In November 2011 The National Institute for Health and Clinical Excellence (NICE) issued some guidelines about how professionals should deal with those that self-harm and the friends and family that help care for them. Ruth summarises below what the guidelines say and tells us why they matter for carers.
These guidelines represent best practice and it is worth knowing what they say so you can measure the care your loved one receives from professionals in these situations and argue from a position of strength for better care if you need to.
As a useful summary: NICE recommends that staff should develop trusting and supportive relationships with those that self-harm and adopt a non judgmental approach; staff should also fully involve the person in decisions about their treatment and care. According to NICE staff should offer an integrated comprehensive psychosocial assessment of needs and agree a care plan that looks at preventing the self-harm escalating, reducing its occurrence, improving social and occupational functioning and improving the person’s quality of life. Consideration should also be given to offering three to 12 sessions of psychological intervention that is specifically structured for people who self-harm.
The good news for CARERS is that they get a mention! Professionals should ask the person who self-harms whether they would like their carers, family or significant others to be involved in their care and subject to that consent, professionals should encourage them to be involved where appropriate. So carers should be consulted on the plans that are drawn up including a crisis plan.
The guidelines also state that: 'Families, carers and significant others should also be given the information and support they need.’
Where Carers are involved professionals should:
1. Offer written and verbal information on self-harm and its management including how families, carers and significant others can support the person.
2. Offer contact numbers and information about what to do and whom to contact in a crisis.
3. Offer information, including contact details about family and carer support groups and voluntary organisations and help family, carers , and significant others to access them.
4. Inform them of their right to a carer’s assessment and how to access it.
If your loved one is under 18 then the guidelines say that professionals should balance the developing autonomy and capacity of the young person with the perceived risks and the responsibilities and views of parents and carers.
A CARER’S STORY
"I have a daughter who used to self harm, a common occurrence in those with a diagnosis of borderline personality disorder. I can still remember how dreadful it was to see marks on her where she had cut herself or burnt herself with cigarettes. She started to self harm at the age of 15 and when she was in various psychiatric hospitals it got worse as she learnt new ways to hurt herself.
"I never felt that the staff understood how terrible it was for me and her father to see our beautiful child hurt and how helpless we felt not knowing why she was doing it or how to help. Perhaps because they worked with it every day they seemed blasé about it, never taking the time to explain to us and coming out with expressions such as ‘better out then in’ which at the time made no sense to us.
"I remember on one occasion they questioned why we had taken her to hospital which again made no sense to us. They never explained that it might be better not to fuss over her [unless hospital treatment was required], ask her to clean up any mess and to keep matters as calm as possible. We learnt eventually that that was what they did on the unit she was on and it would have helped to have that explained at the time so we were all on the same page.
"It would have helped to be told what to do in a crisis and it would have helped to have time to explain how we felt. I remember once asking the unit if they could let us know before we visited if she had self harmed as it was always such a shock to see the fresh marks and they agreed to do this but never did.
"My daughter hasn’t self harmed for three years now but I was very pleased to see the new NICE guidelines as I think they could have helped at the time. It would have helped to discuss the issue and be given information about what drives self harm and what you can do to help and what can be unhelpful. I had to get all my knowledge from books or other carers. I hope it helps other carers now and also that the idea of being non judgmental filters through to some of the A&E units we went to!" Ruth
