Staff should admit their anger towards people who self-harm, conference hears

June 22, 2005
by Angela Hussain

Professionals should admit their feelings of disgust and anger towards people who self-harm, delegates at a conference were told yesterday.

Doing so will help stop them acting in a punitive way towards people who self-harm, psychiatrist Leonard Fagin said at the annual conference of the Royal College of Psychiatrists in Edinburgh.

His comments come after psychminded revealed last year that psychiatrists had fiercely criticised colleagues who described self harming patients as "willfully immature" and who "seem to thrive on the chaos they cause and attention they receive." The rebukes were posted on the discussion board of doctors.net.uk, an online resource for psychiatrists and other doctors.

Last year, the National Institute for Mental Health issued guidelines stating that professionals should treat people who self harm with the same respect as they would any other patient.

However, Dr Fagin, a consultant psychiatrist at South Forest Centre in London, emphasised that mental health and A&E staff are not receiving appropriate support when working with people who self harm.

"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," he said.

"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."

Dr Fagin said a solution was for practitioners to talk openly about negative feelings that prompt 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."

Dr Fagin added that he was concerned that surveys continue to show that training in treating self-injury is not good enough.

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.

See also:
Clinical psychology comment
Dec 13, 2004: The usefulness of self harm - Self harm can be an imaginative way to cope with trauma. To avoid shaming people who self harm clinical psychologists should not assume that self harm is wrong, argues Sam Warner
August 26, 2004: Psychiatrists rebuke colleagues over remarks on self harming patients - concern after people who self harm described as "willfully immature"
July 29, 2004: Treat people who self harm with respect, new guideline urges professionals - A&E staff should also receive specialist training, NICE recommends

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