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Self harm – getting good care
Self-harm is a very distressing issue and one which workers struggle to offer help with. There are lots of ideas around as to the causes and consequences of self-harm. For example, self-harm among young people has traditionally been regarded as an issue for girls and yet some statistics released just before Christmas showed a dramatic increase in the number of young boys being admitted to hospital as a result of harming themselves. Statistics from the Health and Social Care Information Centre show the number of young boys admitted has been on an upward curve for the past few years. This got me thinking about some of the ideas that are around the subject.
Of course it’s very difficult to get meaningful statistics because a lot of self-harm doesn’t result in someone going to hospital or even being involved with medical services. We do know that last year there were more than 110 000 admissions to hospital in England and Wales for self-harm. Now self-harm is not an illness or disorder in itself. It may well be linked to a mental disorder but may be the result of a lot of other pressures and stresses such as bullying, family breakdown, pressures of body image or academic demands at school or university.
What happens if someone gets to hospital following an incident of self-harm? National Institute for Clinical Excellence (NICE) guidelines say the person should be afforded the same professional and caring service as anyone else. There have been studies showing some unhelpful attitudes, but that staff training can improve these. Guidelines say that an incidence of self-harm should be followed up by a risk assessment to help plan future care. Self-harm may be part of a repeated pattern, it may go on to attempts at suicide. The important message is not to assume people who self-harm are all the same. And not all self-harm occurs in the same way. Self-harm can include cutting, burning, drugs overdoses, punching oneself, or overeating.
Trying to help
Practitioners used to talk about deliberate or intentional self-harm, now we talk just about self-harm in an attempt to be less judgemental. So attitudes are important but what else can health and social care workers do?
- Being able to recognise the problem. There’s lots of information out there, and there’s a particularly useful leaflet produced by the Royal College of Psychiatrists which is geared to young people but could be useful for anyone working with someone who is at risk of self-harming which you can find at: http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/feelingontheedge.aspx
- Try not to make assumptions – not everyone who thinks about harming themselves is the same, there may be very different reasons why they might do it – it’s very important to have a whole assessment of the young person and their needs.
David Beckingham – QCS Expert Mental Health Contributor