ERs Can Push Self-Harming Kids into Shame Cycle

New research from the U.K. suggests that young people who self-harm often shun care due to prior experiences in the ER where they received punitive treatment from staff. These experiences, in turn, perpetuate a cycle of shame, avoidance, and further self-harm.

The University of Exeter study discovered young people only seek emergency hospital care as a last resort due to a deep sense of shame and unworthiness.

The research, published in the British Journal of Psychiatry shows that young people who self-harm avoid Urgent Care and Emergency departments wherever possible.

Dr. Christabel Owens, senior research fellow at the University of Exeter Medical School, and her co-authors Lorraine Hansford, Professor Tamsin Ford, and Dr. Siobhan Sharkey, found that young people who self-harm visit ERs only when their injuries are too serious to manage at home or when they develop complications.

The researchers analyzed the perceptions of ER treatment in 31 young people between the ages of 16 and 25 who engage in self-harm. Investigators examined views on what constitutes a “positive clinical encounter” using data from an online discussion forum.

Findings showed that, when forced to seek medical help, the self-abusers did so with feelings of shame and self-loathing. These intense negative emotions were reinforced when the young people received what they perceived as punitive and stigmatizing treatment from ER staff.

One young person described how, following a visit to ER, she felt like “going home and finishing the job” (i.e. making a more determined effort to kill herself). Another said that she “just wanted to get back home, hide under the duvet and die of shame.”

The young people described positive encounters as those in which they received “treatment as usual” or non-discriminatory care, delivered with kindness, which had the potential to challenge their negative self-evaluation rather than perpetuate it.

Said Owens, “Presentation at an emergency department is a key opportunity to engage with a young person who self-harms and sometimes to prevent suicide, and this opportunity is frequently being missed.”

The paper calls for further research into new models of care for the vulnerable group of young people. And it calls for compassionate care to be delivered to all care seekers.

Owens added: “It is easy for staff working in busy NHS ER departments to regard those who present with self-inflicted injuries as mere ‘time wasters’ and ‘attention seekers’. From the perspective of those who have self-harmed, however, nothing could be further from the truth.

“Unfortunately, there seems to be a persistent belief among staff who work in the ER that being too nice will encourage ‘difficult’ patients to keep returning and cause the system (and those who work in it) to collapse under the strain. Our research suggests the opposite, namely that compassionate care is good for everyone concerned.”

Source: University of Exeter