Electronic Letters to:
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eLetters: Electronic letters published:
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Self Harm Rules - OK?
- Joss Bray (18 January 2009)
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Boundaries and Containment
- Dr Alexis Bowers (18 January 2009)
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Joss Bray, Substance Misuse Specialist The Huntercombe Centre, Sunderland
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jossbray{at}aol.com Joss Bray
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I was very interested to read the paper by Anthony Livesey in the current Psychiatric Bulletin. I am the chief medical officer in a residential unit where we have been treating people who have drug and alcohol problems for over ten years. These are people that cannot be successfully managed in the community. As you might expect therefore, many have comorbid psychiatric problems including personality disorders and psychotic illnesses as well as all too common depression and anxiety. A significant number have self harmed in the past - some very recently prior to admission. The rule in the unit is that any self harm whilst in treatment will result in discharge and this is explained before admission. People are encouraged to seek out staff if they feel they are going to self harm and talk it through with them. There is 24 hour nursing and support worker presence in the unit. We have seen virtually no self harm in over ten years - maybe one or two incidents out of at least 1500 episodes of care lasting from 1 to 6 weeks. It is very interesting that behaviour can be modified even under the stress of a drug or alcohol detoxification, in people with significant premorbid psychiatric problems and previous self harm, to minimise the risk of self harm by stating a clear rule and providing an alternative to this behaviour. I totally agree with the author that this is worth looking at in other settings too and not just inpatient ones either. Dr Joss Bray |
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Dr Alexis Bowers, Specialist Registrar CNWL NHS Foundation Trust
Send letter to journal:
dralexisbowers{at}hotmail.com Dr Alexis Bowers
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Can I congratulate Dr Livesey and his team at Oakwood for demonstrating a remarkable improvement in their service user's adaptive coping resources (Livesey, 2009). What Dr Livesey demonstrates is a resource and process that is available to all acute in patient settings - psychoeducation, implemention of firm boundaries and containment of any maladaptive behaviour. In addition, Dr Livesey reports evidence of splitting within the team early on, however, supported the team through this change. Self harm is prevalent throughout our mental health services and requires a systemic approach at intervention. With strong and effective leadership, firm and consistent boundaries patients will feel more contained and less likely to act out in relation to psychosocial stress. Livesey, A (2009)Self-harm in adolescent in-patients Psychiatric Bulletin, 33, 10-12 |
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