TW: Contains references to Self Harm.
The greatest exposure I have had to the stigma around poor Mental Health is undoubtedly in A&E. I have lost count of the number of times I have presented at A&E after either cutting or overdosing. What people generally don’t understand about Self-Harm is that, to those of us who do it, the consequences of our actions do not matter. For me, it is a coping mechanism, a ‘release’, a way to externalise the pain of my internal suffering. I don’t do it for attention, or because I enjoy going to A&E.
So it would be good if A&E staff understood this and treated us with a bit more respect. In fairness, there are some compassionate nurses and doctors whom I have come to know and who care for me as they would someone who had broken a leg or bumped their head. But all too often I have to contend with a boredom that translates, to me, as ‘here we go again’ or an abruptness that says ‘I don’t have time to treat self-inflicted wounds’. Bearing in mind that the short-lived benefits of SH pass long before I ever reach hospital, this is an attitude I could do without having to face. By the time I reach A&E I feel: angry, frustrated, agitated, ashamed, low, anxious…and sitting waiting to be seen while everyone is taken before me, labelling me the very lowest priority, does nothing for my self-esteem. In my own mind, I feel like a nuisance, a fraud, a waste of Oxygen, so could do without this being reinforced by inconsiderate staff.
In my previous life, I worked for the NHS, managing budgets for different services. Ironically, Mental Health came under my remit and I recall vividly asking the MH manager: ‘what is A&E Liaison?’ and feeling moved and saddened by the answer. I now have lots of first hand experience of Psychiatric Liaison services. For those who don’t know, this is the team of MH professionals based in a hospital who come and see (among others) patients presenting at A&E with self-inflicted injuries. They usually assess your state of mind and determine whether you are ‘safe’ enough to go home. Strangely, I have been frustrated at being ‘sent home’ on more than one occasion. To feel so desperate that I would harm myself to the point of requiring medical attention and then to be deemed rational enough to return home with advice such as ‘call your CPN later today’ or ‘try out this relaxation CD’ seems wrong somehow. SH is a huge scream for help, like standing on a chair in the middle of a crowded room and shouting at the top of your lungs – WHY DOESN’T SOMEBODY DO SOMETHING?? But at least Psych Liaison ‘get’ SH and why people do it.
So what is the solution? Perhaps a designated member of A&E staff, trained to deal with SH patients? An outpatient area attached to a psychiatric ward, where people can drop in for minor medical attention and a chat? I realise this latter is rather ‘pie in the sky’ and, to be honest, it shouldn’t have to come to that. A&E should be able to deal with MH patients as easily as they do the physically sick. I am only one voice as they say and, at the end of the day, it always comes down to ‘funding’. However, with inside knowledge of NHS budgets and how some of the money is spent, you really have to wonder.