Julie overcame the gremlins of the computer age, which prevented her providing a power point presentation with a more informal approach that encouraged audience participation through information & discussion.
As a practitioner who rarely comes into contact with self harm I was anxious to gain greater understanding of the psychological problems that drive people to do this, particularly as it was stressed that there is a worrying increase in such cases & also in the incidence of men self harming. Here organisations such as the Samaritans are attempting to offer contact & support via Information Technology.
Teenagers are the most susceptible group & it is especially sad that the UK has one of the highest rates of self harming in Europe.
One suggestion that the breakdown of the nuclear family could have some connection with this trend is worthy of investigation, but it was constantly reiterated that self harm has no set pattern & therefore more understanding & sensitivity is required in dealing with the problem. Also as the session progressed it became increasingly disturbing that the attitude of some health professionals was quite prejudiced with the result that many self harmers are being driven away from A & E to continue self harming in secrecy.
So what is self harm? Wounding with scissors, knives, razor blades, picking at wounds so they are unable to heal, burning, inserting needles or other foreign bodies into or under the skin - the list is endless & although there is a greater risk that self harmers are more likely to commit suicide, the two are not connected as self harming is not intended to be fatal.
Basically self harm is a coping mechanism as physical pain is seen as easier to cope with than emotional distress. Self harmers seem to be looking for an escape from mental pain or emotional anguish & the loss of control of their lives.
This manifests itself in a lack of self worth & low self esteem possibly through negative early life experiences (50% of cases have reported incidence of sexual abuse) or disharmonious relations at work or in personal life. Special dates such as Christmas or Valentine's Day can also act as a trigger.
Research into self harm has established a pattern highlighting the following:-
However, self harming is not always associated with mental health problems though high rates of psychiatric disorders (92%) have been presented of which nearly 75% involves depression. Drug & alcohol dependency are also involved. Borderline personality disorder has been reported as the most common personality problem amongst patients presenting themselves to general hospital with DSH (deliberate self harm)
In both cases self punishment offers a means of assuaging mental torment by asserting a control mechanism which psychiatrically equates with a sense of self preservation.
What is being done now? In July 2004 the NICE Guidelines: Self Harm were introduced to help control & support the patient through collaboration, mood management, boosting self esteem & limitation damage. At last there has been an initiative to prioritise treatment based upon the following criteria:-
As skin camouflage practitioners it is therefore important not to make assumptions as to the cause of injury when providing treatment, as in many cases this may have been hidden for years.
Alison Carroll raised the question put to her by a nurse in a self harm clinic that we were colluding with the self harm patient by providing camouflage treatment. Fortunately a common consensus from our discussion provided the advice "Be there, listen, don't be judgemental."
In conclusion it is important to remember treat every patient as an individual & treat with the respect that we would wish to receive ourselves.
Read the Self Harm article from the 2006 Study Day