Self-harm for clients and carers

1. Self-harmfor clients and carers World Mental Health Day 2006 Adam Bernard RMN Crisis Liaison Nurse Access & Crisis Service Pennine Care NHS Trust

2. What is self-harm? How common is self-harm? Self-harm & suicide Why do people self-harm? Self-harm myths Support & advice for people who self-harm Treatment for people who self-harm Contents

3. Self-harm Deliberate self-harm Intentional self-harm Parasuicide Attempted suicide Non fatal suicide behaviour Self inflicted violence Self poisoning Self-injury Self-mutilation What is self-harm? Terminology Common terms used to describe self-harm:

4. Cutting skin Overdosing Burning or Scalding Picking, scratching, pinching or abrading skin Disrupting wound healing Biting Some types of self-harm

5. Definition The National Institute for Clinical Excellence defines self-harm as: “self-poisoning or self-injury, irrespective of the apparent purpose of the act.”

6. How common is self-harm? Each year up to 170,000 people attend A&E after having self-harmed. However, since many acts of self-harm do not come to the attention of healthcare services, hospital attendance rates do not reflect the true scale of the problem. About one in six people who attend A&E following self-harm will harm themselves again the following year. Between 0.5% and 1% of these people will die by suicide during the subsequent year. This accounts for about one-quarter of the 5,000 people who kill themselves in England.

7. Self-harm & suicide Suicide is a major cause of death in the young, and the third largest cause of life lost. Nevertheless, this is a rare event and has multiple causes. The great majority of those who present at A&E having self-harmed will NOT go on to kill themselves, which makes it extremely difficult to identify those who are at risk of suicide.

8. Self-harm v Suicide The difference between suicide and self-harm is the intent underlying the behaviour: People who attempt to commit suicide want to kill themselves, while those who self-harm seek relief from the tension that they are feeling.

9. Self-harm v Mental Illness Self-harm is not an illness, but is a behaviour that should alert us to an underling problem, difficulty or disorder. Only a minority could be considered mentally ill. Nevertheless, the majority of self-harming patients attending A&E meet the criteria for a mental disorder, with the majority diagnosed as being depressed, however it is likely that these symptoms subside only days later.

10. Why do people self-harm? Most people who self-harm have social problems, such as difficulties involving housing, employment, debts, illness and personal relationships. For some, especially those who have been abused as children, acts of self-harm occur seemingly out the persons control and can be their only way to communicate their distress. While others seek to destroy or damage their body in an attempt to make it less physically attractive. For some, the sight of blood flowing can seem like a cleansing process.

11. Why do people self-harm? Traumatic or repeated experiences of neglect, separation, bereavement, harassment, or physical, emotional or sexual abuse can severely damage a persons concept of self. Self-harm is often the means of communicating this rage, frustration, distress or self hatred. It may also be a way of saying “I need help” or coping.

12. Self-harm myths The treatment of people who self-harm can be based on inaccurate stereotypes. The following responses are based on experiences of patients, taken from the National Self-harm Network.

14. Support & advice for clients who repeatedly self-harm • Give advice regarding self-management of superficial injuries. • If there is significant scarring from previous self-injury, consider providing information about dealing with scar tissue • Discuss the risks of repeat self-poisoning • Discuss harm minimisation strategies (not if self-poisoning) • Discuss alternative coping strategies

15. Alternatives to self-harm Taken from various sources Talking: talking face-to-face or on the telephone to a friend, counsellor, helpline etc. Often self-harmers need encouragement to try and talk about their feelings early, rather than waiting until they are overwhelmed. Writing: writing letters, poems, stories or simply odd words which express feelings and experiences. Art activities: drawing, painting, collage, clay, plasticine, photography, music, etc. The aim is self-expression rather than the production of a good piece of art.

16. Alternatives to self-harm Taken from various sources Exercise: Walking, running, swimming, weights, gym, hitting a punch bag, cycling, dance, etc. Exercise helps release pent up emotions, tension and energy and distracts the person from self-injury. Physical mean of expression: smashing, hitting or kicking something (safely) shouting, screaming, crying, moving one’s body in an appropriate way. Relaxation: Warm bath, aromatherapy, yoga, relaxation tapes or gentle music, nurturing massage, etc.

17. Treatment for people who self-harm People who self-harm are no more similar as a group than people with a cough. Coughs have numerous possible causes including smoking, common cold, tuberculosis and lung cancer. The same variability applies to self-harm. Precisely why a person self-harms at a particular point in their life will be unique, even if someone self-harms frequently. This creates a difficulty for choosing and reviewing the best care for people who self-harm. The main interventions offered to people who have self-harmed include: • Psychological interventions (talking therapies) • Pharmacological interventions (medication) • Social and service-level interventions (practical support)

18. The main interventions offered to people who have self-harmed include: Psychological interventions (talking therapies) Psychological therapies are often aimed at improving social functioning, as well as reducing self-harming behaviour. Pharmacological interventions (medication) The use of medication for people who self-harm is derived from the link between mental ill heath and self-harm. Social and service-level interventions (practical support) This support aims to improve contact and engagement with services, because adherence to outpatient treatment programmes after an episode of self-harm is generally poor.

19. Access & Crisis Serviceand self-harm • 24 hour Mental Health Support Line (0161 778 3701) • Educating professionals, service users and carers • A comprehensive psychosocial assessment of needs including the motivational factors specific to the act of self-harm • A comprehensive assessment of risk including identification of the main clinical and demographic features known to be associated with risk of further self-harm and suicide. Following these assessments, the decision about referrals for interventions are made

20. Access & Crisis Service Mental Health Support Line0161 778 3701 Adam Bernard RMN Crisis Liaison Nurse Pennine Care NHS Trust Access & Crisis Service Roch House, First Floor Fairfield General Hospital Rochdale Old Road Bury BL9 7TD Tel: 0161 778 2462 Fax: 0161 778 2433 email: adam.bernard@nhs.net