A & E

New Guidelines to Standardise Care for People Who Self Harm.

The National Institute for Clinical Excellence (NICE) have issued new guidelines to standardise care for people who self harm in England and Wales.

Firstly, the new guideline makes recommendations for the physical, psychological and social assessment and treatment to be offered to people in the first 48 hours after a self harming incident. This covers all acts of self harm.

• Everyone who it is believed to have self harmed, should be offered a preliminary psycho-social assessment when at the triage stage.
• Proper care of a physical injury should not reflect a patients willingness to undergo psycho-social assessment or psychiatric treatment.
• Self harmers should receive the same care, dignity, respect and privacy as is offered to any other patient. Healthcare professionals should be supportive and take into account the distress of the self harm patient, over and above the nature of the injury.
• Accident and Emergency departments should have activated charcoal available at all times for self harm patients who have self-poisoned or overdosed.
• Always use proper anaesthesia and/or analgesia if treatment for self injury is painful.
• All staff who come into contact with people who self harm should receive appropriate training.
• All people who have self harmed should be assessed for future risk of self harm or suicide.
• Health professionals should take account of emotional distress as well as physical distress.
• Medical staff should not delay treatment because it is self inflicted.
• Acts of self harm by the elderly should be regarded as evidence of suicidal intent until proven otherwise.
• The key phychological characteristics associated with risk, in particular, depression, hopelessness and continuing suicidal intent, should be identified.

Dr Tim Kendall, a consultant psychiatrist and co-director of the National Collaborating Centre for Mental Health, is reported to have said: "Self harm and suicide have now become the third leading cause for life years lost after cancer and heart disease in all age groups. Few people providing care in casualty understand why people self harm and don't know how to help them effectively.

"Hopefully, this statement won't be true for much longer!

[taken from: Distant Healer.Co.UK]

Bill Of Rights For People Who Self Harm

Preamble
An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike.

Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

• The right to caring, humane medical treatment.
• The right to participate fully in decisions about emergency psychiatric treatment (so long as no one's life is in immediate danger).
• The right to body privacy.
• The right to have the feelings behind the SI validated.
• The right to disclose to whom they choose only what they choose.
• The right to choose what coping mechanisms they will use.
• The right to have care providers who do not allow their feelings about SI to distort the therapy.
• The right to have the role SI has played as a coping mechanism validated.
• The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
• The right to have self-injury regarded as an attempt to communicate, not manipulate.

Bill Of Rights For People Who Self Harm

[Full Document]

© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.

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