The patient is a person just like anyone else: Changing attitudes to self harm

Warning, this post may be triggering for some readers.

 

It’s this year that I reach 10 years since having first been diagnosed with a mental health problem, and I’m delighted by how attitudes seem to be changing for the better, particularly in primary care, such as A&E departments. Josie's blog

Self harming can look on the outside like “attention-seeking”

The subject of taking an overdose is particularly fraught with stigmatizing attitudes; if you do this and regret it afterwards you know that you need to tell someone, but doing so is terrifying because you know you might be judged. Self harming and then seeking help can look on the outside like some kind of ‘attention-seeking’, and the first time I had to seek medical help after an overdose in 2008 the attitudes of the A&E staff reflected this.

“Oh, for god’s sake!”

“Not you again!”

I felt judged and misunderstood

I felt frightened about seeking help after experiences like this, because I felt judged and misunderstood. When taking an overdose the last thing on my mind was seeking attention – I’d do so impulsively because at that moment I wanted to die, or at least harm myself as punishment for supposedly being a ‘bad person’. Only at some point in the minutes, hours or days afterwards a niggling doubt would creep in and I’d get frightened and start to regret what I’d done.

I had a big relapse, but this time I felt supported by the doctors and nurses

Last year I had a big relapse and I had to go to A&E after taking an overdose again, six years after the last time. I was very nervous in case I experienced judgemental attitudes from the A&E staff, but in my entire 3-day stay in hospital I did not, and the care was fantastic. There were no snarky comments from nurses, the A&E doctor held my hand and said she’d endeavour to make sure that I’d get the help I needed so I wouldn’t be in this position again, and further doctors listened and let me talk about what had happened without jumping in with pre-conceived ideas of what my motivations were.

Early experiences of stigma kept me unwell, but now I feel safer seeking help

I think the experiences of stigma in 2008 kept me unwell for longer. After each hospital admission I’d feel worse and worse as I came across more stigma, and I felt like I couldn’t talk to people in case they all felt the same way. And then, because of this, I got more and more unwell and ended up harming myself again! This time around I had people listening from the very beginning, and by talking things through I was able to come up with plans to stop it happening again, and started to get better much quicker. And I now feel safer about seeking help if it were to happen again.

A&E Staff: Remember that the patient is a person just like anyone else

If I were to offer some tips to A&E staff treating patients admitted as a result of self-harm or an attempt on their own life, these tips would be:

  • To remember that they don't know the intentions of the patient, and the patient may not be entirely sure themselves. To seek attention is only one of many different reasons the patient may be there, and even if that is the reason, it means simply the person needs help to develop better communication and coping strategies, not judgement. 
  • To understand that a patient in A&E who has harmed themselves probably got up that morning with just as little intention as any other patient of ending up in A&E. Harming themselves would probably have seemed the only (or the least worst) option available to them at the time. 
  • To remember that the patient is a person just like anyone else, and deserve dignity and respect. Mental health problems are common and self-harm affects at least 1 in 10 young people, so it's likely they know and care about people with similar problems without even realising.

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Comments

A&E Attitudes

Thank you for finding the courage to talk about this highly sensitive and stigmatised subject. During a recent admittance to A&E following an overdose I was subjected to a tyranny of negative reactions and less than basic care. I was threatened with sectioning if I tried to leave (despite the fact I could not stand), was told horrifying stories relating to what may happen to me i.e needing a liver transplant and it was assumed that I was an alcoholic. All of which was done in a very cold and angry manner. I wasn't offered or given access to a drink of water which led to me becoming severely dehydrated and I was basically left to 'stew' in a room, on my own for 7 hours. I was looked on as if I were sub-human and did not deserve the care of staff. One HCA was very kind to me but once she spotted the marks on my arm her attitude seemed to change and I didn't see her again. Lack of understanding, awareness and basic compassion are just a few of the ways I would describe the people responsible for my care that day. More stories need to be told in order to challenge these attitudes and facilitate a change whether it be through training or simply letting these people know how these experiences impact on us. I have vowed not to go back to A&E which basically leaves me with nowhere to seek help should I find myself in that situation again.

Re-Josie's blog

I agree with everything Josie says,when I became Ill 15 years ago the medical personnel didn't understand.After one attempt of suicide I was admitted to hospital and a nurse told me you stink.Which I didn't I told her I tried to kill myself not win a beauty show. Gradually the staff at A and E started understanding more even though some are still ignorant. I've started on the recovery road but I lost my wife last year and it knocked me back,but I am trying once more for my wife.

Well said!

Hi Josie, I just really wanted to thank you for sharing this post because I think you are spot on with everything you are saying. Especially with your list of things A&E staff should remember! I have had too many hospital admissions for overdoses and have received some very mixed responses from the staff..but I don't think they realise how damaging a negative response can be to someone in that situation. Even if they mean well they really need to think about what they are saying and treat us in a similar way to the other patients as much as possible. We are still ill, just in a slightly different way!

Respect

Wow what a well written blog. It explains really well and respect for daring to speak out. Hugs xx

Fantastic article

Thank you for sharing your experiences. I can very much relate to the issues raised and you've ecpresded really well why someone might harm themselves, and that is often a result of desperation. If the person is seeking attention, there's a reason for that abd that needs to be addressed rather than just being seen as trouble making. I hope things a improving for you x

so true

I can relAte to this very much. First few times i was. Admitted to a&e i cud here the staff talking and judging me sayin i can wait its my own fault things like that but last yr wen admitted i was treated wiv respect And compassion which helped me so much bin over a yr now since i bin admitted. A patient no matter the means of being there shud be treated wiv care and respect and wivout judgment. Just because we are not physically ill doesn't mean we are any different. We need just as much help sometimes if not more as everyone else.

Kathryn - oh that's just

Kathryn - oh that's just awful! The staff who gave you such a poor level of care should be utterly ashamed of themselves. I do hope you never need to be in hospital for that reason again, but if you do I hope you get much better care. xx Donald - that was such a horrible thing for the nurse to say! Just awful. So sorry that you've lost your wife - bereavement is just so incredibly difficult when combined with mental health issues (I lost my mum at 18 and it made everything just so much worse) - I hope your recovery continues. Georgia - thankyou! I'm sorry to hear you've had some negative experiences in hospital too; it seems so common. Joanne - thanks very much :) Ali - thankyou :)

Josie's blog

Hi Josie, that was a very well-written and thoughtful blog. It is a very difficult situation we find ourselves in when, as you say, we wake up not knowing that hours later we might want to take our lives. It's often that we just want to block everything out, and I certainly have felt that I just don't care if the upshot is that I die. I can't say that I've had too many unkind nurses or doctors after serious suicide attempts, where I think it's been patently obvious that the intention was to die. But I remember my CPN called round one day when I had taken a lot of paracetamol, intending to die, and not expecting any visitors. When in hospital I was given the antidote - parvalex is it? And went into shock. So they couldn't give me the stuff intravenously and had to take me up to a ward where I would be given it by mouth and monitored. The nurse who accompanied me up to the ward, along with the porter, said 'I don't know why it bothered you going into shock, you wanted to die!' - it was incredibly unkind and hurtful. But anyway, I wasn't in the frame of mind where I cared whether or not people were nice to me, as my general depression told me nobody cared anyway. To have somebody treat you with care and respect can make the difference between remaining in that cycle of self-harming and overdosing, or learning, as you say, to cope a little better in future. I'm not going to praise you for speaking out, as people have now been speaking out for years - but I praise you for taking this situation by the horns and dealing with it. I hope that your blog and the response are read by nurses and doctors who treat people who self-harm or overdose, or as you say, just cry out for attention. The need for attention is not something to be scorned - because it is causing you to act out in such self harmful ways. The underlying causes have to be sorted out, and you seem to have realised that, which is wonderful. I was afraid your blog might spark of some competitiveness - I have often been in hospital and seen young women competing with their self-harming - again, it's difficult to understand but at the bottom of it all is confusion and an inability to cope with every day life.

Self harm

When it happened to me for the last time in 2001 I'd not taken my violent ex-husband's name off the next of kin details, kind of slipped my mind at the time. Not only did the staff let him in when I was in A and E in a terrible state (tho I repeatedly tried to tell them not to) they stood by while he verbally abused me ...... Thank god things are changing for the better.

Great article

Thank you for posting this, and for your openness in discussing this difficult issue. I recently took two overdoses within a week and I found A&E staff to be really kind and caring. The second time, I needed an overnight stay, and that was when I was made to feel insignificant and a waste of their precious medical resources, as I was in a medical ward. The nurses were exemplary in their physical care but ignored my obvious distress and constant tears. I was not given an explanation as to why my meds were withheld that night, causing massive anxiety as I was already experiencing massive withdrawal effects from my previous meds. I saw no one with any mental health training for nearly 24 hours, and when I did finally see someone from the crisis team I hoped for some compassion. Instead I was made to feel like a small child hauled in front of the head teacher, being told off for my behaviour and asked what I planned to do to change my behaviour. They made me feel worse than ever, and that was how I was sent home. My partner is now helping me manage my meds and I have not taken another overdose, but I have to say that my treatment in the hospital was so lacking in compassion that I hope it might make me stop and think before I act

lack of awareness by hospital staff

I recently had a short stay in hospital and found the attitude of the hospital staff towards mental illness as disgusting. I told them I was taking antiddepressants and two different members of staff said "so apart from a bit of depression do you you have any actual health problems? " I was shocked. They had no idea how severe my depression was but decided it was just 'a bit' and also they clearly didn't see it as a health problem. I discharged myself that very day.........ignorance is certianly not bliss....

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