Training the Medical Profession
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).
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.
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