Self help for self injury - Lancashire Care NHS Foundation ... Info... · What is self injury? 6...

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Network Name

Children and Families Community Services Mental Health Secure Services Specialist Services

Self help for self injury

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About the authors 3Sarah’s reasons for writing this booklet 4How is this booklet going to help me? 5What is self injury? 6Why do people start to self injure? 7What is the difference between self harm and self injury? 8Facts about self injury 9How common is self injury? 10Talking to family and friends 11Advice for friends and family 12What leads to self injury? Something to try out 13States of mind before self injury 14Alternatives to try for each state of mind 15Find some support and using the written exercises 18Practical advice 19First aid kit 20First aid advice 21• Cutsandgrazes 21• Burnsandscalds 21• Overdosesandpoisoning 21Scar reduction 24Sources of support 25Written exercises 26Seeking medical attention forms 28

Contents

The image on the front of this booklet was photographed and edited by Sarah

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By Jenny Winnard, CPN and Sarah Devlin, Service User

About the authorsJenny and Sarah decided to do something about the lack of support and treatment locally for people who self injure after working together as CPN and client. There seemed to be self help guides which the trust used for things like depression and anxiety, but nothing for self injury. This idea progressed and Jenny and Sarah have now produced this booklet along with some training for staff about dealing with people who self injure.

About Jenny by Sarah:

Qualified as an RMN in 1999 and worked at Ormskirk Hospital on the Scarisbrick In-Patient unit and Lathom Suite psychiatric intensive care unit until 2005. Jenny then got promoted into a community mental health team in Skelmersdale. Jenny has been my CPN since October 2005. Jenny is ace! She has helped me a lot and is very understanding, caring and open minded. She’s also very girly and pink.

About Sarah by Jenny: Qualified as a primary school teacher in 2000. Because of Sarah’s experiences of mental health problems, Sarah now works as a mental health development worker, helping people to give their views about mental health services.Sarah has been self – harming since she was 12 years old. Sarah is a very motivated and dynamic person. She has tremendous courage to talk about her experiences in order that it will help others, this is always something that drives Sarah to do the things she wants to do to help others. This, does however, ultimately help her too.

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By Jenny Winnard, Community Psychiatric Nurse (CPN) and Sarah Devlin, expert by experience

About the authors

Jenny and Sarah decided to do something about the lack of support and treatment locally for people who self-injure after working together as CPN and Service User. There seemed to be self-help guides which the Trust used for things like depression and anxiety, but nothing for self injury. This idea progressed and Jenny and Sarah have now produced this booklet along with some training for staff to help them support people who self injure.

About Jenny by Sarah:

Jenny qualified as a registered mental nurse (RMN) in 1999 and worked at Ormskirk Hospital’s Scarisbrick in patient unit and Lathom suite psychiatric intensive care unit until 2005. Jenny moved into a community mental health team in West Lancashire in 2005, and was my CPN (Community Psychiatric Nurse) for 6 years. She’s worked in a few different mental health teams in West Lancashire since then. Jenny is lovely. She helped me a lot, is very understanding, caring and open minded. She’s also very funny, girly and pink!

About Sarah by Jenny:

Sarah and I began working on this booklet in 2006 when I began to support her in the community as her CPN. I always remember being very humbled by Sarah’s honesty and her courage to want to overcome her self injury.

Sarah loves to help people and having the courage to share some of her personal struggles and how she has overcome some of this is a very special thing in my eyes.

Sarah has worked very hard in making this booklet happen, her journey will hopefully give others hope that recovery is possible and I feel glad that hers is a journey that I was lucky enough to be part of.

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When we originally wrote this booklet a few years ago, the aim was to create a practical self help booklet for people who self injure. Jenny and I had been looking at a lot of self help information Lancashire Care had about other topics, but there was nothing locally about self injury, so we decided to create something ourselves. We wanted it to be something people could use in a very practical way either by themselves, or with their care co-ordinator, we also wanted it to be written in plain English, not the jargon that is sometimes used, and most importantly, we wanted it to help people to resist the urge to self injure.

Back when we first wrote the booklet I was still self injuring quite often, but all the research into self injury, and the writing of the booklet did help. Unfortunately in 2012 I had a massive relapse in my mental health, and my self injuring became worse than ever. I was fortunate enough to be accepted onto a Dialectical Behaviour Therapy course within the mental health team in 2012, which has helped me massively. It’s been really difficult, and even though I had support, I still had to work hard to get to where I am now. I still have thoughts of self injuring, I may always have them, but what I do with them now is very different. Finding the right therapy has helped me to manage my thoughts and emotions, and to bring my self injuring under control. Currently it’s been a year since I last self injured. Why am I telling you this? Because I want you to have hope that you can bring it under control too. I hope this booklet helps you on your way to beating self injury.

Sarah’s reasons for writing this booklet…….

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Sarah’s reasons for writing this booklet…….Self help for self injury

How is this booklet going to help me?

This booklet will tell you more about self injury and will hopefullyhelp you find useful alternatives to self injury.

This booklet has been designed for health care professionals to usewith their clients to help raise awareness and understanding forboth the client and the health care professional.This booklet aims to:

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Raise awareness

Help you to better understand the reasons behind your self injury

Help you with telling people about your self injury

Help find alternatives to self injury

Give practical advice on how to care for wounds

Tell you where else to get help and support

How is this booklet going to help me?

This booklet will tell you more about self-injury and will hopefully help you find useful alternatives to self injury.

This booklet has been designed for health care professionals to use with their clients to help raise awareness and understanding for both the client and the health care professional. This booklet aims to:

Raise awareness

Help you to better understand the reasons behind your self injury

Help you with telling people about your self injury

Help find alternatives toself injury

Give practical advice on how to care for wounds

Tell you where else to get help and support


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What is self-injury?

“Self harm happens when you hurt or harm yourself. It can feel to other people that these things are done calmly and deliberately – almost cynically. But we know that someone who self-harms is usually in a state of high emotion, distress and unbearable inner turmoil. Some people plan it in advance, for others, it happens on the spur of the moment. Some people self harm only once or twice, but others do it regularly - it can be hard to stop.

Some of us harm ourselves in less obvious, but still serious, ways. We may behave in ways that suggest we don’t care whether we live or die – we may take drugs recklessly, have unsafe sex, or binge drink”.

Royal College of Psychiatrists (2014)

“Self injury, as defined in the NICE guideline, is an expression of personal distress, usually made in private, by an individual who hurts him or herself. The nature and meaning of self-injury however, varies greatly from person to person. In addition, the reason a person injures him or herself may be different on each occasion, and should not be presumed to be the same”.

National Institute for Health and Care Excellence (NICE) guidance.CG16 (2004) and CG133 (2011).

What self-injury is not

Self injury is not attention seeking, manipulation, or ‘cool’. It is not a failed suicide attempt. Self injury is private and personal and usually hidden.

“Most of my scars are on my stomach and are hidden from view. When things get really bad I injure my arms or hands, but I always

have a cover story if that happens”. Sarah aged 29


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Why do people start to self injure?

Self injuring behaviour can usually be split into three categories. Although there are three categories it may be that they cross over, and the reasons may not always be the same for each episode of self injury.

People who are unable to talk about how they are feeling or have been coached not to tell people (e.g. by an abuser) may feel so many emotions which they cannot otherwise release.

Self injuring validates their feelings, and reduces the amount of turmoil they feel.

Self injury may be a way to communicate to people that something is wrong. This category can be viewed as attention seeking, but for someone to physically injure themselves, regardless of whether it is viewed as attention seeking still shows that something is wrong.

Sometimes self injury can be as a punishment or a control. They may feel that they are bad and deserve to be punished more than they can punish themselves mentally, or they may feel that the rest of their life is out of control and self injuring is the only genuine control that they, and no-one else has control of.6

Why do people start to self-injure?

Self injurious behaviour can usually be split into a number of categories. Although we only identify 4 categories here, it may be that they cross over, or that there are other reasons for injuring. Always remember that the reason someone self injures may be different each time they do it.

• Validatingemotions– People who self injure are often unable to talk about how they are feeling or have been coached not to talk about how they feel (e.g. by an abuser, or growing up in a household where talking about feelings was frowned upon). Self injury validates these feelings and reduces the amount of turmoil they experience. It is a response to the intense emotions they are feeling, and can be comforting.

• Control – It may seem like the rest of the person’s life is out of control and self injuring is the only thing that they, and no-one else has control of.

• Communicatingdistress – Self injury can be a way to communicate to people that something is wrong. This can be viewed as attention seeking, but for someone to physically injure themselves, regardless of whether it is viewed as attention seeking, still shows that something is wrong.

• Punishment– Sometimes self injury can be as a punishment. A person may feel that they are bad and deserve to be punished more than they can punish themselves mentally.


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What is the difference between self harm and self injury?

Self harm can include any kind of action or behaviour which can be harmful to the body or mind e.g. drugs, alcohol, smoking, these things have long term effects.

Self injury causes a more instant harm, is more visible, and carries increased stigma. Projects like this are aiming to challenge the stigma associated with self injury.

Some people still use the term self harm rather than self injury, but both are generally accepted terms. The lists below show a few examples of how self harm and self injury could be classed differently.

Self injury CuttingBurningHead bangingTaking too many tabletsPunching self or walls

Inserting things into woundsSwallowing objects or harmful substancesPicking or pulling skin or hairScouring or scrubbing skinBreaking bones

Self HarmDrinkingTaking drugsOverworkingUnder/overeatingNeglecting physical/emotional needsSmokingRisk taking behaviours

Body piercingTattooing

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Facts about self-injury

FACT Self injury isn’t necessarily about suicide.

Sometimes people injure themselves because they want to die but often it’s more about staying alive. People may hurt themselves to help them through a bad time. It’s a way to cope.

FACT It doesn’t mean you’re off your head.

All sorts of people self injure. Even people in high powered jobs. It’s a sign that something is bothering and upsetting you, not that you are mad.

FACT It’s not just attention seeking.

People self injure because they are in pain and trying to cope. They could also be trying to show that something is wrong. They need to be taken seriously.

FACT It can happen once, or many times.

Some people attempt suicide or hurt themselves just once or twice. Other people use self injury to cope over a long time. They might hurt themselves quite often during a bad patch.

FACT People do stop self-injuring.

Many people stop self injuring when they’re ready. They sort their problems out and find other ways of dealing with their feelings. It might take a long time and they might need help. But things can get better.

Taken from “What’s the harm?” by Lois Arnold and Anne Magill The Basement Project, Abergavenny.

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1 in 11 young people have asthma

1 in 20 people have diabetes

1 in 10 people self injure in their teenage years

1 in 20 people over 18self injure at some point

in their lives

How common is self-injury?

Sometimes it can feel like you are the only person in the world who self injures, but the fact that this booklet has been written, and that there has been such high demand for it, proves that you are far from being alone. The following statistics show just how prevalent self injury is.

In 2002 a study by the Office of National Statistics found that 2% of men and 3% of women over the age of 16 had deliberately injured themselves.

The Lancashire Child Health Profile for March 2012 showed 502 children were admitted to hospital as a result of self harm and nationwide it is estimated that between 8 - 10% of teenagers have self injured. http://selfharm.co.uk/get/facts/self-harm_statistics (last accessed 23rd June 2014)

In 2011 there were approximately 63 million people in the UK. Using the statistics above, this means that approximately 2 million people in the UK have self injured at some point.

Self injury is often a very hidden problem that people do not talk about, therefore the actual number of people who have self injured is likely to be a lot higher.

The boxes below show some comparisons to other common conditions.


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Talking to family and friends

It is up to you whether you want to tell someone, how you want to tell them, when you want to tell them and how much you want to tell them.

Sometimes it’s useful to try to gauge someone’s opinion about self injury before you tell them. Many TV shows have self injury storylines, so you could start up a conversation about that, or maybe ask advice from the person you are thinking of telling about a friend you are concerned about.

Once you have decided to tell someone, you need to make sure you prepare yourself for their reaction. It is important to remember that you may have done this for years before telling someone, and that you may have got your head around it, but the person you are telling will be receiving new, possibly distressing information. It may be worth thinking of any questions they may have beforehand so that you are prepared with an answer. It may also be useful to find some information for them or show them this booklet if you feel that you won’t be able to answer all of their questions.

It’s also worth considering how you might wish for that person to support you, before you tell them; as one of the first questions they ask may be “What can I do to help?”.

It is advisable to make sure that you have some support in the build up and the period after you tell someone. You are laying your emotions on the line and you need to be prepared before, and have that support afterwards just in case it doesn’t go according to plan.

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Advice for friends and family

This page is designed specifically for anyone who wants to support a friend or family member who self injures.

Finding out that a friend or relative self injures might leave you feeling shocked, confused, guilty, helpless, angry and upset. These feelings are totally normal, and very common. It is important to recognise your own feelings and responses, and to have someone you can talk to about this.

We have compiled ten top tips which may help you to help both your friend or relative, and yourself.

Ten top tips for helping a friend/familymember who self injures

•Staycalm–don’tgetangryorupset,thiscanmakethingsworse.

•Askthepersonwhattheywouldlikeyoutodotohelp.

•Listen–butdon’tforcethemtotalkiftheydon’twantto.

•Helpthemtotreatorgettreatmentforphysicalinjuries.

•Encouragethemtoseekhelpfortheirmentalhealthfroma professional, and encourage them to look at this book.

•Makesureyouhavesomeoneyoucantalktoabouthowyoufeel.

•Don’tblamethemorblameyourself.

•Neverassumethattheyhaveselfinjuredforthesamereasoneverytime.

•Careaboutthem–Theyarestillthesamepersonasbefore,it’s important to help them feel loved, cared for and accepted, in spite of the fact they have self injured.

•Educateyourself–Findoutasmuchasyoucanaboutselfinjuryin general, and also about your friend or relative’s self injury, e.g. what triggers it, what helps them, what methods they use, whether they want to treat their own injuries, or whether they would prefer to seek medical assistance


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What is the difference between self harm and self injury?

Self harm can include any kind of action or behaviour which can be harmful to the body or mind e.g. drugs, alcohol, smoking, these things have long term effects. Self injury causes a more instant harm and has long been seen as less socially acceptable, however projects like this are aiming to change this view. Some people still use the term self harm rather than self injury and both are generally accepted terms.

What leads to self injury?

Trigger“A thought or incident, which causes someone to need to self injure.”Dictionary definition: Verb: to begin, stir up, or set in motion as if by pulling a trigger

Urge“A strong desire to self injure.”Dictionary definition: to force or drive to some course or activity

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What leads to self injury?

Trigger - “A thought or incident that causes someone to feel the need to self injure.”

Urge - “A strong desire to self injure.”

Something to try out

At a time when you’re not feeling a strong urge to self injure, you could spend some time learning about “mindfulness” and practice it, so that when you need to use one of the alternatives you do it mindfully. i.e. you focus all of your mind and attention on the alternative you choose to do.

There are many books about mindfulness available from your local library, and the following websites may also help.

www.getselfhelp.co.uk/mindfulness.htm

www.freemindfulness.org

www.mind.org.uk – Click on the “information and support” tab, then click “A-Z mental health”, then click on mindfulness

If you practice doing alternatives mindfully when you are not distressed, it will be easier to do them when you are distressed.


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Emotions before self injury

Anger, frustration, restlessness – Feeling very wound up and annoyed

Low self esteem – feelings of guilt and low mood, hating yourself and feeling the need to punish yourself.

Sad, unhappy and depressed.

Control – feeling that self injury is the only control in your life.

Feeling empty, unable to feel, numb, not real – these feelings can mean that you need to injure to feel pain or see blood to know you are alive.

Craving the feeling to self injure – this relates to the feelings of euphoria felt when self injury occurs.

Each time you feel an emotion which will usually lead you to self injure, try to identify it from the list above and try to pick an alternative from the lists on the following pages.

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States of mind before self injury

Below are the states of mind you may be in when you feel the urge to self injure.

Anger, frustration, restlessness – feeling very wound up and annoyed

Depression and low self esteem – feeling sad and unhappy, having feelings of guilt and low mood, hating yourself and feeling the need to punish yourself.

Feeling empty, unable to feel, numb, not real – these feelings can mean that you need to injure to feel pain, or to see blood to know you are alive.

Craving the feeling of self injury – this relates to the feelings of euphoria felt when self injury occurs.

Control – Try any of the alternatives. Doing any of them means you have a degree of control, particularly if you do it mindfully.

Each time you feel an emotion which would usually lead you to self injure, try to identify it from the list above and try to pick an alternative from the lists on the following pages.

Make a list of your top 5 alternatives in the notes pages at the back of this booklet.


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Emotions before self injury

Anger, frustration, restlessness – Feeling very wound up and annoyed

Low self esteem – feelings of guilt and low mood, hating yourself and feeling the need to punish yourself.

Sad, unhappy and depressed.

Control – feeling that self injury is the only control in your life.

Feeling empty, unable to feel, numb, not real – these feelings can mean that you need to injure to feel pain or see blood to know you are alive.

Craving the feeling to self injure – this relates to the feelings of euphoria felt when self injury occurs.

Each time you feel an emotion which will usually lead you to self injure, try to identify it from the list above and try to pick an alternative from the lists on the following pages.

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Alternatives to try for each emotion

Anger, frustration, restlessness

Play dartsExerciseDraw on yourself with washable red felt penScribble on paperWrite – Stories, diaries, poems, lettersPlay an instrumentSingDanceFlick rubber bands on your skinBlow bubblesPillow fightPaint, draw, create somethingRip paperPop bubble wrapPlay with plasticine or play dohPop balloonsThrow socks at the wallDeface the good looking people in magazinesPlay with a slinkyPlay with kids toys or computer games

ScreamCryColour a pictureHousework


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Alternatives to try for each state of mind

Anger, frustration, restlessnessPut your face in ice water

Exercise

Draw on yourself with washable red felt pen

Scribble on paper

Write - Stories, diaries, poems, letters

Play an instrument

Sing

Dance

Flick rubber bands on your skin

Blow bubbles

Punch a pillow

Paint, draw, create something

Rip paper

Pop bubble wrap

Play with plasticine or play doh

Pop balloons

Throw socks at the wall

Deface the good looking people in magazines

Play with a slinky

Play with kids toys or computer games

Scream into a pillow

Cry

Colour a picture

Housework


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Low self esteem

Write – Stories, diaries, poems, lettersBe with other peopleThink about not wanting more scarsPaint your nailsHot shower/bath (pamper yourself)Paint, draw, create somethingPut your books, CD’s, Videos, DVD’s in alphabetical orderMemorise song lyrics or passages from booksMake a tape or CD of your favourite songs and play itPhone a friendCurl up under a blanketSleepCryList positive things about yourselfDo something to help someone elseMake your favourite food or drink

Feeling empty, unable to feel, numb, not real

Flick rubber bands on your skinHot shower / bathCold shower / bathBite into a lemonScreamCryCurl up under a blanketFocus on breathing

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Depression and low self-esteemWrite - Stories, diaries, poems, lettersBe with other peopleGo for a walkPaint your nailsHot shower/bath (pamper yourself)Paint, draw, create somethingPut your books, CD’s, Videos, DVD’s in alphabetical orderMemorise song lyrics or passages from booksMake a tape or CD of your favourite songs and play itPhone a friendDo something energeticDo you something you really enjoyCryList positive things about yourselfDo something to help someone elseMake your favourite food or drink

Feeling empty, unable to feel, numb, not realFlick rubber bands on your skinHot shower/bathCold shower/bathBite into a lemonScreamCryDo something energeticFocus on breathing


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Craving the feeling to self injure

ExerciseFake tattoosDraw on yourself with washable red felt penScribble on paperThink about not wanting more scarsPaint your nailsFlick rubber bands on your skinPut plasters or dressing pads onHot shower / bathCold shower / bathKnitting (or if you feel too young for that try Skoobi strings)Paint, draw, create somethingRip paperPop bubble wrapPlay with plasticine or play dohPop balloonsBlow bubblesThrow socks at the wallDeface the good looking people in magazinesColour a picture

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Craving the feeling to self-injureExerciseFake tattoosDraw on yourself with washable red felt penScribble on paperPaint your nailsFlick rubber bands on your skinPut plasters or dressing pads onHot shower/bathCold shower/bathKnitting (or if you feel too young for that try Loom bands)Paint, draw, create somethingRip paperPop bubble wrapPlay with plasticine or play dohPop balloonsBlow bubblesThrow socks at the wallDeface the good looking people in magazinesColour a picture


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Find some support As you have seen if you read Sarah’s introduction page, getting the right help and support really can make a difference, and can help you to gain control of self injury. We recognise that sometimes asking for help can be difficult, particularly when it comes to something such as self injury, but the best starting point is to speak your GP, as they will be able to refer you to someone who is able to help you. If you find this difficult you could speak to someone you trust, and ask them to support you in talking to your GP.

Using the written exercisesN.B: You might find it useful to photocopy the written exercise pages on pages 26 to 27, and also the seeking medical attention forms on pages 28 to 29 before you write on them.

Recording the urge to self injure Recording the urge will help you to look back and see how you’ve coped, particularly if you manage to resist the urge. It will also help you and your care co-ordinator to identify issues you may need to deal with.

Recording self injuryRecording these things will help you to look back and decide whether it was worth it, it may also help you to manage to resist the urge under similar circumstances.


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Practical adviceIf you have tried everything that normally helps you to avoid self injuring, and have also tried our suggestions but feel unable to resist the urge to self injure; you may find the following pages helpful. Please look at the checklist below before you make your final decision.

Have you…..?c Identified why you want to self injurec Completed the written exercise from page 26c Tried your top 5 alternatives for 10 minutes eachc Talked to someone about how you feel e.g. friend, relative, healthcare professional, helpline, crisis team, etc?

If you have tried all of the above strategies but feel unable to resist the urge to self injure, please use the information on the following pages to help you to stay as safe as possible.

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First Aid Advice

The first key thing for people who self injure is to keep a well stockedfirst aid kit. The contents of your kit may vary depending on how youinjure. Below you will find a list of essential basic items, and lists ofitem for specific injuries.

EssentialsAntiseptic wipes/spray/wound washDressing pads (adhesive and non-adhesive)Micropore tapeScissorsCotton woolPlastersExtras for cutsBandagesAntiseptic CreamKitchen RollSteristrips (If you can’t get hold of these you can make them by cutting strips of micropore tape)Blood stopping spray (Don’t expect too much from this, it’s not brilliant)

Extras for burns/scaldsBandagesCling filmExtras to help with scarsAloe vera spray / cream / moisturiserVitamin E Oil / spray / cream / moisturiserBio oilScar reduction patches.

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Essential first aid kitIt is good practice for everyone to have a well-supplied first aid kit. These are items you may find helpful to have in the house.

EssentialsAntiseptic wipes/spray/wound washDressing pads (adhesive and non-adhesive)Micropore tapeScissorsClean gauzePlastersAlcohol free wipes

Extras for cutsBandagesAntiseptic CreamKitchen RollSteristrips (If you can’t get hold of these you can make them by cutting strips of micropore tape)

Extras for burns/scaldsBandagesCling filmExtras to help with scarsAloe vera spray/cream/moisturiserVitamin E Oil/spray/cream/moisturiserBio oilScar reduction patches (use as directed).


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First aid advice

Scars are the permanent reminder of self injury. Whether you need to see your scars or you hate them, they will always be there.

The following first aid advice will not only help to prevent infection, but will also help to prevent scars being larger or more visible than necessary.

Note: Lancashire Care NHS Foundation Trust acknowledges that a purely “preventative” approach may not be in the best interests of each person; however for the purposes of this booklet, the Trust should not be viewed as encouraging self injury. Decisions to self injure rest with the individual.

For cuts and grazes

Before you injure:

• Cleantheareayouintendtoinjurewith antiseptic BEFORE you do anything. • Makesurethatwhateverimplementyou’reusingtoinjureyourself with is clean, not rusty and if possible clean it with antiseptic.• Makesureyouhaveallthefirstaidequipmentyouarelikely to need within reach, including something you can press on to a wound to prevent excess blood loss.• Haveaphonewithinreachincasethingsgowrong. After injuring:

Using a dressing pad, clean cloth or several sheets of kitchen roll, apply direct pressure to the wound for at least ten minutes, and raise the wound above the heart if possible.

If the wound continues to bleed profusely seek medical attention immediately.

Before using steristrips or putting a dressing pad on, you should ensure that you clean the wound and the area around it under running water or with alcohol free wipes.


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If the edges of the wound are more than a few millimetres apart you may need to use steristrips in order to make sure the edges can knit together whilst healing.

To do this, stick one end of the steristrip underneath the wound. Hold the edges of the wound together and pull the steristrip towards the area above the wound. Stick down so that at the point where the steristrip is, the edges of the wound are held together. Repeat this all the way along the wound, leaving a space about the same width of the steristrip between each steristrip so that the edges of the wound are completely together and form a straight line.

If you cannot manage to get the edges of the wound to stay together using steristrips you probably need stitches and should seek medical attention.

Once you have either used steristrips or are sure that the wound will be able to knit together, cover the wound with a clean, dry dressing. You should change the dressing every 2 to 3 days and check that there are no signs of infection e.g. swelling, redness, more pain than you expect, discomfort, discharge, a foul smell or a change in colour of the surrounding skin.

If you have used steristrips you should leave them on for at least a week. They should fall off in time when the wound has healed.

If the edges of the wound are more than a few millimetres apart you may need to use steristrips in order to make sure the edges can knit together whilst healing.

To do this, stick one end of the steristrip underneath the wound, hold the edges of the wound together, pull the steristrip towards the area above the wound and stick down so that at the point where the steristrip is, the edges of the wound are held together. Repeat this all the way along the wound, leaving a space about the same width of the steristrip between each steristrip so that the edges of the wound are completely together and form a straight line.

If you cannot manage to get the edges of the wound to stay together using steristrips you probably need stitches and should seek medical attention.

Once you have either used steristrips or are sure that the wound will be able to knit together, cover the wound with a clean, dry dressing. You should change the dressing every 2 to 3 days and check that there are no signs of infection e.g. swelling, redness, more pain than you expect, discomfort, discharge, a foul smell or a change in colour of the surrounding skin.

If you have used steristrips you should leave them on for at least a week. They should fall off in time when the wound has healed.

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Self help for self injury Self help for self injury

For burns and scalds

If you have burnt or scalded yourself you should hold the effected area under cold running water for at least 10 minutes. If after this time the area has blistered or is bigger than two fifty pence pieces, you will need to seek medical attention. Advice on what to do next tends to vary, but based on personal experience, the best thing to do is to take a piece of cling film large enough to completely cover the area plus around an inch all around it, place it on the area and make sure the cling film is sealed to your skin all the way round with micropore tape. To protect the cling film from letting any air in, put a dressing or bandage over the cling film. If you leave the cling film on for five days it will ease any pain from the burn and will also prevent any blisters forming.

Once you have taken the cling film off, check for infection (e.g. swelling, redness, more pain than you expect, discomfort, discharge, a foul smell or a change in colour of the surrounding skin) then cover the area with a dry dressing and check on it every 2-3 days.

For overdoses and poisoning

As this very much depends on what medication or substance you have taken, the only advice we can give for overdoses or poisoning is to seek medical attention immediately.

After any form of self injury

After you have injured, look after yourself. You and your body have been through an ordeal.

Do something good for yourself, but above all, put your feet up and relax, not just because you deserve to relax, but also your body may go into shock, so raising your feet will help to combat this.

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For burns and scaldsIf you have burnt or scalded yourself you should remove jewellery and clothing from around the area, unless it is stuck to the burn, then hold the affected area under cold running water for at least 10 minutes. If after this time the area has blistered or is bigger than two fifty pence pieces, or if anything is stuck to the burn e.g. clothing, you will need to seek medical attention.

Advice on what to do next tends to vary, but based on the author’s personal experience, the best thing to do is to take a piece of cling film large enough to completely cover the area plus around an inch all around it, place it on the area and make sure the cling film is sealed to your skin all the way round with micropore tape. To protect the cling film from letting any air in, put a dressing or bandage over the cling film. If you leave the cling film on for five days it will ease any pain from the burn and will also prevent any blisters forming. Once you have taken the cling film off, check for infection (e.g. swelling, redness, more pain than you expect, discomfort, discharge, a foul smell or a change in colour of the surrounding skin) then cover the area with a dry dressing and check on it every 2-3 days.

For overdoses and poisoningAs this very much depends on your metabolism and what medication or substance you have taken, the only advice the authors can give for overdoses or poisoning is to seek medical attention immediately, regardless of how big or small the overdose.

After any form of self injuryAfter you’ve injured it’s important to remember that you and your body have been through an ordeal. You may be in shock so it may be advisable to sit, raise your feet and assess if you are able to physically and emotionally manage your injury yourself or need to seek advice from a professional.

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Scar reduction

As we said earlier scars are the permanent reminder of self injury. You can reduce the severity of scarring right from the start. If you have a cut or a burn and you follow the first aid advice you can take the first step towards minimising the scar.

After this it is important to watch out for infection and to resist the urge to pick at any injury.

We have suggested some items for a first aid kit which can help to reduce scarring. It is possible to use aloe vera on a wound before it has completely healed, however this can be painful. Moisturisers, creams and sprays containing Aloe Vera or Vitamin E can be used on scars and can reduce the redness of a scar if used over a period of time. There are also other items on the market such as bio oil and scar reduction patches which should be used as directed. All of the above items can be found at most chemists, and many of the items can be found at the major supermarkets.

Ask for advice

If you have followed all of the first aid advice but are still unsure about something, seek advice. You can always go to your GP, practice nurse, A&E, a Minor Injuries unit, an NHS walk in Centre, call NHS Direct (number shown on page 22), or even ask your CPN (if you have one).

19

Scar reduction



We have suggested some items for a first aid kit which can help to reduce scarring. It is possible to use aloe vera on a wound before it has completely healed, however this can be painful. Moisturisers, creams and sprays containing Aloe Vera or Vitamin E can be used on scars and can reduce the redness of a scar if used over a period of time. There are also other items on the market such as bio oil and scar reduction patches which should be used as directed. All of the above items can be found at most chemists, and many of the items can be found at the major supermarkets.

Ask for advice

If you have followed all of the first aid advice but are still unsure about something, seek advice. You can always go to your GP, practice nurse, A&E, a Minor Injuries unit, an NHS walk in Centre, call NHS Direct (number shown on page 22), or even ask your CPN (if you have one).

19

Scar reduction



We have suggested some items for a first aid kit which can help to reduce scarring. It is possible to use aloe vera on a wound before it has completely healed, however this can be painful. Moisturisers, creams and sprays containing Aloe Vera or Vitamin E can be used on scars and can reduce the redness of a scar if used over a period of time.

There are also other items on the market such as Bio Oil and scar reduction patches which should be used as directed. All of the above items can be found at most chemists, and many of the items can be found at the major supermarkets.

Ask for advice

If you have followed all of the first aid advice but are still unsure about something, seek advice. You can always go to your GP, Practice Nurse, A&E, a minor Injuries unit, an NHS walk in Centre, call NHS 111, or ask your mental healthcare professional (if you have one).


25


Other sources of support

Self injury organisations and resources

All of the following websites offer support and information to people who self-injure and other people interested in knowing more about self injury.

Lifesigns www.lifesigns.org.uk

The Basement Project www.basementproject.co.uk

Young people and self harmwww.thesite.org/selfharm and www.selfharm.co.uk

The National Institute for Health and Care Excellence (NICE) have clinical guidelines and user-friendly versions of these for service users and carers:

www.nice.org.uk/cg16 and www.nice.org.uk/133

Plus a quality standard on what people can expect from services: http://www.nice.org.uk/guidance/QS34/InformationForPublic

Helplines

Lancashire Care Mental Health Helpline. FREEPHONE (from landlines) 0500 639000. Mon to Fri 7pm – 11pm and at weekends from 12 midday to midnight. www.lancs-mentalhealthhelpline.nhs.uk

Mind – 0300 123 3393 (local rate call cost) www.mind.org.uk

Rethink – 0300 5000 927 (local rate call cost) www.rethink.org

Samaritans - 08457 909090. Open 24 hours a day (local rate call cost) www.samaritans.org

Saneline – 0845 7678000. www.sane.org.uk

NHS Direct: NHS 111 (FREEPHONE) www.nhsdirect.nhs.uk

26

Recording the urge to self injure

Why do you want to self injure? Has something triggered the urge to injure yourself?

What state of mind are you in? (use the list on page 14

Is there another way of dealing with the way you feel?

What alternatives have you tried?

How will you feel after you injure yourself?

Do you still feel the urge to self injure?

If you answered YES to the last question, please make sure that you have read the advice on page 19

If you answered NO to the last question, make sure you give yourself some credit for resisting the urge


27


Why did you want to injure yourself?

How did you injure yourself?

Did you follow the first aid advice?

How did you feel whilst injuring?

How do you feel now?

Did injuring yourself help?


28


SH information sheet

Basic Information

Name:

Address:

Phone Number:

Date of Birth:

Next of kin:

Name:

Phone Number:

GP:

Name:

Address:

Have you attended here before?

Medication/s:

Allergies:

Are your vaccinations up to date?

Have you had any alcohol or drugs?

24

29


Injury Information

I have (tick appropriate):

Cut myself with

Burnt myself with

Taken an overdose of

I took tablets

Approximately minutes ago

Swallowed

Amount

Approximately minutes ago

Tried to break my

Mental Health Contact Information

Delete the following as appropriate:

I am / am not in contact with mental health services

I have / have not brought my care plan with me

My Care co-ordinator is:

Phone number:

25

30

Notes Notes

31

Notes Notes

32

Other sources of information:The Mental Health Helpline provides an information and listening service for people in Lancashire. It is available between 7.00pm and 11.00pm Mondays to Fridays and from 12.00 noon until 12.00 midnight on Saturdays and Sundays. Freephone 0500 639000.

The Patient Advice and Liaison Service provides advice and information. Please contact East Lancashire PALS on:

01282 474178 or 07507 857345

If you have problems reading the print we can provide this leaflet in large print, audio book or Braille.

Leaflet number: XXX XXX/XXXX Name of Leaflet: Seeing a Clinical Psychologist in Blackburn with Darwen Date produced: February 2009 Review date: February 2011

© Lancashire Care NHS Foundation Trust 2009-02-18. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner.

Copies of this leaflet are available from:-Lancashire Care NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Bamber Bridge, Preston, PR5 6AW. Tel: 01772 695300e-mail: [email protected]

Data Protection The Trust will endeavour to ensure that your information remains secure and confidential at all times. The Data Protection Act 1998 explains how personal information should be processed and this applies to all information whether held on paper or electronically on computer systems. We must ensure that all personal information is processed fairly, lawfully and as transparently as possible so you: • Understand reasons for us processing your

personal information • Give your consent for the disclosure and use of

information where necessary • Gain Trust in the way we handle your

information• Understand your rights regarding the right to

request access about the information we hold about you.

The Caldicott Guardian, who is a senior health clinician, has the role to ensure we meet the highest standards for handling personal information at the Trust. For further information regarding data protection, please read our leaflet called “Protecting Your Data - How we use your health records” or visit the Information Governance pages on the Trust website.

Other sources of information:

© Lancashire Care NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner. Data ProtectionLancashire Care NHS Foundation Trust adheres to The Data Protection Act 1998. The Trust will endeavour to ensure that your information remains secure and confidential at all times. For further information regarding data protection please visit the Trust’s website or ask a member of staff for a copy of our leaflet entitled “Sharing Information With Us”.

Copies of this leaflet are available from:

Lancashire Care NHS Foundation Trust,

Sceptre Point, Sceptre Way,

Walton Summit, Preston PR5 6AW

Tel: 01772 695300

Email: [email protected]

Website: www.lancashirecare.nhs.uk

The Mental Health HelplineThis provides an information and listening service for

people in Lancashire. It is available between 7:00pm

and 11:00pm Mondays to Fridays and from 12:00

noon until 12:00 midnight on Saturdays and Sundays.

Freephone 0500 639000.

Customer Care

If you wish to pay a compliment about the Trust’s

services, make a comment, raise a concern or complaint,

please contact the Customer Care Department on

01772 695315, freephone 0808 144 1010 or

email [email protected]

Leaflet Code:Date Produced: Review Date: Name of Leaflet:011/20132nd Edition

April 2013 June 2019 Self-Help for Self-Injury

If you have problems

reading the print we can provide this

leaflet in large print, audio

book or Braille.W przypadku jakichkolwiek problemow z odczytaniem tekstu z przyjamnoscia dstarczymy Panstwu ulotke z duzym drukiem,

tasme do odluchu lub tekst w jezyku Braille.

For useful contact information please see page 25

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