Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

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In all these situations, staff need to support each other to talk through these feelings, so that they can help the service user by being curious, concerned and practical: • Assess the risk associated with the injury and respond accordingly (for example, do they need an ambulance, or do they have a wound that needs suturing?) • What needs to be done now to make the person safe? (Do they still have pills or instruments that could be used to harm themselves further?) • Is it possible to understand what triggered this behaviour on this particular occasion? • Has the situation that triggered this been resolved or are they still at risk? When the immediate situation has been dealt with, you might think with the service user about: • Is it possible to understand more about what leads them to self-harm? • Is there a risk management plan in place and does everyone (including the service user) know what it is? The NICE Guideline on Self Harm (2004) has specific advice on good practice for people working in primary care, emergency departments, in secondary mental health services, and with older people as well as children and young people. www.nice.org.uk/cg16 The Royal College of Psychiatrists also provide guidance for staff from all settings, in responding effectively to self harm. www.rcpsych.ac.uk/healthadvice/problemsdisorders/self-harm.aspx “I remember being on the ward and having a dressing put on a wound that I had caused myself. Although everyone was very professional and were treating it properly I think I wanted someone to ask me about it: to ask me why I did it. I wonder if they were afraid of what I might say.” curious, concerned, practical, curious, concerned, practical, curious, concerned, practical, PRIMARY TASK 44
PRACTICAL GUIDANCE HELPFUL THINGS TO CONSIDER IF SOMEONE HAS SELF-HARMED • Ask the individual if they know what would be helpful to them at that moment – but don’t assume that they will be able to tell you.They may not know. • Try not to appear overwhelmed by the injury,but at the same time do not ignore or shut off your own emotional response.If you do,you may come across as cold and uncaring. • Even if the person does not appear to be emotional,it may be helpful to acknowledge that they may feel very upset or stirred up. • If you need to touch the person to treat an injury,remember that they may have a history of being abused or assaulted;explain what you are doing and why. • Ask whether there is a friend or someone they would like to have with them while receiving physical treatment. APPROACHES THAT MAY BE UNHELPFUL • Avoid saying things which reinforce a sense of shame and failure like,“oh but you were doing so well”,“It’s been so long I thought you’d stopped doing that”. • Avoid seeing this as not a real problem – “We’ve got people here with real injuries to deal with you know”. • Avoid implying that the service user has done this by choice to ‘get attention’. • If you have a negative emotional reaction to someone who has selfharmed, but don’t step back and reflect on this, you may subtly communicate your negative feelings to them and risk making them feel worse. “I couldn’t understand my behaviour and why I reacted like I did and the most helpful thing for me was when I was able to explore where that behaviour started and why I acted in those ways.” Practical suggestions for helpful ways to respond to someone who has self harmed Evidence suggests that the attitudes and behaviour of staff towards people who self harm is the most significant factor affecting their experience of care. In thinking about dealing with challenging behaviour we have explored why it can be so difficult to respond well; an empathic and non-judgemental approach is crucial. 45
Page 1 and 2: Working effectively to support peop
Page 3 and 4: Contents Foreword .................
Page 5 and 6: Executive summary It’s not person
Page 7 and 8: INTRODUCTION THE PURPOSE OF THIS GU
Page 9 and 10: WORKING TOGETHER Professionals have
Page 11 and 12: BACKGROUND Each person’s personal
Page 13 and 14: BACKGROUND • People with personal
Page 15 and 16: BACKGROUND taken overdoses is stock
Page 17 and 18: BACKGROUND How do we describe and u
Page 19 and 20: BACKGROUND 1) Openness (seeking out
Page 21 and 22: BACKGROUND “Music has got me thro
Page 23 and 24: LEARNING POINTS FROM CHAPTER 1 —
Page 25 and 26: BACKGROUND There is no underlying
Page 27 and 28: BACKGROUND The notion of treatabili
Page 29 and 30: BACKGROUND For many years, because
Page 31 and 32: Learning points from Chapter 2 —
Page 33 and 34: BACKGROUND Most professionals agree
Page 35 and 36: BACKGROUND soothing, responsive car
Page 37 and 38: BACKGROUND THE THEORY OF MENTALIZAT
Page 41 and 42: PRACTICAL GUIDANCE RECEIVING GOOD C
Page 43 and 44: PRACTICAL GUIDANCE What might get i
Page 45: PRACTICAL GUIDANCE THERE ARE MANY R
Page 51 and 52: PRACTICAL GUIDANCE Here are some ex
Page 53 and 54: PRACTICAL GUIDANCE Some teams will
Page 55 and 56: PRACTICAL GUIDANCE Specific psychol
Page 57 and 58: PRACTICAL GUIDANCE borderline and a
Page 61 and 62: PRACTICAL GUIDANCE There are many d
Page 63 and 64: PRACTICAL GUIDANCE It is extremely
Page 65 and 66: PRACTICAL GUIDANCE 6) ISSUES OF POW
Page 69 and 70: PRACTICAL GUIDANCE We all know that
Page 71 and 72: PRACTICAL GUIDANCE Common defences
Page 73 and 74: PRACTICAL GUIDANCE It is possible t
Page 75 and 76: PRACTICAL GUIDANCE ORGANISATIONAL V
Page 79 and 80: therapist and client is a collabora
Page 81 and 82: Appendix 2: References and resource
Page 83 and 84: SELF HARM: National Self Harm netwo

Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

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