The attitude of casualty staff towards self-harm

Every year in the UK, 150,000 people attend Accident and Emergency (A&E) having deliberately harmed themselves. These are vulnerable people, up to five per cent of whom, based on current rates, will have committed suicide within five to ten years. The staff at A&E are often the only professional contact these patients will have. Yet evidence suggests self-harm patients are unpopular among A&E staff, and in a recent survey self-harm patients rated medical personnel as providing the most unsatisfactory support.

Nadine Mackay and Christine Barrowclough investigated what factors might influence an A&E nurse or doctor’s willingness to help someone who has self-harmed. Eighty-nine A&E nurses and junior doctors working in the Manchester region responded by questionnaire to short accounts about fictitious self-harm patients.

Overall, where self-harming followed an event the A&E staff deemed controllable (e.g. financial problems), they subsequently reported feeling less sympathetic and less willing to help, compared with when it followed an uncontrollable event (e.g. bereavement). The staff also reported feeling less optimistic about patients who had attended A&E after self-harming for the sixth time, compared with patients attending for the first time, and this reduced optimism was associated with less willingness to help.

Doctors reported feeling more irritated by, and less willing to help self-harm patients than did nurses. They also felt less need than nurses for extra training. Male doctors and nurses were also less sympathetic and less willing to help than female staff.

Acknowledging the danger of extrapolating from responses to fictitious accounts, the researchers concluded that A&E staff could benefit from extra training in the management of self-harm patients. “This might be aimed at encouraging staff to examine and challenge their beliefs about the causes of deliberate self-harm and the value of support and treatment that can be provided”, they said.
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Mackay, N., Barrowclough, C. (2005). Accident and emergency staff’s perceptions of deliberate self-harm: attributions, emotions and willingness to help. British Journal of Clinical Psychology, 44, 255-267.

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