SELF HARM

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SELF HARM
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Treatment Approaches

• What Works

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The aim of this presentation is

• Introduce and define self harm
• Brief history of previous interventions and
  attitudes to self harm
• Motivation to change
• Therapeutic approaches and changes in attitude
• Way forward (sharing good practice) and
  implication for practice
• A patients perspective

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The Dynamics and Motivation Underpinning Self Harm

• Identifying therapeutic alternative approaches
  whilst risk managing within a safe environment

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• The issue of self harm is a very complex one and
  we must firstly understand the dynamics of self
  harm and why do people self harm.

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SELF HARM

• Any harmful act to the self, or omission, in
  which the direct intent is not to die (Smith
  2003)
• Self injury is an act which involves deliberately
  inflicting pain and/or injury to ones own body,
  but without suicidal intent (Babiker and Arnold
  (1998)
• Any behaviour engaged in by an individual,
  regardless of intent, that results in deliberate
  harm to their body or interference with their
  vital functioning (Beasley 1999)

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• There are numerous definitions of self
  injury/harm which are available, all of which we
  can agree involves harm to the individual and
  that self injury is seen as a maladaptive coping
  strategy that enables individuals to express
  themselves in one way or another and can manifest
  in varying forms.

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Forms of Self Harm

• Cutting
• Burning
• Self hitting
• Hair pulling
• Bone breaking
• Picking (at wounds/skin)
• Swallowing (foreign objects)

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HISTORICALLY

• Self harmers in psychiatric services were seen
  as attention seeking, are disliked by staff and
  were seen as being in control of manipulative
  behaviour
• Self injurious behaviour is complex and costly to
  services, and can cause concern and distress
  amongst professionals.
• A survey in 1997 by (Liebling et al) on women who
  self harm in a secure setting, reports half of
  the women stated that their urge to self harm was
  prompted by their surroundings and the attitudes
  of staff.

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Motivation to Change

• A positive attitude and sound knowledge base
  about our client group (female forensic patients)
• A greater familiarity with risk assessment
  procedures
• Changes is staff team members
• Gain an understanding of why individuals self
  harm and why they go to such lengths.
• Reduce the incidents of self harm
• Work towards improving attitudes towards self
  harming patients, for example through training
  aimed at increasing knowledge.
• Work towards recommendations from the NICE
  Guidelines 2004 around key priorities

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• Within the Female Forensic Services at Northgate
  Hospital (part of Northumberland, Tyne Wear NHS
  Trust) a positive therapeutic approach to self
  harm has been developed in order to educate staff
  to enable them to safely manage individuals who
  self harm within a safe and secure setting.

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Therapeutic approaches and changes in attitude.

• Involved the service user
• Provided staff training
• Held regular patient meetings.
• Individual one to one sessions.
• Research
• Recording of incidents
• Looked at approaches that could be adopted to
  assist in minimising self harm and increasing
  self esteem.

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Staff Training

• Definitions of self harm
• Understanding self harm both from a patient
  perspective and those who support them.
• Self harm seen as a way of communicating rather
  than manipulating.
• Risk Assessment
• Supporting staff to support individuals who self
  injure
• Infection advice.
• Clinical supervision
• Debriefing following any self harm incident
• Identifying a harm minimisation approach rather
  than one which looks at exclusive prevention.
• Alternative therapies including the holding of
  ice cubes, use of henna tattoos, use of elastic
  bands, use of red marker pens, playing loud music
  to distract, using other alternatives for hitting
  (pillow etc) This list is not exhaustive.
• Exploring what works for who?

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Way Forward

• Sharing good practice.
• Implications for practice.
• Evaluating incidents of self harm before and
  after.
• Maintaining positive attitudes and knowledge.
• Continuing research and new approaches.
• Improve the clients quality of life.
• Continue to manage risk. There will never be a
  risk free environment or risk free situation.
• Monitor legislation and nursing guidelines
• Work together as a MDT

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Summary

• A positive attitude and a sound knowledge base
  about this client group (female forensic
  patients) together with a greater familiarity
  with risk assessment procedures has enabled
  nurses to provide the necessary emotional support
  in times of self harm.

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• Within the female service (Longhirst Villa 15) we
  have been able to provide the support, training
  and guidance for nursing staff who work within
  the service with patients who self harm and feel
  we have therefore moved a step closer to
  fulfilling out aim of reducing the incidents of
  self harm.
• Recent statistics following the new intervention
  has shown a decrease in episodes of self harm by
  70.

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Incidents of Self Harm 1st March 2005 28th
February 2006
Number of Incidents
Month
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MISUNDERSTOOD

• Since the day I was abused
• Nobody would listen
• This is difficult for me to explain
• But Ill try and tell you about my position
• I love talking, but the pain stops me
• I feel numb
• I love being honest, but the pain stops me
• I feel dumb
• Sometimes I feel really low
• Thinking about my past
• The tears fall down by face, and I shake
• And I wonder how long this will last.
• To take away the pain
• I will cut myself with anything I can find
• Im angry with myself
• So wound up Ive let him win