Speaking with medical professionals:
For a lot of people who self-harm, when they’ve decided – or come to a point where – they’re going to reach out, tell someone, and ask for help and support; their General Practitioner (GP) is the first port of call.
This is usually for one of two reasons, the first is that speaking to your GP when you begin struggling with your mental health is arguably the most common recommendation in guidance from most psychiatric services and charities. Secondly, a GP tends to be more easily accessed (though that’s a struggle at the minute considering the pandemic!) and that usually means a person has a more pronounced relationship with them over anyone else in the medical profession.
Unfortunately, though, GP’s are definitely ‘general’ and that means that when it comes to mental health – whilst some may have a passion and better understanding and appreciation in it, mostly; they need to seek advice from others where self-harm and other psychiatric difficulties are concerned. Sometimes, a person looking for help will either already know this (in which case they’ll likely look to another professional/person) or, they’ll be unaware and upon talking to their GP they’ll become disappointed or feel hopeless when they’re told that the GP only holds so many answers.
Other medical professionals who may be involved when a person seeks help for self-harm, are those who are stationed in a hospital accident and emergency (A&E) or minor injuries unit such as Doctors, Nurses, and healthcare assistants. Whilst they’re definitely and very obviously the right people to go to when you’ve actually self-harmed and need medical treatment for it (which I’ll talk about later), they’re not the best if you’re struggling with thoughts to self-harm or need to talk about all the reasons why you’ve done it.
Aside from the obvious of medical professionals having limited education in mental health, I think that working in such a frequently used service which tends to examine a person, treat them, and then send them on their way (whether onto a ward or back home), also really impacts their ability to thoroughly help someone where taking care of them will be much longer than a few hours.
“Have you had a bath?” – The infamous Crisis Team line:
A typical service which medical professionals (including your GP) might contact for advice or to refer you to, is your local Crisis Team.
One of my first and memorable experiences with the Crisis Team was after my first admission to a psychiatric hospital. I had attempted suicide again and my Mum called them out to her home (where I lived at the time) where they promptly attempted to persuade me to cooperate and go to our local A&E for life-saving treatment. I refused. So, they took it upon themselves to arrange a Mental Health Act assessment in our home and after two Psychiatrists and a Social Worker sectioned me, they had six Police Officers drag me from the house kicking and screaming.
For a long time, I resented the Team for it. I honestly despised them for saving my life because I was so sure that I deserved to die and then I began to see their life-saving decisions as punishments. I mean, why would they want to keep me in a life where I’m unhappy?
So that was one side of my rationale for hating them, the other part was to do with the headline – “have you had a bath?” After a year or so, I adopted the mindset that if I rang them when I was struggling and they (as I predicted) didn’t help, then at least I could say I had tried. I mean, I was already suicidal so how much worse could they make it?!
I once called them on the cusp of a suicide attempt and when they suggested I go home, take a bath, and make a hot drink… I was done! Their response felt so dismissive and belittling of my thoughts and feelings as though saying they didn’t think I was really suicidal because they thought a cup of tea and some Radox would help! I seemed to find myself almost saying ‘I’ll prove I’m suicidal!’ and that’s very obviously not the safest attitude to have!
When I was admitted to the specialist psychiatric hospital and began Dialectical Behaviour Therapy (DBT) I learnt a ton of alternative coping skills which were so much more safe, healthy, and positive. One of these skills, was ‘self-soothe’ (which I’ll talk more about later) and through the Therapy I learnt not to be ashamed or embarrassed about what helps you. Don’t judge yourself for what you find helpful, and don’t care what others may think of you for it. If it helped, then it helped. If having a bath can save a life then yeah, maybe the Crisis Team will suggest it to people where it isn’t appropriate, but what if they eventually say it to the right person?
Ultimate insight into my self-soothing toolbox:
So, through DBT I learnt that self-soothing is all about finding something – an activity, a sensory experience etc. which you find soothing and which placates your unsafe thoughts and feelings.
This was a struggle initially because I had spent years feeling guilty for the abuse and thinking myself deserving of punishment so to be taught that this actually isn’t the case, it took a while to sink in and take effect. When it did though? Well, I found this coping skill from the Distress Tolerance module of DBT one of the most helpful lessons to come from the Therapy.
When I found self-soothing helpful, I then had the battle of finding the courage to tell people it had helped. I was so afraid that I’d be judged, and that people would doubt the validity of my thoughts to self-harm if doing my nails or my makeup helped reduce them and earn me some safety. In the end? I imagined what I would tell someone else in my shoes. I’d tell them not to care what others think. I’d tell them that they need the courage to speak about what has worked for them in case it encourages someone else to try it and it helps them too. I’d tell them that they have the potential to help others feeling how they did.
So, here’s a few images and links to some of my favourite self-soothing items/products etc:
This Works Deep Sleep Night Oil: £20.00
Garnier Banana Hair Food: £4.00
Bed Head Volume Lotion: £7.50
John Frieda Frizz Ease: £5.62
Redken Perfecting Conditioner: £21.27
Coco & Eve Hair Mask: £39.90
Flannel Blanket with PomPom: £19.99
Linen House Haze Duvet Cover: £205.99
Jelly Bean Factory: £10.00
Baileys Salted Caramel Fudge: £8.36
Yankee Candle Baby Powder: £16.79
Shearer Candles Amber Noir: £6.40
Unisex Slipper Fluffy Socks: £6.99
Why being sectioned can worsen your self-harm:
As you’ll know – even if this is the first post of mine which you’ve read – that I’ve been detained under Section 136, Section 2, and Section 3 of the 1983 Mental Health Act a number of times, with my longest detention/admission lasting two and a half years.
Being sectioned is something which the Crisis Team, the Police, and a few other professionals can initiate, influence, and have power over. I think it’s really seen as defining how mentally ill you are – as though there’s some sort of scale and needing your GP means it’s insignificant or less important than if you have to be admitted to a psychiatric hospital against your will. And in some cases, this may be a fair assumption. But I think that from my experiences, there’s people whose mental health is solely under the care of their GP (a stage which may deem their mental illness to be ‘minor’) and yet they go on to commit suicide!
This kind of leads onto one of the key dangers of being hospitalised, the competitive nature of some of the other inpatients. I’ve met so many service users who have looked to one another with jealousy and this has held particularly true around self-harm…
A key example was when this girl was admitted to the specialist hospital and she had been self-harming in a completely different way so she had no wounds, no bandages, no stitches, no scars… And then she was admitted to a ward where literally every inpatient has at least one of those things!
When I got talking to her, she confided that she felt as though her methods were insignificant compared to some of the ways the other girls self-harmed, and she said that left her feeling as though she needed to ‘up her game’ and began using methods which eventually resulted in her needing plastic surgery.
I also remember whilst in that hospital when one of the girls snuck a blade in from her leave out of the hospital and I found out when the staff ordered everyone into the sitting room, locked everyone’s bedroom off and began searching each room and questioning us. After taking four of the girls to A&E in the last few days, the staff had realised that they each had very similar injuries and someone eventually came forward with the blade.
During the ward lockdown, there was one girl who everyone thought it was and I remember asking her how she could cope knowing she’d given someone a tool to self-harm with. Knowing full well what that person would do with it. Knowing that whilst people have to take responsibility for their actions, she was responsible for enabling that self-harm.
Promising you won’t do it again…
A lot of what I’ve been talking about – the Crisis Team, the Police involvement, being sectioned… can often lead to a person finding themselves in a position where they either feel the need to, or are asked to, promise that they won’t self-harm again.
As a person who has self-harmed but who would be deemed in recovery, I can honestly say that this promise can mean one of two things. Either the person genuinely means it and honestly believes they are putting their every bit of time and effort into keeping that promise. Or the person recognizes that it’s something which they are expected to say either in their situation or to obtain a particular decision e.g., in a Mental Health Act assessment in the hope they won’t be sectioned when they’ve made that promise.
Being a person who has made this promise numerous times, I’ve learnt that saying it for the sake of others or to escape or avoid a hospital admission or a chat with a Therapist, can obliterate the trust others have with you. It means that once they see the promise was fake and that you had no dedication to keep your word to them, they’ll have a very hard time believing you when you actually mean it!
In the specialist hospital, the staff obviously held control over many of the sharp objects you may have – under normal conditions – had in your bedroom or en-suite bathroom. It meant that when you asked to use one of those objects and self-harmed with it, the staff would be very strict on allowing you the item again – even when you genuinely needed to shave your legs!
Are friends and family really good enough?
I’ve honestly lost count of the number of times – after self-harming – a professional of some sort has asked if I have family and friends I can ‘talk to.’
To be honest, my answer changes depending on the exact situation I’m in after self-harming… Whilst I have a fantastic group of best-friends and an incredibly supportive Mum and Aunt, I usually say ‘no.’ And it’s not meant as an insult or a slight on all those who would say I could talk to them about anything… It’s more that I’m feeling so terrible, I wouldn’t want any of my loved ones to know the thoughts running through my head and the feelings I’m experiencing… because I’m afraid it would break their heart. And this is a huge reason why the thought of talking to loved ones can be a hesitation because you naturally feel like you need to protect them and telling them about all this darkness, makes you worry that it’ll turn their lights off too.
Where a professional asks me this, it has often led me to the mindset that they were trying to pass the buck. As though they couldn’t be bothered or didn’t want to help and support me. It really – and obviously – affected my belief that I was undeserving of help anyway.
Another difficulty around talking with family and friends about self-harm is that at the end of the day, they aren’t professionals. They aren’t trained in mental health. Which can add to the chance of them saying something unhelpful. Although(!) sometimes you get actual professionals who seem to know nothing and are just reading from a book – or computer screen! I think that sometimes the best support you can get is from someone who can identify with you – and with mental illness affecting 1 in every 4 people, that person could be a member of your family or a friend.
There’s some things that are just silently agreed not to talk about…
Another point I thought important to mention and raise awareness of, is that even amongst other people who self-harm, there are things which you just don’t say. You know, I’ve tried to be so careful in this blog post (and other times too!) to ensure that I don’t give really triggering or distressing details (you may have noticed that on the first post in this series, I didn’t talk about examples of self-harm). I do this because when I was in that specialist hospital and my discharge was being discussed, and the girl I spoke about earlier (who had been admitted with no wounds) asked what I thought had changed. Being the open and honest person I am, I didn’t think twice before telling her that my turning point had come when I’d gone AWOL from the hospital, made a suicide attempt, and ended up on life support again. I told her that it had been a wake-up call. The next thing we knew, she had run off.
I cried and kept repeating over and over that it was my fault. That I’d put the idea into her head and had been a terrible influence. All of the other inpatients and staff reassured me that I shouldn’t blame myself and told me that the girl had to take responsibility for what she’d done with the information I’d given her. I remember arguing that if I hadn’t told her that answer then she might not have had to make a decision on whether to act on it. In the end though, I’ve coped with that instance by learning from it…
I learnt that you have to take responsibility for your response to something. I learnt that sometimes people take what is said and they use it in a way which it was never intended. I learnt that if I wanted to not feel that way again, then I needed to reconsider my answer to that question. And I learnt the danger of giving details like that.
How self-harm taboo impacted me:
When I first started self-harming in 2006, mental illness as a whole was hardly talked about – both in person and in the media. So, I have never really had high expectations for the level of stigma or how taboo the subject is, and that’s meant that I’ve greatly appreciated the improvements being made; even where many other people don’t deem them to be ‘good enough.’
I think that the lack of conversation around mental health partly contributed to the length of time it took me to get help and support and to the gravity of my self-harm because it might not have become so dangerous and life-threatening had I gotten that help sooner.
I guess the silence around mental illness and self-harm left me terrified when I became poorly because I didn’t know what it meant – I didn’t know that hallucinations could be silenced with medication, and I didn’t know that my self-harm could be placated in ways which didn’t involve people in white coats locking me away!
Oddly enough, today is nine years since I first publicly talked about my mental illness on Facebook. After coming off life support, I was told I’d be going to the specialist hospital where the average length of admission was 12 – 18 months and I realised that whilst I could wear cardigans on nights out, I really couldn’t hide the fact that I’d be away from home for so long… So, I published a post on Facebook and the support and reassurance I got from all my friends and family was immense! And I think that experience contributed to my ability to have created I’m NOT Disordered.
Living with scars
Kind of going to cheat here because I wrote a blog post a while ago about the reality of living with scars from self-harm and everything in it still rings true so…: http://www.imnotdisordered.co.uk/2019/04/the-reality-of-living-with-self-harm.html
One more alternative coping mechanism – distract:
So, another skill I learnt in DBT which helped me to cope with thoughts of self-harming was all about distraction. Distracting your mind, your body, your thoughts – everything! And putting your focus, attention, energy, and time, into something other than self-harming.
Here’s seven of my favourite ways to distract:
HP Stream: £218.73
Alice in Wonderland: rent - £3.49, buy - £11.99
The Sims 4: £14.99
A5 Notebook: £7.69