
   For years now in the U.K. an effort has been underway to train the
   medical personnel in A&E departments (the equivalent of emergency
   rooms) about self-injury and how to cope with a patient who presents
   with a self-inflicted injury. Just recently, efforts are being made in
   this direction in the U.S, It's crucial work, for the people are often
   the self-injurer's first contact with the medical system, and if
   handled badly could prevent someone from ever seeking treatment again.
   
   Horror stories abound: people being stitched without anesthesia,
   people being accused of attention-seeking and wasting time, people
   being roughly handled by emergency workers. In many cases,
   self-injurers do not seek treatment for their wounds unless the wounds
   are severely infected and beyond their capability to treat at home any
   longer.
   
   In a 1998 paper, Clarke and Whittaker said, "...we believe that the
   act is not seen as strictly a 'proper' medical event at all, and that
   massive elements of a psychosocial and moral kind are suspected, by
   professionals, to be involved." In other words, professionals are
   unwilling to assess and treat self-inflicted injury as a medical
   problem; they call in psychiatric staff when sometimes it isn't
   necessary because they misinterpret the event as an indicator of
   extreme suicidality.
   
   Clarke and Whittaker also state that practitioners must recognize the
   client's autonomy, which ultimately means recognizing and accepting
   that self-harm is something they do: "Tacitly we accept that some
   people abuse drugs and we appropriately supply them with clean
   syringes. Similarly we should give self-mutilators clean blades and
   first-aid kits."
   
   A more moderate approach is taken by a bimonthly support group, the
   North West Self-Injury Interest Group. Started in 1995 by Christine
   Hogg and Maureen Burke to provide education and support to medical
   professionals, the group acknowledges the difficulty of caring for
   self-injurers but seeks to provide resources to allow medical
   professionals to do so in a way that validates caregiver and client.
   They have succeeded somewhat in their goal of ending the negative
   stereotypes and punitive treatment that is too often the experience of
   self-injurers seeking medical help (Hogg and Burke, 1998). You can get
   information and order their resource pack for training medical
   professionals by calling +44 151 471-2460.
   
   The National Self-Harm Network in the U.K. is compiling incident
   reports of mistreatment in A&E departments, campaigning for more
   private and humane treatment of self-injurers, and publishing a
   workbook (The hurt yourself less workbook) that will help those who
   self-injure explore their self-harm, be kinder to themselves about it,
   and learn ways to get the treatment they need and want (Batty, 1998).
   [1]The hurt yourself less workbook is available from NSHN, PO Box
   16190, London, NW1 3WW. NSHN are also running workshops and preparing
   a workbook for caregivers on therapeutic approaches to self-harm.
   
   In an interesting experiment in the U.K., Crawford et al. (1998) found
   that after a brief education presentation about self-harm, doctors and
   nurses had more positive attitudes about self-injurers, were able to
   distinguish better which self-injuring clients should be admitted and
   which discharged to home, and filed more complete notes, improving
   communication between the A&E staff and the hospital parasuicide team
   and resulting in better care for patients. They found that junior
   house staff were able to accurately assess patients using a form and
   the "SADP" suicidality/depression checklist, and that staff felt more
   confident in their ability to deal with deliberate self-harm.
   
   In the U.S., some movement is being made to allow self-injurious
   patients greater autonomy (Loughrey, et al., 1997), but unfortunately
   restrictive settings with strict no self-harm contracts are still the
   norm here.
   
   return to [2]SI main page

References

   1. http://www.users.zetnet.co.uk/BCSW/workbook.htm
   2. file://localhost/usr/home/llama/Web/psych/injury.html
