National Programme Delivers ‘Better Services For People Who Self-Harm’

Forty inter-agency teams across the UK, comprising patients and staff from mental health, emergency department and ambulance services, have completed the first phase of a national programme to improve services for people who self-harm. These teams have already produced impressive results.

A baseline audit conducted in Spring 2006 identified three key factors that influence the quality of care for this vulnerable group: teamwork, training and staff attitudes.  Two-thirds of ambulance staff and one-half of emergency department staff say they don’t know enough about self-harm to communicate effectively with patients. 

The result is:

– distressed patients:

• “I was told I was a time-wasting attention seeker by the staff at A&E. I always leave feeling more guilty and angry than when I arrived. I just went home and cut again.” – Service User, London

– and frustrated staff:

• “I’m afraid we only treat the cut wrist. We have no training to help us understand these patients, so that we can talk to them or help them with their mental health problems.”  – Paramedic, Belfast  

The “Better Services for People who Self-harm” Programme fosters collaboration between the agencies involved in the care of people who self-harm.  Local teams review their own service against best practice standards drawn from the NICE guideline and then visit another service as part of a peer-review team.  The Central programme team, based at the Royal College of Psychiatrists, supports the process, provides feedback and helps teams to act on their findings.

Service users are fully involved in the programme at all levels.  Helen Blackwell, National Service User Adviser, said, “Often, staff and service users only meet when the service user goes to hospital for treatment.  This programme enables them to get together in a different context to share their expertise and find solutions together”

Changes that participants have made so far include: improved access to mental health staff; better patient information; greater understanding of self-harm; better support and supervision for staff; the upgrading of facilities in emergency departments and much closer joint working between the different staff groups:  

• “These training sessions helped me cope with a situation which otherwise I would have felt very uncomfortable with.” – Student Nurse, Staffordshire
• “The programme has given me the opportunity to facilitate more effective communication between general medicine and mental health services and to work on initiatives in a more collaborative way” – Nurse consultant, Coventry

Lucy Palmer, the Better Services for Self-harm programme manager, said, “This programme was set up to audit teams’ performance against the NICE self-harm guideline. Service users have taken the lead in developing many of the tools and learning materials the programme provides, and their input has been vital.

“Our audit shows that the different members of the 40 participating teams have, in a very short time, achieved a better understanding of why people self-harm. Staff have also learnt more about each others’ roles and are now enjoying closer and more effective working relationships”

This has resulted in better services for people who self-harm:
“All the staff I came into contact with non-judgemental and helpful. I’m thankful for the support. I could have done myself serious harm if I had walked out of that hospital.”  Service user, London.