ࡱ> !( 39/ 00DTimes New Roman(0(z[ 0 DArialNew Roman(0(z[ 0 " DWingdingsRoman(0(z[ 0 0DTrebuchet MSan(0(z[ 0 "@ .  @n?" dd@  @@`` 8Hf       .) ! $% "#', .-**HH <AAf@8 M ʚ;/Yl8ʚ;g4MdMd@z[ 0^ppp@ <4!d!dl 0.<4ddddl 0.<4BdBdl 0.Tf0___PPT10 pp&___PPT9- -  ? %O  =_ Self-harm for clients and carers!!=Adam Bernard RMN Crisis Liaison Nurse Access & Crisis Service$> 12-Contents $XWhat is self-harm? How common is self-harm? Self-harm & suicide Why do people self-harm? YvdY \Self-harm myths Support & advice for people who self-harm Treatment for people who self-harm.]vd!MWhat is self-harm?$RSelf-harm Deliberate self-harm Intentional self-harm Parasuicide Attempted suicide"SdS5  ^Non fatal suicide behaviour Self inflicted violence Self poisoning Self-injury Self-mutilation$_dZ_ Some types of self-harm$zCutting skin Overdosing Burning or Scalding Picking, scratching, pinching or abrading skin Disrupting wound healing Biting${dZ{  Definition $  How common is self-harm?$ "Self-harm & suicide$  Self-harm v Suicide$  Self-harm v Mental Illness$  Why do people self-harm?$ 4.Why do people self-harm?$ Self-harm myths""$$   5Support & advice for clients who repeatedly self-harm66$K Give advice regarding self-management of superficial injuries. If there is significant scarring from previous self-injury, consider providing information about dealing with scar tissue Discuss the risks of repeat self-poisoning Discuss harm minimisation strategies (not if self-poisoning) Discuss alternative coping strategiesP?dPdPzdPdPidPdP&dP(K'"Alternatives to self-harm$Talking: talking face-to-face or on the telephone to a friend, counsellor, helpline etc. Often self-harmers need encouragement to try and talk about their feelings early, rather than waiting until they are overwhelmed. Writing: writing letters, poems, stories or simply odd words which express feelings and experiences. Art activities: drawing, painting, collage, clay, plasticine, photography, music, etc. The aim is self-expression rather than the production of a good piece of art. f^t j(#Alternatives to self-harm$|Exercise: Walking, running, swimming, weights, gym, hitting a punch bag, cycling, dance, etc. Exercise helps release pent up emotions, tension and energy and distracts the person from self-injury. Physical mean of expression: smashing, hitting or kicking something (safely) shouting, screaming, crying, moving one s body in an appropriate way. Relaxation: Warm bath, aromatherapy, yoga, relaxation tapes or gentle music, nurturing massage, etc.f x Z#"Treatment for people who self-harm##$ $  %Access & Crisis Service and self-harm&$24 hour Mental Health Support Line (0161 778 3701) Educating professionals, service users and carers A comprehensive psychosocial assessment of needs including the motivational factors specific to the act of self-harm A comprehensive assessment of risk including identification of the main clinical and demographic features known to be associated with risk of further self-harm and suicide.3 qd qd2 qd qdv qd qd qdG"8/Access & Crisis Service%Adam Bernard RMN Crisis Liaison Nurse2& /856@  ` f3f3` ff̙` ___` ff` 3ff3f>?" dd@,?lPd@   Z l<@ d`"  n?" dd@   @@``@n?" dd@  @@``PR    @ ` ` p>> @8 (  VF y  "yZ  S B7 C DEHFPv @?q 6 6 n(dx  G b q %(@"B y2   `G1?"  T䐠gֳgֳ ?"P  T Click to edit Master title style! !  Tgֳgֳ ?"``  >*  Tgֳgֳ ?"`   @*   T4gֳgֳ ?"`   @*$   0Т "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S`  Hd޽h? ? f3f3 Soaring  @ (   F t  "tZ   S BsC5 DEHFPv @?3 r4 rv$[I_l3HxF 3 %(@" "2   C CRENGCJRQ1? `TO`TR`TO`TRR`TRR"t  TNJgֳgֳ ?"/O J T Click to edit Master title style! !  THQJgֳgֳ ?"pp  J W#Click to edit Master subtitle style$ $  TXgֳgֳ ?"`` J >*  TlsJgֳgֳ ?"`  J @*  TvJgֳgֳ ?"`  J @*`  Hd޽h? ?  f3f3 0 zrp@ (  @ @ 0x$ P    P*   @ 0)     R*  d @ c $ ?   @ 0$  0  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S @ 6@0 _P   P*   @ 66 _   R*  H @ 0޽h ? 3380___PPT10.QP@ d8(  d d 0 Q P    >*  d 0TU     @*  d 6Z _P   >*  d 6l^ _   @* H d 0޽h ? 3380___PPT10.   0 p(  pr p S J M J r p S J   J  p <4J  HPennine Care NHS Trust p <J PWorld Mental Health Day 2006H p 0޽h ? f3f3y___PPT10Y+D=' = @B +u  x8(  8x 8 c $DJP  J x 8 c $J   J  8 c 0e0e  p 9   H 8 0޽h ? f3f3___PPT10u..I +D=' = @B +  w x(  xx x c $J  J   x S J @ <$  0 J   x S J  P  <$  0 J   x 0J ,$  0 w5Terminology Common terms used to describe self-harm: &6 *H x 0޽h ? f3f3___PPT10.+z.tD ' = @B D ' = @BA?%,( < +O%,( < +D ' =%(%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*x%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*xD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*xD#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* x%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* xD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<* xD#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* x%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* xD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<* x++0+ xJ ++0+ xJ ++0+xJ +I  P(  r  S ?      S  _ <$  0  H  0޽h ? f3f31)___PPT10 .+ED' = @B Dd' = @BA?%,( < +O%,( < +D' =%(%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<*+8+0+ +D  :2 (  ~  s *lX      0Z,$D 0 x.The National Institute for Clinical Excellence defines self-harm as:  self-poisoning or self-injury, irrespective of the apparent purpose of the act. .FRFRH  0޽h ? f3f3___PPT10+%xD6' = @B D' = @BA?%,( < +O%,( < +D(' =%(%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-6B+checkerboard(across)*<3<* +8+0+  +   (  ~  s *i     0kp ,$  0 0Each year up to 170,000 people attend A&E after having self-harmed. However, since many acts of self-harm do not come to the attention of healthcare services, hospital attendance rates do not reflect the true scale of the problem. About one in six people who attend A&E following self-harm will harm themselves again the following year. Between 0.5% and 1% of these people will die by suicide during the subsequent year. This accounts for about one-quarter of the 5,000 people who kill themselves in England.H  0޽h ? f3f3___PPT10+Y4ҧD.' = @B D' = @BA?%,( < +O%,( < +D ' =%(%(D' =%(DP' =A@BBB B0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-6B#strips(downLeft)*<3<* +8+0+  +   A9 (  ~  s *`     0ܔ: ,$  0 MSuicide is a major cause of death in the young, and the third largest cause of life lost. Nevertheless, this is a rare event and has multiple causes. The great majority of those who present at A&E having self-harmed will NOT go on to kill themselves, which makes it extremely difficult to identify those who are at risk of suicide.NNH  0޽h ? f3f3P H ___PPT10( +l D ' = @B D ' = @BA?%,( < +O%,( < +D' =%(%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* D' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<* D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* N%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* ND' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<* N+8+0+  +   =(  r  S P   &  0,$D 0 TThe difference between suicide and self-harm is the intent underlying the behaviour:"U lPU]  0Hpp\ ,$  0 People who attempt to commit suicide want to kill themselves, while those who self-harm seek relief from the tension that they are feeling."| PH  0޽h ? f3f3___PPT10t+qD' = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B+checkerboard(across)*<3<*D' =%(DR' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B%strips(downRight)*<3<*+p+0+J ++0+J +q  me (  r  S д`   K  0@@P ,$@  0 Self-harm is not an illness, but is a behaviour that should alert us to an underling problem, difficulty or disorder. Only a minority could be considered mentally ill. Nevertheless, the majority of self-harming patients attending A&E meet the criteria for a mental disorder, with the majority diagnosed as being depressed, however it is likely that these symptoms subside only days later.H  0޽h ? f3f3___PPT10+acD0' = @B D' = @BA?%,( < +O%,( < +D"' =%(%(D' =%(DR' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B%strips(downRight)*<3<*+8+0+ +  0n(  x  c $`śwG     0ƛ: ,$@  0 "Most people who self-harm have social problems, such as difficulties involving housing, employment, debts, illness and personal relationships. For some, especially those who have been abused as children, acts of self-harm occur seemingly out the persons control and can be their only way to communicate their distress. While others seek to destroy or damage their body in an attempt to make it less physically attractive. For some, the sight of blood flowing can seem like a cleansing process.H  0޽h ? f3f3___PPT10+hD0' = @B D' = @BA?%,( < +O%,( < +D"' =%(%(D' =%(DR' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B%strips(downRight)*<3<*+8+0+ +t   phPP(  Px P c $@כwG   H P 0؛ pZ ,$@  0 Traumatic or repeated experiences of neglect, separation, bereavement, harassment, or physical, emotional or sexual abuse can severely damage a persons concept of self. Self-harm is often the means of communicating this rage, frustration, distress or self hatred. It may also be a way of saying  I need help or coping. BBH P 0޽h ? f3f3___PPT10+hD0' = @B D' = @BA?%,( < +O%,( < +D"' =%(%(D' =%(DR' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*P%(D' =-6B%strips(downRight)*<3<*P+8+0+P +Q  ^ V  (  x  c $     0dYF,$D 0 The treatment of people who self-harm can be based on inaccurate stereotypes. The following responses are based on experiences of patients, taken from the National Self-harm Network. Nj   #"@,$@ 0   <?  aSelf-harm is a private activity. A&E only see a few injuries. Its not about its effect on others.bb @`  <?  ~. They re manipulative.  @`T  <|?   If attention was the motivation, its not an efficient way of getting it. There are many easier, less painful and less degrading ways of attracting it. @`  <?  2 It s attention seeking.  @`fB   6o ?`B   01 ?  fB   6o ?fB   6o ?`B  01 ?  fB  6o ?H  0޽h ? f3f3  ___PPT10s + DW ' = @B D ' = @BA?%,( < +O%,( < +DI ' =%(%(D' =%(D+' =4@BB BB%(D' =1:Bvisible*o3>+B#style.visibility<*N%(D' =-g6B fade*<3<*NDF ' =%(Ds' =4@BB2BB%()?D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?bCB#ppt_w+.3BCB#ppt_wB*Y3>B ppt_w<*D' =+4 8?\CB#ppt_hBCB#ppt_hB*Y3>B ppt_h<*D' =-g6B fade*<3<*Ds' =4@BB2BB%()?D' =1:Bvisible*o3>+B#style.visibility<*O%(D' =+4 8?bCB#ppt_w+.3BCB#ppt_wB*Y3>B ppt_w<*OD' =+4 8?\CB#ppt_hBCB#ppt_hB*Y3>B ppt_h<*OD' =-g6B fade*<3<*O+  -0(  l  0*&`J   p - #""@@@Zok,$D 0 % <(?P pa  $A long history of self-harm often results in being  a hopeless case and no attempt is made to offer support.nn @`L # <*?P a   Don t waste your time with her, we ve been treating her for years. EE @`  < 1?P Pp BPsychiatry has had little success in helping people who self-harm.CC @`H  <:?PP   If you won t see the psychiatrist, you can t want to get better. CC @`A  <K?P a p Each person has a different pain threshold; commonly the loss of sensation some people experience during injury returns soon after. @`"  <@U?a P  ^ Either they enjoy pain or they can t feel it. 00 @`   <|F?P pP MHow severe people think the wound is wont tell them how bad the person feels.NN @`   <g?P P R It s self-inflicted so its not serious. ** @`fB   6o ?p`B   01 ?PpPfB   6o ?pfB   6o ?`B  01 ?P P fB  6o ?pp`B  01 ?p`B $ 01 ?a pa   0l 0   ( 2H  0޽h ? f3f3___PPT10a+ DE' = @B D' = @BA?%,( < +O%,( < +D7' =%(%(D' =%(Dg' =4@BB7BB%(D' =1:Bvisible*o3>+B#style.visibility<*-%(D' =+4 8?fCB#ppt_w*0.70BCB#ppt_wB*Y3>B ppt_w<*-D' =+4 8?\CB#ppt_hBCB#ppt_hB*Y3>B ppt_h<*-D' =-g6B fade*<3<*-+) K0 (    c $@M /?<$@ 0     `tgֳgֳ ?   H  0޽h ? f3f3  ___PPT10 .+HDa ' = @B D ' = @BA?%,( < +O%,( < +DS ' =%(%(D ' =%(DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*@%(D' =-6B'blinds(horizontal)*<3<*@DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*A%(D' =-6B'blinds(horizontal)*<3<*ADG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B'blinds(horizontal)*<3<*DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*%%(D' =-6B'blinds(horizontal)*<3<*%DG' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*&L%(D' =-6B'blinds(horizontal)*<3<*&L+    (  x  c $     c $p P 0<$ 0    <쐪P LTaken from various sourcesH  0޽h ? f3f3___PPT10.+!lDQ' = @B D ' = @BA?%,( < +O%,( < +DC' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*A%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*B%(+8+0+ +  0 (   x   c $      c $  0 <$ 0     <짪P LTaken from various sourcesH   0޽h ? f3f3___PPT10++D>' = @B D' = @BA?%,( < +O%,( < +D0' =%(%(D ' =%(Dp' =A@BB*BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-g6B fade*<3<* D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* D' =+4 8?bCB#ppt_y+.1BCB#ppt_yB*Y3>B ppt_y<* Dp' =A@BB*BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* Y%(D' =-g6B fade*<3<* YD' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* YD' =+4 8?bCB#ppt_y+.1BCB#ppt_yB*Y3>B ppt_y<* YDp' =A@BB*BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* Z%(D' =-g6B fade*<3<* ZD' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<* ZD' =+4 8?bCB#ppt_y+.1BCB#ppt_yB*Y3>B ppt_y<* Z+8+0+  +K  @(     `dgֳgֳ ?t     0(zIo,$D 0 People who self-harm are no more similar as a group than people with a cough. Coughs have numerous possible causes including smoking, common cold, tuberculosis and lung cancer. The same variability applies to self-harm. Precisely why a person self-harms at a particular point in their life will be unique, even if someone self-harms frequently. This creates a difficulty for choosing and reviewing the best care for people who self-harm.40lPZ  <ȪS G8Y ,$@  0 |FThe main interventions offered to people who have self-harmed include:GG_  00ʪ ',$ 0  Psychological interventions (talking therapies) Pharmacological interventions (medication) Social and service-level interventions (practical support) H  0޽h ? f3f3k c ___PPT10C +;D ' = @B D ' = @BA?%,( < +O%,( < +D' =%(%(D' =%(DK' =4@BBB B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B+checkerboard(across)*<3<*D' =%(D' =%(D7' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*)%(D' =-s6Bwipe(down)*<3<*)D7' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*)G%(D' =-s6Bwipe(down)*<3<*)GD' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*+8+0+ + K0 P g(  ?  6KW] ,$@  0 %Psychological interventions (talking therapies) Psychological therapies are often aimed at improving social functioning, as well as reducing self-harming behaviour. Pharmacological interventions (medication) The use of medication for people who self-harm is derived from the link between mental ill heath and self-harm. Social and service-level interventions (practical support) This support aims to improve contact and engagement with services, because adherence to outpatient treatment programmes after an episode of self-harm is generally poor.d&0v+q;  < AlZr` |FThe main interventions offered to people who have self-harmed include:GGH  0޽h ? f3f3|t___PPT10T.+=jD,' = @B D' = @BA?%,( < +O%,( < +D' =%(%(D ' =%(D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =-m6Bbox(in)*<3<*0D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*0%(D' =-m6Bbox(in)*<3<*0D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-m6Bbox(in)*<3<*D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*A%(D' =-m6Bbox(in)*<3<*AD1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*B}%(D' =-m6Bbox(in)*<3<*B}D1' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*}&%(D' =-m6Bbox(in)*<3<*}&+   PH(    c $BJ r <$ 0 J    `0Jgֳgֳ ?  J @  0 dtk,$ 0 TFollowing these assessments, the decision about referrals for interventions are made<U8qPTffH  0޽h ? f3f3___PPT10.+a6?DF' = @B D' = @BA?%,( < +O%,( < +D(' =%(%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B+checkerboard(across)*<3<*D' =%(D' =%(DX' =A@BBB B0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-6B+checkerboard(across)*<3<*+p+0+ ++0+ +S zr ` (  `x ` c $   x ` c $ CT    ` < T0  HPennine Care NHS Trust/ ` BW5 T iAccess & Crisis Service Roch House, First Floor Fairfield General Hospital Rochdale Old Road Bury BL9 7TDjjN ` 6I  ATel: 0161 778 2462 Fax: 0161 778 2433 email: adam.bernard@nhs.netBB-  ` Tr5gֳgֳ ?Mt P X(Mental Health Support Line 0161 778 3701))$H ` 0޽h ? f3f3y___PPT10Y+D=' = @B +   0 @D(  DX D C @    D S D@ 0    H D 0޽h ? 3380___PPT10.Q. 0 `T((  T^ T S @    T c $ J@ 0    H T 0޽h ? 3380___PPT10.Qr0!@. 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(2 xfor clients and carers       .. f(2 wfor clients and carers       .-@"Trebuchet MS-. 2 { Adam Bernard    .. 2 z Adam Bernard    .-@"Trebuchet MS-.  2 RMN .-@"Trebuchet MS-. %2 Crisis Liaison Nurse  .-@"Trebuchet MS-. *2 Access & Crisis Service   .-@Times New Roman-. (2  Pennine Care NHS Trust     .. (2 Pennine Care NHS Trust     .-@Arial-. *2 World Mental Health Day       .. *2 World Mental Health Day       .-@Arial-.  2 2006 ..  2 2006 .-՜.+,0    On-screen Shown-sZEA Times New RomanArial Wingdings Trebuchet MSSoaring!Self-harm for clients and carers ContentsWhat is self-harm?Some types of self-harm DefinitionHow common is self-harm?Self-harm & suicideSelf-harm v SuicideSelf-harm v Mental IllnessWhy do people self-harm?Why do people self-harm?Self-harm myths Slide 136Support & advice for clients who repeatedly self-harmAlternatives to self-harmAlternatives to self-harm#Treatment for people who self-harm Slide 18&Access & Crisis Service and self-harmAccess & Crisis Service  Fonts UsedDesign Template Slide Titles_6EKingpinKingpin  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)Current UserSummaryInformation(H`PowerPoint Document(ZEDocumentSummaryInformation8Root EntrydO)5B0Current User_SummaryInformation(H`PowerPoint Document(ZE-_6EAdam & Angela BernardAdam & Angela Bernard