1. Merrick Pope Clinical Nurse Specialist Self Harm Service (SHS)
Royal Edinburgh Hospital

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

3. 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)

4. 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.

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

6. 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

7. 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

8. 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

9. 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”

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

11. 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

12. 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

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

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

15. ARTLINK PROJECT/ART THERAPY

16. 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

19. 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

20. 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

21. Carer Support Either 1:1 if person is an inpatient
Or available through ECC

22. 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.

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

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

25. 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

26. 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

28. “Organisations adapt in units of one”
Rene Carayol