In this frank and open post, Dr Pooky Knightsmith talks about self-harm and shares her own experiences, both good and bad, of responses from health professionals.
This post was originally shared on Pooky’s blog, here
Whilst it’s beyond horrible going through what I’m going through at the moment, I am learning a huge amount that will inform and motivate my work when I am better. Today I have been learning, first hand, about the stigma that surrounds self-harm. I have one very negative and one very positive story to tell.
I had an appointment with my psychologist yesterday, and he was concerned about my self-harm. Things have spiraled this week and he was concerned by the extent of some of my injuries. He felt they needed suturing and asked that I seek medical advice. I was not keen, but agreed to go.
I attended a local walk-in clinic today. The experience was not good. On arrival, I was asked, in front of a busy room full of people, my reason for attending. I spoke quietly and was made to speak up and repeat myself more than once. The receptionist was harsh and cold, compounding every fear I had had before turning up that I may be met with stigma by health professionals (I hear stories of such stigma often in my work with young people). I sat, on the verge of panic, for 45 minutes before it became too much and I decided to go elsewhere. The receptionist questioned me loudly again as I left about why I was there, and when I asked for advice about a better time to return she was unhelpful and cold.
Unsurprisingly, the whole situation left me very, very upset, angry and ashamed; the urge to self-harm was still incredibly strong. Thankfully, my husband (Tom) supported me through it. He suggested we go elsewhere as he knew I wanted to keep my promise to my psychologist, so I went to the GP surgery and was able to book an emergency appointment.
This experience was 100% different. The receptionist was kind and understanding. She dealt with my request matter-of-factly but also swiftly, sympathetically and quietly. She remembered me when I returned an hour later for my appointment looking worried and shaky, and she checked me in and pointed me to the waiting area (you usually check yourself in).
Already things were better. The receptionist told me exactly how long I’d be waiting, which wasn’t long. The GP was hugely understanding; she remembered me from the week before and asked after my grandfather, whose appointment she’d remembered me from. She recalled that he had just moved in with me and I was leading on his care, and she suggested a need for me to care for myself first. She looked at my injuries and discussed them with me without judgement, only with care. She explained which ones should have had sutures, but also told me that it was too late. She told me what to do differently next time so as to access the care that my wounds needed, and reminded me (as my psychologist had) that, whilst I felt I deserved to scar and was not motivated to aid healing now, I needed to accept that this might change and a little more care with any future wounds would leave me with more options.
She also noted that I was shaky, and that this was because she thought I was developing an infection in some of my wounds. She prescribed antibiotics which I must take four times a day with no food for 45 minutes before or after. She noted my anorexia and spoke with me matter-of-factly about whether the antibiotic regime was likely to be harmful to my meal planning. We discussed how it might work. At no point did I feel ashamed or embarrassed, or that I needed to hide anything.
The GP was kind, caring, reassuring and direct. I felt looked after. I was not made to feel ashamed and I understood for the first time the extent of my injuries, which was a bit of a wakeup call.
So, a good experience and a bad experience.
But imagine that I was not me. Imagine I had not been stubborn in seeking help because I had promised Tom and my psychologist. Imagine I had not had the relentless support of my caring husband and wider support network. Imagine I was a scared child. What are the chances I would have tried again when the help was not appropriate the first time? I think the chances are very slim. I think I would have walked away and never returned. I would have walked away with infections developing and no insight into how to better care for myself in future.
So, what next… I have given Tom my blades. He is keeping them, and if I need them he will give them to me if he is not able to help me work through the situation. I feel confident that he will always be able to help me – and could have helped me in the past, save that I did not have the wherewithal to ask in those very difficult moments. Now I will have a motivation to ask and to accept his amazing support. It is a lot to ask of a husband, but he does it willingly. I do not underestimate how lucky I am.
Today has taught me first-hand just how much difference our experiences with healthcare professionals can make to our willingness and ability to access care. This is not a job I am well enough to tackle right now, but you can bet your bottom dollar it is going on my to-do list for when I am feeling better. Improving awareness and understanding of self-harm is one of the jobs I have done most often and most successfully in the last 24 months, but I now need to think how best to reach as many health professionals as possible. All suggestions gladly accepted…
As you’ll have noted, I’m working hard to be open and honest about my current battles with my mental health. I hope that this will prove a helpful insight for my network and, whilst I am regretfully too unwell to fulfill many of the engagements in my diary, I hope that you will support me on my journey back to health and help me to learn lessons along the way which will inform my future mental health work.
Dr Pooky Knightsmith completed her PhD in child and adolescent mental health at the Institute of Psychiatry, London, where she specialised in developing practical strategies for supporting self-harm and eating disorders in schools and other non-clinical settings. The strategies that Pooky advocates through her freelance work are all developed as a result of direct consultation with school staff and students, and she also seeks inspiration from her clinical colleagues at the world famous Maudsley Hospital, adapting and simplifying evidence based approaches for use by non-specialists. In addition to freelance training, speaking and writing, Pooky is currently the mental health and emotional wellbeing advisor at the PSHE Association, an associate trainer for the Charlie Waller Memorial trust, a trustee of Beat, the eating disorders charity and a trustee of the Kidstime Foundation which supports children of parents with mental health issues.
You can find out about Pooky’s book Self-Harm and Eating Disorders in Schools here
Or to find out more about Pooky’s work, visit her blog here