Today, on Self-Injury Awareness Day, Samaritans has responded to draft guidance, published by the National Institute for Health and Care Excellence (NICE)
Today, on Self-Injury Awareness Day, Samaritans has responded to draft guidance, published by the National Institute for Health and Care Excellence (NICE), on the assessment, management and prevention of recurrence for self-harm.
This is the first time that the guidance has been updated for 18 years. This is a rare opportunity to ensure that the guidance is as robust and useful as possible, so that the care received by people who self-harm is as effective as possible.
The best way to get the guidance right is to make sure that people with lived experience (those who have self-harmed and people who support those who do) give their views on the recommendations which affect them directly. To make this happen, Samaritans held a workshop with six people to get their views on what was good about the draft recommendations and what needed to change based on their own experience. The insights of this group formed the basis of Samaritans’ submission.
Who is NICE and what is this guidance for?
NICE provides national guidance and evidence-based recommendations to improve health and social care. Its recommendations set out the care a person should receive when they come into contact with the NHS and other public health settings. NICE guidance sets the standard which all health care professionals should strive towards.
This new draft guidance is primarily for non-mental health specialists, reflecting that many of the professionals who first come into contact with someone who is self-harming won’t be experts in supporting someone in that situation. This includes GPs, emergency department professionals, ambulance staff as well as people working in educational and criminal justice settings.
Why has Samaritans responded?
Samaritans receives a call about self-harm every two minutes. We have heard by speaking to people who self-harm through our research that they face unique barriers to getting mental health support. Excluded from talking therapies due to the risk they are viewed as posing to themselves, people who self-harm are often not eligible for more intensive support because of the high thresholds which guard it.
Having taken the difficult step of reaching out for help, people who self-harm are falling in the gaps between mental health services. They are being ‘pushed from pillar to post’.
“I wouldn’t have cost the NHS so much if I was helped earlier. I was in a much better place when I presented than when I was admitted.” Jess, in evidence to an inquiry of the APPG on Suicide and Self-Harm Prevention supported by Samaritans.
For those who do manage to get support from mental health services, many find that services simply are not set up with self-harm in mind, or that the fact they self-harm means they are excluded from getting help.
Samaritans knows this needs to change and that’s why we responded to this consultation.
What did Samaritans say in our response?
Reflecting the wide range of issues covered in the draft guidance Samaritans’ response is broad.
However, based on what people with lived experience told us, some key points include:
- That professionals look beyond blanket perceptions of risk to ensure that this does not act as a barrier to accessing services
- That professionals take time to understand and respond to the individual reasons why someone might self-harm, how these differ between people and cultures, and ensure that this leads to more care based on individual needs
- That as far as possible, decision making about care should be shared between professionals and people who have self-harmed. This should take the form of shared decision making in assessments, co-production of training and the design and delivery of services
The full guidance is due be published in July 2022. Samaritans will be pushing to ensure that the new guidance makes a real difference to people who self-harm.