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Last Updated: Wednesday, 28 July, 2004, 08:55 GMT 09:55 UK
Bid to boost care of self-harmers
Depressed woman
The UK has the highest self-harm rates in Europe
People who deliberately harm themselves are being offered inadequate treatment, according to a health service watchdog.

Care of the 170,000 people a year who attend hospital after deliberately harming themselves is the focus of new guidelines just published.

They stress self-harmers should be treated with the same care, respect and privacy as any other patient.

The guidance is published by the NHS treatments watchdog the National Institute for Clinical Excellence.

We need A&E departments to be more alert to the potential risks and prevent the vicious cycle of relief by painful self-harm
Marjorie Wallace, chief executive of Sane

Appropriate training should be provided for staff coming into contact with people who self-harm, say the guidelines.

Professor Paul Lelliott, director of the Royal College of Psychiatrists' Research Unit and chairman of the guideline development group, said self-harmers sometimes received a poorer standard of NHS care than other patients.

"There are still examples of people having wounds stitched without anaesthetic, the idea being 'well you cut yourself without anaesthetic so why should we use it?'", he said.

It is estimated that 80,000 of those who attend casualty each year because they have self-harmed never receive a psychological assessment or follow-up.


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This is despite the fact the risk of committing suicide after self-harming one or more times is 100 times greater than the average risk in the population

Self-harm and suicide have become the third leading cause for life years lost after cancer and heart disease in all age groups.

Recommendations are made for physical, psychological and social assessment and treatment to be offered to people who have self-harmed in the first 48 hours after the incident.

Other recommendations include:

  • Everyone who has self-harmed should be offered a preliminary psycho-social assessment when first assessed.

  • A&E staff caring for those who have self-poisoned should ensure activated charcoal is available which helps prevent the absorption of most poisons or drugs by the stomach and intestines.

  • Assessment should determine a person's mental capacity, their willingness to remain for further assessment, their level of distress and possible mental illness.

  • People who have self-harmed should be offered treatment for the physical consequences of self-harm, regardless of their willingness to accept psychosocial assessment or psychiatric treatment.

  • All people who have self-harmed should be assessed for future risk of self-harm and/or suicide.

  • The key psychological characteristics associated with risk, in particular depression, hopelessness and continuing suicidal intent should be identified.

Andrea Sutcliffe, who oversaw the guidance, said: "It makes clear that people who self harm should be treated with the same dignity and respect as any other patient and the distress they experience should be taken into account."

Dr Tim Kendall, a consultant psychiatrist and co-director of the National Collaborating Centre for Mental Health, said: "Few people providing care in casualty understand why people self-harm and don't know how to help them effectively.

"There is no one cause for people self-harming, but very often abusive experiences in their past are significant factors".

He said staff should have appropriate training to provide the right assesment, treatment and follow-up.

'Brutal methods'

Marjorie Wallace, chief executive of mental health charity Sane, said not only were more young people harming themselves but they were using more brutal methods, such as gouging flesh or drinking acid.

She said: "We need A&E departments to be more alert to the potential risks and prevent the vicious cycle of relief by painful self-harm.

"As one young woman said: "I need to cut myself as I need to breathe. It is my only release from mental pain."

"Like most others she was simply sent home from hospital, after having receiving 42 stitches from her self-inflicted injuries, and given no follow-up care."

Richard Brook, chief executive of Mind, said: "The bottom line is that anyone who deliberately harms themselves does so out of extreme mental distress.

"Self-harming patients need empathy, respect and understanding, not judgement.

"These guidelines are a step in the right direction. But fundamental attitudes towards those who self-harm need to change for the better - not just in the medical profession, but across the whole of society."

Louis Appleby, the government's mental health tsar, said: "We commissioned this NICE guidance to help provide the humane treatment and careful assessment which patients who self-harm deserve.

"Self-harm has been a common problem for the NHS for years and this is one of our top clinical guidance priorities."

The BBC's Vicky Young
"Every year more than 170,000 people end up in casualty because they have deliberately harmed themselves"

'Cutting myself is how I cope'
27 Jul 04  |  Health
Inquiry examines self-harm rates
30 Mar 04  |  Health
'I cut myself with knives'
26 Mar 03  |  Health
Girls 'more likely to self-harm'
22 Mar 04  |  Health
Teenage self-harm widespread
26 Mar 03  |  Health

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