Citation

Anonymous. Br. J. Gen. Pract. 2023; 73(736): e490.

Copyright

(Copyright © 2023, Royal College of General Practitioners)

DOI

10.3399/bjgp23X735285

PMID

37884373

Abstract

I am a patient no clinician wants in the room. I have self-harmed by cutting on and off for 30 years and my entire body is covered in scars. Referrals to the Community Mental Health Team are rejected or end in a one-off appointment where I am told I have the capacity to make poor decisions. There is no treatment pathway for self-harm apart from referral to secondary care, which is unlikely to take the patient on for the long-term, intensive psychotherapy they often need. The National Institute for Health and Care Excellence (NICE) guidelines on assessment, management and preventing recurrence have no bearing on my ongoing experiences of the NHS.1

Psychosocial assessment, recommended in the guidelines and provided in Accident and Emergency (A&E), is often a means to no end since there are no new services they can signpost me to. I am easily able to find the Samaritans number, which would be listed in a 'care plan', through an internet search. Repeating the reasons why I self-harm to different workers each time becomes re-traumatising and unproductive, knowing there is nothing at the end except being sent home more distressed than before. Both Psychiatric Liaison Teams and some A&E staff can be cold and indifferent as a deterrent, wrongly fearing if they are 'nice' this will lead to further visits.

Despite being portrayed by the collective Mental Health Team as 'impulsive', 'personality disordered', 'dependent', and 'lacking in coping skills', I am extremely resourceful. I work full time in a responsible job. I live alone without children or partner. I pay to see a psychologist privately. I safeguard myself by avoiding mental health services that I know will only dismiss and insult me. I had not visited A&E for 3 years until last week.

Language: en