Training is Important

When I hear people joke about cutting and self harm, I often shake my head with amazement at how little they seem to understand that behavior. I’ve always kind of assumed that if someone went to a hospital seeking help for their own self harm, they’d find people who were better informed and better equipped to help them. Well, according to the results of a recent survey of National Health Service professionals in the UK, that’s not the case:

Less than half of NHS professionals believe they or their team have had sufficient training to undertake assessments of people who self-harm, according to research by the Royal College of Psychiatrists. The College asked more than 1,500 of its members whether they felt they had adequate training and less than half of respondents felt their training was insufficient to carry out assessments… 26% of staff felt that they did not know about self-harm to communicate effectively (59% of staff in the emergency department).

As one of the members of the working group involved in the survey and report points out, this is a serious problem: “When a person turns up to hospital having harmed themselves, this may well be the first time they have had contact with the health service. Failure to deal effectively with a person at this stage can have major repercussions. It may discourage them from returning in a later crisis and stop them getting the care they need.” It’s also a problem because the general stigma against people who self harm goes unchecked: “large numbers of healthcare staff have a profoundly negative reaction to patients who harm themselves, compared with those with physical illness, and … this is likely to be reflected in the quality of clinical care.”

Not only is this problem serious, it’s also pervasive, as the report estimates that 4 in 1,000 people in the UK self harm, resulting in 170,000 people presenting themselves at hospitals for help with self harm every year. And of course, members of some groups are more vulnerable than others, including asylum seekers, minority ethnic groups, prisoners, QUILTBAG people, and veterans. Young people are also more likely to engage in self harm. And these people are not getting the help they need, the help they deserve.

(You can download the full report here.)


  1. I agree with you that training on self-harm is important. Also, I want to point out the stigma surrounding self-harm extends to situations where self-harmers or those with a diagnosis associated with self-harm (eg. BPD) seek physical health care for something that looks like self-harm (eg. accidental cuts or burns). Oftentimes, in this case, people are receiving less than optimal physical care.

  2. A personal story…

    Several years ago I was stabbed, thankfully only through the elbow. I did the obvious – went straight to the hospital, to make sure there wasn’t any serious injury deeper in my arm.

    Like many with my specific physical conditions, local anaesthetic is almost useless and just plain ineffective. After investigation, the wound was deemed not all that serious, aside from it’s tricky position and likeliness not to fully heal, even with sutures. They sent in a nurse to sew me up, who gave me the standard dose of local before beginning her task. Obviously, I winced the minute she started as the local just wasn’t working. She gave a second dose but that didn’t help much more. In the end, I got seven stitches with essentially no anaesthesia.

    The pain of getting sewn up without a local has stayed with me many years, but not as much as the comment the nurse made when I told her to just get on with closing the wound, which was – “Looking at that [points at my arm covered in self-harm scars], you’re one of *those* who likes pain anyway.” I got the general impression from her demeanour that she didn’t exactly trouble herself to be as gentle as she could have been either. The worst of it for me was that I went in for treatment for a condition not related to my self-harm, yet I still got care that was based on what this misguided person thought I deserved due to the fact that I am a person who self-harms.

    I’ve had a great distrust of medical professionals and their motives ever since.

  3. A few years ago I started self-harming in response to the worsening of my chronic health problems. I plucked up the courage to ask my then specialist if he’d refer me to the hospital’s clinical psychology dept., though – while I conveyed my anxiety and depression, and I think a hesitancy to go into detail (which, as a perceptive man, he may have read into) – I stopped short of saying I was self-harming.

    When that course of therapy finished, I told the clinical psychologist, who was writing back to the referring specialist to say therapy had concluded, that I wanted the specialist to know about the self-harming. We had a good relationship and I felt uncomfortable keeping it from him. She said her advice would be not to let him know explicitly; that usually in such cases she would use language that was purposely – “euphemistic?” I supplied, and she agreed.

    When I asked if that was because not all doctors understood self-harm, and there might be adverse consequences for me down the line if it was stated outright, in a letter that would end up in my regular notes, she said that was her reasoning. I feel very grateful to her, because as sympathetic as my specialist was, I would imagine that most doctors dealing with a chronically ill patient (or any) might be liable to cast aspersions on that patient’s self-care based on knowledge of their self-harm.

    While my self-harm has never involved neglect or manipulation of the self-care regime with which I manage my condition, I’ve had enough problems with mistrustful doctors in the past to know that it’s very difficult to fix a doctor/patient relationship that breaks down. And as it happened, I was assigned a new specialist recently, so even had the original doctor understood, there’s no guarantee that a subsequent one would have – or indeed any of the many doctors and nurses I’d encounter during my periodic hospital admissions.

    So I’m glad to see this research and I hope it is widely highlighted. Where self-harm is concerned, the wider NHS has a very long way to go…

  4. frak, yes, THIS.
    I am sadly unsurprised by the survey you quoted.

  5. I’m a recovering Self-Harmer, and I really appreciated this article. Thank you for writing it!

  6. When I went to my GP to discuss something completely unrelated, he grabbed my arm and started stabbing his finger at old self-harm scars. “Look at these! What are these then! You did these yourself, didn’t you!”

    Ranted about here

    I’m not sure self-harm-specific training is needed for every single doctor/nurse/etc, but you’d think “basic sensitivity training” or “basic not-being-a-douche-canoe” humanity would have prevented this particular episode.

    Super post, by the way.

  7. I’ve been…very lucky in the way medical professionals have reacted to my self-harming attempts. The biggest one was when I attempted suicide when I was 15; the nurses were as I recall kind (other than the threat to put a feeding tube down my nose to get the activated charcoal into me if I wouldn’t drink it, though I recall even that being delivered fairly gently), but the thing that stands out most in my mind is the fire fighter who gave me a little teddy bear and promised me that things would be okay, that I had help. It might sound like nothing, but when you feel like you’re drowning and disappointing everyone, it can mean a lot.

    I wish other people had experiences like mine; I don’t understand how it can be so difficult to comprehend that the last thing a person who is self-harming needs is to be met with indifference or cruelty.