Let’s talk about self harm

By   /   May 12, 2014  /   2 Comments

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Fairfax published this excellent piece on self harm on Saturday, which triggered this blog, as it was fantastic to see some good research from NZ on the topic.

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3 years ago, during the 2011 election campaign, I wrote a blog about self harm, and our mental health system’s struggle to deal with the issue effectively with empathy, understanding and respect. I was pretty mad, you can tell – and for good reason. I was very much over seeing struggling people cast aside by the system and labelled uncurable and an inconvenient troublesome patient they wished would disappear. And my compassion and empathy towards this topic hasn’t faded, in fact it has grown.

Fairfax published this excellent piece on self harm on Saturday, which triggered this blog, as it was fantastic to see some good research from NZ on the topic.

Self harm is an umbrella term for physically-destructive behaviours born out of inner trauma and turmoil. The highest incidence is in teenage girls, however males and adults also self harm. Many self-harmers are survivors of abuse and violence – and I don’t just mean overt – I also mean more covert abuse such as emotional abuse, toxic family dynamics and bullying. It is their way of physically expressing and easing emotional pain too frightening and/or overwhelming to express with words.

A disclaimer: I haven’t struggled with self harm, but I have had a lifelong battle with PTSD and depression. And as a friend, activist & support person I have a high level of interaction with survivors of abuse and violence – many of whom struggle with self harm. So I admit that my view on the situation is painted by lots of anecdotal evidence. However I also closely follow mental health & psychology developments in NZ and worldwide, and progress on effectively treating self harm is ramping up overseas, but is still very slow here.

Every person struggling with self harm I have met in NZ has had issues being taken seriously by mental health services, and accessing treatment that works. For them, going to hospital for self harm issues guaranteed crisis treatment, then a hasty ‘diagnosis’ of borderline personality disorder (BPD), followed by being denied ongoing help – because personality disorders aren’t the same as a ‘real’ mental illness (the common view expressed is: Personality disorder = your fault, Mental illness = chemical imbalance + fixable). There was no organised treatment plan, no holistic approach, and no resources available to help (read: you’re incurable, you’re not mentally ill, you’re just screwed up, we’re done with your drama, go away).

I’m not sorry to say that is not good enough.

Which is why studies like Hermansson-Webb’s are so vital. 12.5% of teenage girls in NZ. That’s a big number. The vast majority of these girls will move on from this period and have normal, successful lives – and more will thrive with the right treatment. The prevalence of BPD in the community is still up for debate, but studies reflect a range of 1-6%. So clearly, the majority of self-harmers do not have BPD. It’s a time in their life where things are messy, this works for others, I’m going to try it – and with support, move on with better coping mechanisms. It often isn’t – and never needs to be – a forever sentence. There are now also effective treatments for BPD, so that chestnut being thrown at patients and their families isn’t valid either anymore.

It takes a lot of guts, parental & friend panic, and often life threatening events for someone who self harms to seek help. Which is why I struggle with psychiatry’s frustration in treating patients who self harm. It is difficult. It is frustrating. There definitely are 2 steps forward and 3 back and so forth on the journey. But that is no excuse to not provide effective treatment and support. Because not doing so often doesn’t end well. Research indicates that between 55% and 85% of those who self-injure will attempt suicide at least once. And real or perceived rejection by mental health professionals while seeking help is often a trigger for suicide attempts.

There is hope if you or someone you love is experiencing issues with self harm or suicidal ideation (A nagging desire to commit suicide, seeing suicide as the only way out). You should not be condemned to a life of self destructive behaviour and an incurable personality ‘defect’. A form of cognitive therapy called dialectic behavioural therapy (DBT) is showing fantastic results worldwide in treating people with self harm issues. It’s been around for a while now, but it isn’t available in all areas of NZ, with the most resources located in the Auckland region. However Googling dialectic behavioural therapy with Invercargill pulls up nothing helpful. What NZ needs is trained and competent DBT (and other proven, effective therapies for self harm) practitioners available in all of our communities, so no matter where you are, you can access the right help – both from mental health services and accredited counselling/psychotherapy practitioners.

The Green Party’s long-standing youth policy promises that we will make young people’s mental health services an urgent priority. That includes specialist services for youth struggling with self harm issues, which this study shows is rampant among our vulnerable teenagers.

With such a huge risk for suicide, providing the right help to people struggling with self harm should make a valuable contribution to not only improving people’s lives, but to stop people from ending their lives too.

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About the author

Rachael Goldsmith (B.App.Med.Arts – Journalism, Nat.Dip – Human Resources, Nat.Cert – Social Services) is a writer & social justice activist from Invercargill, Southland.

2 Comments

  1. Marc says:

    Self harm or suicide is a sensitive area to write about and discuss. Often those that do tend to self harm also have mental health issues.

    Yes, re mental health too many GPs and psychiatrists tend to believe in the “chemical solution”, prescribing pills to do the “re-balancing” and “moderating” of moods and thoughts.

    Psychologists are often offering better solutions, but since it costs so much to get counselling or group therapy with a professional psychologist, there is only so much in the way of services available. There is of course wider use of ordinary counselors. They usually charge fees. Especially those on WINZ benefits may struggle getting enough funding for such treatment, as I learned that they often only pay half or so of the actual costs.

    DBT has worked well with some persons, and others recommend CBT (cognitive behavioural therapy). These approaches work for some, but not for everyone, and it can be time consuming and a bit difficult to find the right treatment for an individual.

    There have been some improvement in mental health services, but not everywhere, and not across the board. Also is it important to get a good client and treatment provider mix, as we are dealing with often complex personalities.

    I have so far been wondering, what the government is actually providing in the way of treatment for those with illness and disability on WiNZ benefits. My impression is they are now trying to move more into work, but they try to “solve” issues by having GPs prescribe more drugs, rather than look at other forms of treatment.

    Expecting sick and disabled to prepare for and try work, without sufficient treatment options and support options to manage their conditions, that seems unreasonable to me. So I remain concerned about what is going on in regards to “work ability assessments”, that they are now conducting. There is a lack of mental health focus, as the new contractors WINZ are using mainly seem to focus on those with physical barriers.

    Also is there a “blurring” going on, what mental health issues clients may suffer from, how seriously they should be taken, and how there may be a risk to simply write too many off as “common mental health problems”. Perhaps read the following re that:

    ‘WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME – PARTLY FOLLOWING ACC’s APPROACH: A REVEALING FACT STUDY’

    http://accforum.org/forums/index.php?/topic/16092-work-ability-assessments-done-for-work-and-income-%E2%80%93-partly-following-acc%E2%80%99s-approach-a-revealing-fact-study/

    As for hoped for improvements in mental health treatment and support, I wonder what the “great” budget will offer for those affected. We will know more on Thursday, I presume. I fear we will once again be disappointed.

  2. Whutu says:

    I am a dissenter on therapy. I expect it does have its uses. I am as a middle aged, middle class white male. I still have episodes of self harm. My suicidal tendencies are mild, but I have them.

    The most important thing for me, and for others like me I see in my community, is material stability and work. Especially work.

    I think this is an area the state can be very effective in and it has proven results for mental health. It also has positive benefits for the rest of the community. I know that the more people who are working the people will be able to find work, and creating the material wealth and stability we need will take a lot of work.

    Too often therapy makes things worse. Those of us with trauma in our lives, some at least and me certainly WANT TO FORGET!!!

    Keep me busy. Give me something useful to do. Let me live in a warm house that does not leak.

    Up until I was thirty I was constantly bullied. People do not often think of grownups being bullied, but I was.

    I was bullied at school by my peers, I was bullied by my teachers. When I started to become a young adult I was bullied mercilessly by the police. (TO this day I *hate* the fucking pigs! I am so lucky I am white)
    At university I was bullied again by my peers. (The staff at the university were almost universally fantastic, one exception I can think of and he was unwell himself). I feel in love at 19 and was bullied by her for seven years. On and in it went.

    I do not get bullied any more, I am too tough, too old, too white too middle class.

    But thinking about that list what could the state have done? It could have dealt better with the bulling at my school. It could have fired about 1/3 of the teaching profession of the 1960s and 1970s (a bunch of cunts!) It could have stopped the police from bullying young men. It could have legalised cannabis, which over the years has been a great help and benefit to me. It could have not allowed unemployment to develop like it did in the 1970s and 1990s when I really needed a job – and I hated myself for not getting one.

    Reform of the police is essential. I think we need lay police officers. I believe in the draft for the police, every body should have to spend some time in a community other than the one they come from keeping the peace and helping/protecting the weak and vulnerable. That is what the police should be for. We do need a professional police force but our purely professional police force uses young men for career advancement. Provokes them into crime then arrests them. I know it is even worse for young men who are not maori.

    And now we have legalised prostitution, sodomy and gay marriage (good, good and good) it is time we legalised cannabis. It really helped me.

    I tried counseling, and for me it was a waste of time for all concerned. Social work is more important. Work and housing. The material things. That is what the state can do.

    I have nothing to contribute about the fate of young women, I was never one. I think counseling helped my daughter (she shared some of my life, and got it worse than me) but really you would have to ask her.

    So to finish I appreciate where this blog comes from and it is good to air these issues, but I want to see the state put its resources where it will do the most good. We should recognise the harm that our failure based hierarchical system is doing and we should stop it. We should manage the economy so that resources are fairly shared and manage the power structures so they work to help not to expand themselves. Then, perhaps, we can see where we stand re mental health. I expect the problems will be much less, and the job of therapists would be clearer (a therapist is not a social worker and cannot do that job even if that is what their client really needs)

    peace