Confronting self-harm crisis in A&E departments

Health service staff have been told to 'own up' to widespread feelings of anger and disgust when faced with people who need medical treatment because they cut or harm themselves.

Dr Leonard Fagin, consultant psychiatrist at South Forest Centre in London, said the incidence of self-injury, much of it carried out in secret, was reaching epidemic proportions. 'Despite Government guidance that practitioners should avoid a punitive approach to self harm, health care staff are still too quick to condemn or dismiss this group of patients.

'Nurses are especially vulnerable to becoming involved in an emotional maelstrom when a patient hits a self-harm crisis because they are not receiving the support they need,' he told the annual conference of the Royal College of Psychiatrists.

Dr Fagin said the solution was for practitioners to be encouraged to talk openly about the negative feelings that prompted them to act in a punitive way. 'People who treat those who self-harm have to find an approach to therapy that is not accusing, critical or hopeless - which is caring yet doesn't collude.

'It's not easy to do and it is not helpful for people to have to pretend that powerful feelings of anger, hatred, rage and revulsion do not exist. Professionals need be able to own up to these feelings at group meetings with colleagues.'

He said it was worrying that recent surveys continue to show that training in treating self-injury is not good enough. 'The concern is that with increasing evidence that self-harm is reaching epidemic proportions, society will become complacent and assume that the disorder is not serious. All the evidence suggests that this is not true.'

Another speaker, Dr Paul Gill, a community psychiatrist at Longley Centre in Sheffield, said it was vital to establish protocols between different professional groups within the NHS in treating people who self-harm. 'There is evidence that inter-professional rifts prevent self-harm patients receiving optimal care. A&E staff, for instance, often think that psychiatrists will be reluctant to attend a self-harm patient and will be slow to respond, and that when they do arrive, their decisions may be incomprehensible'.

'Psychiatrists pick up on this hostility and the victims are the patients. The evidence shows that when care pathways are agreed, rates of self-harm go down,' he said