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.