Merrick Pope Clinical Nurse Specialist Self Harm Service (SHS) Royal Edinburgh Hospital merrick.pope@nhslothian.scot.nhs.uk 0131 537 6390

“Developing a service and training people want, not what they are told they need”

How did the SHS come about? Royal Edinburgh Hospital Services were criticised in Beyond Trauma report (Health in Mind, 2001) Concerns had been raised by the Patients Council and the Safety, Privacy, Dignity group of the hospital. Launch of Choose Life(2002), NICE guidelines (2004) and National Enquiry into Self Harm and Young People (2006)

Initial remit; Examine the care, services and supports given to people who self harm or are affected by it, admitted into the acute wards of the Royal Edinburgh Hospital Recommend and guide change where needed.

Information, experiences, views and ideas for change gathered from: Service user sessions Patients Council Activity/social centre meetings Staff sessions Staff questionnaire Carers Audit

Facilitated involvement in an informal, confidential format What had been helpful/unhelpful in their experiences How they would like services developed Involvement crucial in developing a proactive, progressive service

Service users reported Some staff did not appear to understand self harm Staff were not being approached Staff did not talk about self harm/minimal specific interventions Lack of structured therapeutic activity Wanted increased awareness and better understanding of self harm Wanted more positive engagement

Staff described: Awareness of stigma towards people who self harm Insight into how this impacts on services given/received Identified a culture of containment Felt ill-prepared or equipped Wanted training, support, clinical guidance, specialist input

Carers views Had difficulty accessing their views and needs Described being given little information and feeling marginalised Feeling helpless in their situation, excluded due to “confidentiality”

However, all had comparable hopes and aims in mind!!

If we could improve interactions and the service we could hopefully minimise the harm admission can bring Aim to improve someone’s experience and confidence in services Attitudinal change the cornerstone A bottom up approach

Link nurses Allows for quick access to someone with specialist interest Means to disseminate information/research Resource folder Educational information, approaches and interventions, tools for practice, leaflets

Clinical guidelines Developed with user and carer involvement Set standards of care Each member of staff received their own copy

Inpatient work Advice 1:1 caseload Team work Staff can access support, clinical supervision and the SHS also work with staff who self harm

ARTLINK PROJECT/ART THERAPY

Skin Camouflage Clinic In Partnership with the British Red Cross Specialist creams and powders offer a way to cope with scarring Aim to improve someone’s self confidence and give them choices

Swimming Group For women who would like to go swimming, but are self conscious due to marks or scars from self harm. Sessions/changing areas only open to members of the group Aim to improve self esteem Social contact Improve physical health

Support Group Aim of the group is to offer emotional and practical support, and information. Open to In and Outpatients and self referrals. Agenda led by users of group

Carer Support Either 1:1 if person is an inpatient Or available through ECC http://www.edinburghcarerscouncil.co.uk

Men only creative writing group Over the age of 18 with lived experience of self harm. Small group, thinking about and using different forms of the written word ,facilitated by an experienced creative writer.

Conversational French Classes Following on from idea from a service user Small group, aiming to improve self esteem/self confidence through skills development.

The Edinburgh Emotional Symptoms Study questionnaires and computer based tasks sample of blood or saliva for genetic testing fMRI scan of brain.

Training working with people who self harm The existing training programme was reviewed Variable uptake from different wards Nursing/recreational assistances under-represented Promoted at a more local level, specific wards targeted 1/3 more people through in 10 months than previous 5 years

Personality training Multidisciplined , included “remote” user involvement in development and content evaluation Aimed to develop understanding of personality and factors which might lead to interpersonal difficulties Chance to reflect in a supportive setting

“Organisations adapt in units of one” Rene Carayol