Day 530

Self-harm. What can we do?

Well, the most important thing is to keep one’s prejudices aside. It is also the most difficult. Ask them how they feel and listen with empathy.

Put no blame on them so they don’t feel guilty about it. Respond as calmly as you can and try not to appear shocked or angry. Don’t be dismissive. Self-harm could be an important warning sign.
Perform first aid and accompany the person to A&E or the GP as appropriate.
Ask directly about suicidal thoughts.
If they share thoughts of suicide, continue listening and ask open-ended questions.
Stay with them.
Reassure them.
Tell them about the treatments and support available such as school nurses and CAMHS for the young and clinical psychologists, psychiatrists and counsellors in general.

Introduce them to ways in which they can help themselves: relevant books and websites; keeping a mood diary to monitor thoughts and feelings; regular exercise and healthy eating; reducing caffeine; getting support from friends and family; identifying enjoyable activities and finding ways of spending time doing those; identifying local support groups and addressing underlying mental health problems.

Saagar’s discharge letter from psychiatric services said – “No history of self harm.” They were wrong. On questioning they said that it was because he had never presented to A&E having harmed himself. But that is not a criterion. I don’t know if he was ever specifically asked about it or whether he misled them. He had prominent burn marks on his left forearm that could easily be picked up by trained eyes. When I asked him about it he made up a story to assuage my worries and made nothing of it.

I didn’t pick up the seriousness of it and sadly, we never spoke about it.

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