Professional Help

What problems may be encountered when getting professional help?

Self-injury brings out many uncomfortable feelings in people who don't do it: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.

People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers.

What problems may be encountered in the emergency room?

In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.

Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer already feels.

Although offering mental health follow-up services is appropriate, psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is clearly a danger to his/her own life or to others. In places where people know that self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.

taken from Focus Adolescent Services

Guidelines for ...

the
Management of
Deliberate Self Harm

Published by:
Australasian College for Emergency Medicine (ACEM) and
The Royal Australian and New Zealand College of Psychiatrists (RANZCP)
May 2000

16 Page pdf file

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]

A & E

It is estimated that around 170,000 people each year deliberately harm themselves. Of these, around 80,000 of those who attend the casualty department never receive a phychological assessment or follow-up. This is despite the fact that the risk of committing suicide after self-harming is 100 times greater than the average risk in the rest of the population.

You'd think that self harmers would be 'in safe hands' at hostpial, but there is growing concern and evidence (and I can back this up with personal experience) that self harmers sometimes receive a poorer standard of NHS care than other patients that were deemed to have sustained their injuries by accident. Self harmers are classified with drug addicts, drunks, glue sniffers and other groups who are in the same vicious cycle of tranquilizing their anxiety by inflicting harm and pain to themselves.

There is a deep seated feeling among some health care staff that self harmers of all kinds, clog the system, and consume resources that should be allocated to the 'deserving'. Charactistically, this goes with a general lack of patience when dealing with self harmers, right alongside the sarcastic or cutting remarks, that demean the self harmer, and sap their already low self esteem. Indeed, Professor Paul Lelliott, the director of the Royal College of Psychiatrists Research Unit, is reported as saying; "There are still examples of people having wounds stitched without anaesthetic, the idea being 'well you cut yourself without anaesthetic, so why should we use it?'"How barbaric is that??

This is not to say this sort of thing happens in all hospitals, and is not representative of the feelings of all staff. Many casualty staff are highly sympathetic and understand there is an underlying cause to the actions of a self harmer, which may require the efforts of other fields of medicine to resolve.

[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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