Emergency tools for dealing with self-harming patients

A pilot scheme aims to train emergency department staff to deal better with patients who have self-harmed

AS A crisis nurse in the emergency department of a big city hospital, Rose Lynch has first-hand experience of treating people who arrive at the facility following deliberate self-harm.

Between them, Lynch and the other crisis nurse at Cork University Hospital (CUH), Sylvia Quinlan, see all individuals after they come through the emergency department having attempted suicide or engaged in self-harm, from overdoses to attempted hangings, gunshot injuries to drownings.

Lynch, who has worked in the role since September 2001, says that sometimes such patients can feel ignored, dismissed and embarrassed in the emergency department.

“If there is a serious endeavour to kill themselves and they are left sitting there for an hour, they feel no one cares,” she says.

“Sometimes they say they feel dismissed or they have heard someone saying, ‘Here they are in again’.”

Consultant psychiatrist at CUH, Dr Eugene Cassidy, says that emergency department staff sometimes don’t find it easy to address the needs of patients who self-harm.

“My own experience of emergency department staff is [of] an extremely positive and compassionate group who work under tremendous pressures.

“Individuals who have presented following self-harm have specific needs, which are mental health needs, which the emergency department don’t always feel able to deal with.”

But it is hoped a new training programme, which targets all non-mental health emergency department staff, including doctors, nurses and care staff, will change that.

The pilot programme, which will run in a number of hospitals in Cork and Kerry, including CUH and the Mercy University Hospital, Cork and will be delivered by senior psychiatric nurses, aims to improve the skills, knowledge and confidence of staff in dealing with patients who have self-harmed or who are suicidal.

It is a joint project between the National Suicide Research Foundation (NSRF) and Cassidy, and is funded by the National Office for Suicide Prevention.

Lynch, one of the trainers, says one aspect of the programme involves providing staff with information on suicide and supplying them with a set of questions to help broach difficult subjects such as whether the patient feels suicidal or not.

“We’re encouraging the staff to talk to the patients about what they have done. If people open up and respond to empathy, they are more likely to engage,” she says.

“Sometimes it’s like the elephant in the room. No one talks about it. It’s important to see the human side,” says Lynch, who describes the incidence of self-harm as “huge”.

Over the past 12 months she has noticed an increase in the number of men who are cutting themselves.

“The cutting is much more violent than in women . . . a lot of anger is turned in on themselves.”