Staff need training to deal with self-harm

[Posted: Mon 27/09/2010 by Deborah Condon www.irishhealth.com]

Healthcare workers are still not receiving the appropriate training and support they need to help people who self-harm and this can result in their patients receiving inadequate levels of care, a new study has shown.

The most recent figures available from the National Registry of Deliberate Self-Harm in Ireland show that over 9,000 people present to A&E units every year because of self-harming injuries. However the number of people who actually self-harm is thought to be significantly higher than this.

Mental health specialists from the UK analysed 19 papers from Ireland, the UK, Sweden and Australia, dating from 1998 to 2009. The papers looked at the views of 1,300 nurses, other healthcare professionals and patients and included all aspects of self-harm, from patients trying to cut themselves through to patients attempting suicide.

"Research has historically shown that people who have self-harmed often have negative experiences because of the attitudes of the healthcare professionals employed to help them. Our study showed that, on the whole, little has changed," explained researcher and staff nurse, Jo McHale, of the University of Nottingham.

Ms McHale and her co-researcher, lecturer Anne Felton, found that a lack of professional education on self-harm for healthcare staff was the main cause of negative attitudes. Where special education programmes did exist, staff tended to have more positive attitudes and offer an improved quality of care. This was because these staff had a better understanding of why people self-harm.

The study also found that a lack of support left nurses feeling that they were failing in their duty of care towards patients who self-harmed and that fear of litigation affected their confidence.

"The gap between what health professionals saw as their role and what they were expected to do in practice also influenced negative attitudes. For example, some felt it was wrong to remove clients' property and that leaving them in nightwear to stop them self-harming contravened their rights. The people who self-harmed also had more challenging needs than medical patients on wards and were subject to different rules," Ms McHale explained.

She noted that negative attitudes were also linked to the health professionals' perceptions of a client's ability to control their self-harm. Staff were more negative if they felt that the factors leading to the self-harm were within the client's control.

"Service users who presented frequently at hospitals were also seen to challenge healthcare staff, affecting their professional ability and confidence to cope with such situations. On the plus side, attitudes were mainly positive when staff were knowledgeable about self-harm, and training and experience clearly did make a difference," Ms McHale said.

She added that the consensus in the papers reviewed is that education and training are vital when it comes to caring for people who have self-harmed and that health professionals face similar issues across the world.

Details of these findings are published in the Journal of Psychiatric and Mental Health Nursing.