Self harm: better care needed

Caroline has been harming herself since she was ten

Thousands of people who deliberately harm themselves are being offered inadequate treatment by the NHS according to the government's own Health Service Watchdog

It's thought that around 170,000 people each year deliberately injure themselves, by cutting their bodies, taking overdoses or other forms of self harm.

And the care they receive in Accident and Emergency departments across the country may not be sympathetic, according to the National Institute for Clinical Excellence.

It's introducing new guidelines for treatment, to ensure, for example, that all wounds are stitched up with anaesthetic and that all self-harmers are offered a psychological assessment.

This morning, Breakfast looks at the problem of self-harm

Getting help: try the links on the right or jump to our list of helpline numbers

We talked to Marjorie Wallace of the mental health charity, Sane.

She told us that around three in four calls to the charity's helpline involve self-harm.

The NHS seems reluctant to take such cases seriously and some staff may actually be hostile to patients, she said.

"Of the 170,000 cases which are seen by doctors each year, around 80,000 people are just stitched up and sent home with no psychiatric help," she said.

I took myself to the Local A&E. The attitude was not nice towards me and ... they were not exactly kind. No attempt was ever made to find out why I'd gotten so low I'd attempted to self-harm. I was basically told to 'go away' like a 'naughty boy' Chris Read more comments from Breakfast viewers

"People lascerate their arms and gouge the flesh out, saying it's evil.

"We need to understand that they do not harm themselves because they are seeking attention - it's the only way of relieving pain.

We talked to the government's Mental Health Tsar, Dr Louis Appleby

He told us that the official figure of 170,000 self-harm incidents each year is almost certainly an under-estimate: many people don't seek medical treatment.

The new guidelines apply not just to mental health services, but also to ambulance and casualty staff who may have less experience of dealing with mental illness.

"They are about treating people fairly and not being prejudiced against those with mental health problems," he explained.

watch Breakfast's interview in full with Dr Louise Appleby

We heard from Susan Elizabeth, who runs a charity - the Camelot Foundation - which helps people who harm themselves.

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Further details from BBC News Online

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

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."

Getting help

If you have tried to harm yourself, do not suffer in silence. There are links to organisations which can help on the right hand side of this story.

You can also ring Saneline on 0845 767 8000 - or Childline (for children and young people): 0800 1111, or Mind: 0845 766 0163. The Samaritans can provide a sympathetic listening ear: 08457 90 90 90.

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