Deliberate SelfHarm: a simulated clinical experience

1
Deliberate Self-Harm a simulated clinical
experience

• Darren Prince Rachel McMillen
• Senior Lecturers
• University of Glamorgan

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Outline

• What is deliberate self-harm (DSH)?
• The simulated experience
• Student evaluations

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DSH the myths

• All self-harm is attention-seeking behaviour
• All self-harm is a sign of mental health
  problems
• The first thing we must do when helping someone
  who self-harms is to get them to stop
• People who self-harm dont want to die, they
  wont kill themselves

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DSH the facts

• Admission rate 300 per 100 000 per year
• Average age is 30
• 40 taken a previous overdose
• 20 will take a further overdose within a year,
  especially if
• History of substance misuse
• Discharge themselves before initial assessment
  completed
• Several previous episodes
• Up to 10 have mental health problem

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Self Harm The short-term physical and
psychological management and secondary prevention
of self-harm in primary and secondary care July
2004
Self Harm The short-term physical and
psychological management and secondary prevention
of self-harm in primary and secondary care July
2004 NICE
Truth Hurts Report of the National Inquiry into
Self-Harm among Young People Dr Marcia
Brophy (2006) Camelot Foundation/MHF
Look Beyond The Scars Understanding and
responding to self-harm P Bywaters A
Rolfe (2002) NCH
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What is Self Harm?

• self-poisoning or injury, irrespective of the
  apparent purpose of the act. (NICE, 2004)
• Self-injury is a compulsion or impulse to
  inflict physical wounds on one's own body,
  motivated by a need to cope with unbearable
  psychological distress or regain a sense of
  emotional balance. The act is usually carried out
  without suicidal, sexual, or decorative intent.
  (Sutton 2005)

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Methods

• What is your primary method of self-injury?
  (choose one) 38728 votes total
• Cutting (27436)
  71
• Burning (1750)
  5
• Hitting (Self/Object) (1619)
  4
• Head banging (455)
  1
• Skin picking/Scratching (4721)
  12
• Wound Interference (740)
  2
• Bone-breaking (196)
  1
• Biting (553)
  1
• Other (1199)
  3
• No Longer SI (59)
  0

Self Injury Poll (2004) What is your primary
method of self-injury (online)
httpvote.pollit.com/webpoll2?ID25897 (accessed
25-02-08)
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DSH Why?

• To stop bad feelings (immediate relief)
• To feel something, even if it was pain
• To punish yourself
• To relieve feeling numb or empty
• To feel relaxed
• Social modeling 82 of responders say at least
  one friend self-injured in the last 12 months

Nock and Prinstein (2004) A functional approach
to the assessment of self-mutilative behavior.
Journal of Consulting and Clinical Psychology 72
885-890.
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Some Quotes (Look Beyond The Scars, 2002)

• Its something that needs to be done to get me
  living (Vicky, over 25)
• I didnt want to kill myself. I just wanted some
  of the hurt and all of the pain to just go away
  (Rachel, late teens)
• Way of coping when things get really bad.
  People deal with things in different ways and,
  unfortunately or not, this is my way (Kirsty,
  early 20s)

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How Did It Come About?

• A need for training
• Negative experiences of people who engage in acts
  of DSH
• Janes Story
• Students feedback from placements
• NMC Simulation Learning Pilot

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Deliberate Self-Harm

• The Simulated Clinical Experience

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• TASK
• Meaningfulness
• Typicality
• Relevance

• PHYSICAL CONTEXT
• Work space
• Resources
• Time frame

• CRITERIA
• Based on that used in practice
• Realistic
• Criterion-referenced

• SOCIAL CONTEXT
• Similarity to social context of professional
  practice

• RESULT/FORM
• Demonstrate competence
• Presentation to others
• Multiple indicators of learning

Guliker (2004)
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Evaluations

• Students Evaluations
• Attitudes
• Evaluations Content
• Evaluations Process

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Attitudes (SHAS, Patterson et al 2007)
Care Appraisal
Care Futility
Rights Responsibilities
Care Intent Manipulation
Acceptance Understanding
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Content Results
Meeting Needs
Team Player
Care for Person who DSH
Work Therapeutically
Sutures
Knowledge Skills
Lacerations
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Process Results
Integrate Theory Practice
Valuable Learning Experience
Felt Comfortable
Transfer Learning
Team Playing
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Service-Users Advice to Professionals

• Treat us with more care, compassion, concern,
  support and interest
• Listen to us
• Dont judge us
• Respect us as you would others dont treat us
  as children/aliens
• Look at the individual we have different
  reasons for doing it
• There is always a reason for self-injury/self-harm

Bywaters P and Rolfe A (2002) Look Beyond the
Scars NCH London
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• The attitude and behaviour of staff were the
  most significant factors affecting service users
  experience of care
• Palmer L, Blackwell H and Strevens P (2007)
  Service User Experience of Emergency Services
  following Self-Harm a national survey of 509
  patients (online) http//www.rcpsych.ac.uk/resear
  chandtrainingunit/centreforqualityimprovement/self
  -harmproject.aspx

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Conclusion

• There is a need for training staff in working
  with people who engage in acts of DSH
• Simulation of both physical and psychological
  care are important
• Some evidence that simulation is a useful means
  of achieving this

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Sources

• Gulliker, J.T.M., Bastiaens, T.J., Kirschner,
  P.A.(2004) Perceptions of authentic assessment.
  Available online at www.ou.nl/Docs/Expertise/OTEC/
  Publicaties/judith20gullikers/paper20SIG202004
  20Bergen.pdf (Accessed on 6/8/07)
• (NICE (2004) Self Harm The short-term physical
  and psychological management and secondary
  prevention of self-harm in primary and secondary
  care. London, NICE. Available online at
  www.nice.org.uk (accessed 25/2/08)
• Nock and Prinstein (2004) A functional approach
  to the assessment of self-mutilative behavior.
  Journal of Consulting and Clinical Pyschology.
  72, 885-890.
• Sutton, J. (2005) Self-harm, deliberate self-harm
  and self injury clarifying terms. Available
  online at www.siari.co.uk (accessed 6/8/07)