Prevention of Self Injury

Recently, at an advisory board meeting at a behavioral health hospital, a participant recounted her experience involving seeking treatment for self injury. The story left the members of the board shocked. She stated she had received treatment via the emergency department was humiliating and the medical professionals were cold and hostile. One instance included an emergency physician suturing her arm without benefit of anesthesia.
To those of us who work in behavioral health, this is not surprising. In this setting nurses often sue restraints and continuous staff monitoring to manage the severity of the self injury. This puts the staff in control, are the most restrictive in nature and place a huge financial burden on the facility, which can result in negative feelings from both the staff and the patients.
To understand this issue it is important to know individuals who struggle with self injury have difficulty managing their lives and use this behavior as a way to cope with stressors. Over 50% of self injurers have a history of abuse, neglect, or chaotic family lifestyles. They generally range in age from 13-30 but can be seen in children as young as 6. Adolescence is usually the prime time for emergence of self injury as a coping skill. The highest age range shown to experience self injury on a routine basis is between 18 and 24 years old. The primary reason for self injury is for emotional release, with combating dissociation a close second. Additionally, avoidance of suicidal impulses, for distraction and to gain a sense of control were also reported.
Treatment for self injury can include family and individual therapy, group work, and medical attention to any wounds to avoid infection and scarring.
The practice of continuous monitoring by staff can costs hundreds of thousands of dollars over time. Approximately 10% of psychiatric patients are using self injury at some point in their illness. Over time this adds up. In an effort to change how self injury is treated and regarded a study was conducted in the northwest involving consultation with experts in the field and a focus group. The program that emerged included a training effort to increase staff understanding and empathy for people who self injure. Additionally it is vital that staff evaluate each other as frustrations can mount over time. At no time should financial considerations take precedent over quality patient care and the well being of the patients we serve. The addition of sensory tools to the treatment protocol is important. Weighted blankets, stress balls, sand,clay music,etc can help the patients use other methods to self soothe. Sensory tools are very effective in addition to impulse control logs, skill cards and educational materials. Information  for parents in a format that is easily understood is vital. The biggest part of any successful self injury protocol is the staff. They must be engaged and passionate about the impact their interactions can have for their patients. A caring accessible staff that checks in periodically just to see how your day is going adds a sense of security  while allowing the patient freedom and choice.

Self injury is a coping skill used by many people with a multitude of psychiatric issues. It is nothing more than a way to cope, just like running, smoking or drinking. It just happens to leave lasting scars. It also horrifies people who do not understand the pain the person is carrying with them. Perhaps if more programs like this are accessible to people across the country, self injury will be regarded as a valid psychiatric issues that responds well to treatment. We can then add it to the growing list of psychiatric illnesses that can be managed with continued appropriate care.