

‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self-injure, Journal of Clinical Nursing, online early view, 2009

Margaret McAllister, Wendy Moyle, Stephen Billett and Melanie Zimmer-Gembeck

Authors: Margaret McAllister, RN, Ed D, Associate Professor, University of the Sunshine Coast, Maroochydore, Australia; Wendy Moyle, RN, PhD, Professor, Griffith University, Brisbane, Queensland, Australia; Stephen Billett, PhD, Professor, Griffith University, Brisbane, Queensland, Australia; Melanie Zimmer-Gembeck, PhD, Associate Professor, Griffith University, Brisbane, Queensland, Australia

Correspondence to Dr Margaret McAllister, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore,

ABSTRACT

Aim and objectives. This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury.

Background. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies.

Design. A mixed method pretest–posttest group design was used.

Methods. Nurses (n = 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning.

Results. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses’ capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented.

Conclusions. The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting.

Relevance to clinical practice. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Harmless (DVD Trailer)

'Out of harm's way' is a DVD featuring seven short documentaries exploring the meaning of self harm and the factors which lead to recovery.

The full DVD is available to purchase from http://www.harmless.org.uk, and all proceeds from its sale will be used to provide services to people who self harm.

This Week At . . .

Post Secret

Guest Post - Dr. Kevin Keough

Understand Self Injury- Awareness Video

This is a video on self-harm I made to help those who don't understand. Please check it out and ask any questions if you have any. If there is hate comments, rude or disrespectful I will delete and block you. Below I have posted a lil more details about those who self-harm. Please take a moment to read it. http://www.recoveryourlife.com/ http://www.meetup.com/ http://www.psyke.org

====================== Song: Breathe-Sia ======================

SI is something I go through personally everyday of my life. I think about it all the time. Even tho the thoughts are there, most likely I'll be able to control myself & not hurt my body. Sometimes I slip & hurt myself but it shows how hard I work towards being heathly & safe. DBT is a good source to help the urges & to find safe ways to cope with the feeling.

Self-injury or self-harm is when somebody damages or injures their body on purpose. Self-injury is a way of expressing deep emotional feelings or problems that build up inside.

Cutting the skin is probably the most common form of self-injury. The cuts are not usually deep but in some cases, medical attention is needed to clean, dress or stitch the wounds. The most common places on the body to cut are the wrists, upper arms, inner thighs and upper chest. Less common are the face, breasts, abdomen and genitals.

Often people who cut themselves will use one or two methods, for example, knives, glass or razor blades. The person tends to have a certain area of the body that they prefer to cut, such as the arms.

Burning the skin (usually with cigarettes) is also common. People may also self-harm by scratching, hitting or punching, sometimes using an object. Other forms of self-injury include picking at the skin, pulling out hair, swallowing poisonous substances, taking an overdose of tablets or drugs or deliberately breaking bones.

Although, there is a connection between self-harm and suicide, the majority do not risk their lives. For many people who self-injure, their actions are only an attempt to cope with the stress and difficulties they face; their purpose is not to end their life.

However, there is a possibility that those who self-injure may commit suicide either deliberately or accidentally as the result of their actions.

Self-harm is much more common among girls than boys, often starting in adolescence (between 13 and 18 years of age), although it can affect children from as young as 11 years. Fear of discovery, shame and embarrassment often means that people keep self-injury a secret. Because of this, it is difficult to know how many people self-harm.Some people self-harm only once or a few times while others do it on a regular basis, sometimes throughout their life.

People who self-injure are very careful to hide the damage and scars. They will often injure themselves in places that can be easily hidden by clothing so friends and family members may be unaware of the person self-injuring in private. Another sign that someone could be self-harming is that the person will insist on keeping covered up at all times, even in hot weather.

People self-injure for a variety of reasons and sometimes, the person doesnt actually know why they are doing it. However, it is commonly thought to provide a release for pent-up emotions and feelings. For some people it is their way of coping with a specific problem. Self-injury is a sign of emotional distress and is not an attempt to seek attention.

People who self-harm often describe feelings of numbness or deadness or they may feel detached from reality, as if they are not part of the world. Some may injure themselves to stay separated from reality but others do it to make them feel more real, connected and alive.People who self-harm often describe feelings of numbness or deadness or they may feel detached from reality, as if they are not part of the world. Some may injure themselves to stay separated from reality but others do it to make them feel more real, connected and alive.

People who self-injure risk infections if their wounds are not treated properly. Cuts can become infected if a person uses non-sterile or dirty cutting instruments.

Source:Healing From Addictions

Friday Readers Story

Anonymous said...

im a 14 year old and i started cutting about a year ago. to be honest i dont really remember why i started self harming. i think it began with me just wanting to express some emotion without having to explain myself to anyone. it was the one thing in my life that i felt like i could control. now things are going badly at school and i self harm more. i paniced and tried to find a site to get help. but then i read about all these people who were abused or close relatives and friends had died so they started self harming. that just made me fell worse because i had no real right to self harm, i had no real problem. of course i got depressed and cut myself because i was so ashamed of myself and it ended up going round in a loop. i was cutting to let out my hatred of myself, to get rid of my bad blood which made me want to cut even more. my cuts are getting deeper.

i dont really know why i left this comment i just felt like i needed to tell someone who wasnt going to come up to me the next day and ask me why i did it. thank you

American Self Harm Information Clearing House

Approximately 1% of the population has, at one time or another, used self-inflicted physical injury as a means of coping with an overwhelming situation or feeling. ASHIC - the American Self-Harm Information Clearinghouse - strives to increase public awareness of the phenomenon of self-inflicted violence and the unique challenges faced by self-injurers and the people who care about them.

Self-harm scares people. The behavior can be disturbing and difficult to understand, and it is often treated in a simplistic or sensational manner by the press. As a result, friends and loved ones of people who self-injure often feel frightened, isolated, and helpless. Sometimes they resort to demands or ultimatums as a way of trying to regain some control over the situation, only to see things deteriorate further.

The first step toward coping with self-injurious behavior is education: bringing reliable information about who self-injures, why they do it, and how they can learn to stop to people who self-injure and to their friends, loved ones, and medical caregivers. ASHIC was founded to meet this need for honest, accurate information.

Wordless Wednesday

Post-traumatic Stress Disorder

Written by HealthyPlace.com Staff Writer Jan 03, 2009

Full description of Post-traumatic Stress Disorder (PTSD). Definition, signs, symptoms, and causes of PTSD.

Description of Post-traumatic Stress Disorder (PTSD)

Post-traumatic Stress Disorder is a severe reaction to an extremely traumatic event. The person can actually experience the event (i.e. be in a plane crash) or be a witness to the event (i.e. rescue worker at a plane crash).

Over time and with psychological help, some people learn to cope with the aftermath of the event. However, for others, symptoms such as flashbacks and depression can become worse, lasting a long period of time, and seriously disrupting the person's life.

Sometimes symptoms do not begin until many months or even years after the traumatic event took place. If post-traumatic stress disorder has been present for 3 months or longer, it is considered chronic.

PTSD is an anxiety disorder which can affect both children and adults. About 7% of the population will develop PTSD in their lifetime; 5 million adults in the U.S. have PTSD during any given year.

Diagnostic Criteria for Post-traumatic Stress Disorder (PTSD)

The person has been exposed to a traumatic event in which both of the following were present:

• the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
• the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

The traumatic event is persistently reexperienced in one (or more) of the following ways:

• recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
• recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
• acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
• intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

• efforts to avoid thoughts, feelings, or conversations associated with the trauma
• efforts to avoid activities, places, or people that arouse recollections of the trauma
• inability to recall an important aspect of the trauma
• markedly diminished interest or participation in significant activities
• feeling of detachment or estrangement from others
• restricted range of affect (e.g., unable to have loving feelings)
• sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating
• hypervigilance
• exaggerated startle response

Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Causes of Post-traumatic Stress Disorder (PTSD)

Living through or seeing something that's upsetting and dangerous, psychological trauma, can cause PTSD. This can include:

• Being a victim of or seeing violence (kidnapping, torture, sexual abuse)
• The death or serious illness of a loved one
• War or combat
• Car accidents and plane crashes
• Hurricanes, tornadoes, and fires
• Violent crimes, like a robbery or shooting.

Studies indicate the amount of dissociation that directly follows a trauma predicts PTSD. Individuals who are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.

There also seems to be a genetic component to post-traumatic stress disorder. PTSD runs in families. And, as with many psychological disorders, a person's temperament, brain chemistry and other environmental factors likely play a role in the development of PTSD. In addition, having an existing psychiatric disorder, a family history of depression, or a poor support system following a traumatic event are all risk factors for PTSD.

For comprehensive information on post-traumatic stress disorder (PTSD), visit the HealthyPlace.com Anxiety-Panic Community.

Sources: 1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association. 2. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. 3. NIMH, Post-Traumatic Stress Disorder, July 2008. 4. Brown, Scheflin and Hammond (1998). Memory, Trauma Treatment, And the Law. New York, NY: W. W. Norton.

Book Review: Freedom from Self-Harm

Publisher's Site

Post-traumatic stress disorder and deliberate self-harm (also called non-suicidal self-injury) are often linked.

"Deliberate self-harm" means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors include cutting, burning, scratching, punching, or carving words or pictures on oneself.

Self-harm behavior can be difficult to stop and many people are reluctant to seek out treatment for self-harm due to the shame they feel about the behavior. Fortunately, there is a new self-help book available for people who deliberately self-harm.

A New Resource for Coping with Deliberate Self-Harm Behavior

Freedom from Self-Harm: Overcoming Self-Injury with Skills from DBT and Other Treatments (published by New Harbinger Publications) by Doctors Kim L. Gratz and Alexander L. Chapman may help those struggling with self-harm behavior.

Freedom from Self-Harm is an easy-to-read and accessible book that provides a wealth of information on:

• Why people often engage in self-harm
• Myths about self-harm
• Causes of self-harm behavior
• Mental health disorders that often co-occur with self-harm, such as PTSD and borderline personality disorder
• The consequences of self-harm
• Psychological treatments and medication that may be helpful for self-harm
• Coping skills for self-harm

The information provided in the book is up-to-date and presented in a validating and respectful manner. The authors also provide case examples throughout the book to help illustrate more complicated points.

Probably one of the greatest advantages of the book is its presentation of coping skills that someone struggling with self-harm could implement right away. For example, the book provides information on healthy ways of managing emotions (given that self-harm is often thought of as a way, albeit unhealthy, of regulating emotions), as well as worksheets to help people use these skills.

If you struggle from deliberate self-harm and are looking for a way to stop this behavior, you may benefit from checking out this great resource.

Publisher's Site

Burn Out

Maslach & Leiter define burnout as:

"the index of the dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit and will--an erosion of the human soul. It is a malady that spreads gradually and continuously over time, putting people into a downward spiral ..."

Symptoms include exhaustion, cynical detachment from our work, and feelings of ineffectiveness.

Why are so many social workers are burning out? We're good people who are staunchly committed to helping others. Here's where we think the problem lies:

Too many of our employers fail to empower us with the ability to perform effectively, doing so in a multitude of ways.

• Mismanagement While social workers may be nice people, many social work middle managers do not appear on the surface to be skilled administrators. However, looking at the problem more closely, when upper management mandates cost-cutting, middle management is often left powerless to support front line staff. This results in front line workers who are overburdened with unmanageable workloads. We suspect that social work middle managers, squeezed between the directives to "do more with less" and "work smarter," experience burnout just as intensely as front line workers. And we further suspect that we "front line workers" fail to recognize burnout in our supervisors as quickly as we recognize it in our same-level peers. But regardless of the reason for mismanagement ... lack of training, lack of experience, lack of insight, etc. ... when we find ourselves poorly treated by a social work supervisor, it seems to have an especially biting sting because it happens at the hands of "one of our own."
  
  

• Schedule Imbalance Many of us are employed in agencies which provide 24 hour services, such as hospitals, crisis centers, protective agencies, etc. It is to be expected that we all have to share the burden of working holidays, weekends, and off-shifts. Some employers, however, repeatedly assign undesirable shifts to the same workers. Additionally, the distinction between being at work and time off from work becomes blurred when we are required to carry beepers and/or make ourselves available for consultation or crisis intervention on an on-call basis during our time away from the work setting.
  
  

• Intense Work Days It is our observation that the most intensely burned out social workers are those with the most relentless work days. Far too many social work employers schedule exhausting shifts with no provision for meal breaks or short-term, essential mental/emotional refreshment. Burnout under these conditions appears quite pervasive to us.
  
  

• Chronic Fear of Downsizing Money is the bottom line for most of our employers. Social workers in mental health, health care, and many public agencies function with constant fears and sometimes threats of staff reduction. Who's next ... me? This type of atmosphere does little to encourage professional autonomy, growth, or performance.
  
  

• Lack of Professional Projects We've discovered from personal experience that when we do nothing but patient care day after day, week after week, month after month, we begin to lose enthusiasm for our job and our profession. Feelings of professional isolation emerge, as well as the decreased ability to contribute meaningfully to the organization. Time and an opportunity to work on projects promoting better care of clients would lead to much more professional satisfaction!
  
  

• Office and Inter-Agency Politics Who doesn't hate this one? We'd all rather just do our jobs and forget the power struggles that take up time needlessly. Many of our work days suffer from reduced productivity caused by the need to jump through internal or inter-agency hoops that are of little value for the care of our clients.
  
  

Lack of Appreciation This certainly occurs in all professions. But have you ever noticed how social workers are supposed to routinely deal with difficult and stressful situations without so much as a "please" or "thank you?" Management sometimes compounds the our feelings of being unappreciated with last-minute schedule changes, denial of employee benefits, staff reductions, etc.

Personal Risk Frequently social workers are expected to perform effectively in hazardous situations without adequate protective measures for our health and safety. Dangerous situations are common for psych social workers and child protective workers. Medical and prison social workers often face patients with an airborne-communicable diseases such as TB without being informed of the risk and without adequate protective masks. Social workers frequently must interact with clients on a crisis basis without security staff or basic safety precautions. In our opinion, nothing else more clearly communicates an employer's lack of appreciation and respect than to jeopardize social workers in this way during the course of our work day.

It has been a couple of months since I wrote about my teen daughter’s cutting, and what it was like to be a parent surviving through self-injury. Now I see parents arrive here at MereWisdom.org from time to time with searches that break my heart - for I typed so many of the same things trying to find answers. For these visitors, I offer the following wisdom gained from making a million mistakes in responding to my daughter’s self harm.

For those looking for people who are getting through this, I would point you to my daughter’s site where she wrote to share some of her story of Survival of a Self Injurer. Worthy of note and celebration in this is that she now has nine months free of self-injury, one day at a time.

Caring for Myself and Family

1 - There is nothing I can do to save her or protect her completely - The belief that if I just try harder to protect her, to limit her choices, and keep her safe to get her through this without being able to harm herself further is, in the end, a lie. I had to accept my powerlessness to stop her from harming herself before I could stop dying inside from whether she has or has not self-injured today. It’s her behavior and only she can make different choices.

2 - I did not cause it - I struggled with my own guilt for a long time. A long, long time of second guessing myself, thinking that my own faults and failures ends up, really, only another form of the false beliefs in item one, above.

3 - Her Self-Injury is not the most important thing in my life - She is more important to me than what she does. My son is equally important to me, and can’t be ignored because of constant crises in her life. Self-injury can pull a family out of a normal orbit into a tight orbit only around the self injury. This reinforces the self-injury from my experience, and it harms everyone else now out of orbit.

4 - I needed help for myself and my family and not just my daughter - It’s her behavior, but it affects all of us. More importantly as the family increasingly becomes centered on the self-injury, the more the family systems break down and require conscious rebuilding. Normal systems and family behavior that act as balancing forces for our children and ourselves become reinforcing factors for out of control behavior instead. And as we broke down, it was invisible to us. Outside help is critical.

5 - Learn to live in Daytight Compartments - The notion of “One Day at a Time” is almost a cliche in dealing with these situations, but there is some truth to the idea that just for today I can endure and do the things that I could never do for the rest of my life. For me, the idea of daytight compartments, like watertight compartments on a ship, helped me get through tough times.

Responding to Self Injury

6 - Talk about it - One of the things I did right in this was insist from day one that we would not act ashamed about it and talk freely about self-injury. It is always ok to ask if injuries need immediate treatment, for example. It’s ok to talk about feelings - from my feelings about specific events to her feelings before or after cutting. It’s also ok to talk about other things besides self-injury - there is a whole life taking place at the same time.

7 - Set Boundaries on Behavior - I mentioned above that trying to control her behavior stems from a false belief that somehow I can do it for her. This is one of the broken systems that reinforces negative behavior, rather than balancing or opposing it. Natural consequences are much better. One of the first consequences we had was that all cuts had to be examined by a medical professional within 24 hours.

8 - Build a Team - My daughter’s recovery team became her school nurse, her family doctor, her psychologist and later a psychiatrist. Each of them got a copy of the Bill of Rights for People Who Self-Harm and it made a very real difference in the level of care she received.

9 - Stay the Parent - My daughter at one point was using her self-injury as a point of leverage to take control of the family. She would threaten to cut herself to get herself out of situations, and these tools helped get us past that point. She would threaten, and I would respond that I can’t stop her if she chooses self-injury but then medical care is required, and if self-injury was a part of any behavior contract, then those consequences would happen as well.

10 - Love her enough to respect her decisions - This is the hardest one, and a recent bit of learned wisdom. I think this is because the same need I have to protect her from harm is also in play to keep her from harm by way of her consequences of her actions. This is still an ongoing struggle for me as it is a great theory until I see behavior that is likely to cause problems for yars to come or legal issues and so on. In our case, it meant loving her enough to respect decisions even when the consequences included not living at home for a while, hospitalization, school settings that took her away from music, and so on.

Brilliant post written by James at Mere Wisdom, I thoughly recommend his site