On 1 March, people across the globe took part in the annual Self-Injury Awareness Day. Introduced around 15 years ago, its aim is to encourage people to be more open about their own self-harm, with mental health organisations making special efforts to raise awareness about self-harm and self-injury (LifeSIGNS, 2014a).
The self-injury guidance and network support charity LifeSIGNS defines self injury as: ‘any deliberate, non-suicidal behaviour that inflicts physical harm on your body and is aimed at relieving emotional distress’ (LifeSIGNS, 2014c). The majority of people who self-harm are aged between 11 and 25 years, and it is estimated that between 1 in 12 and 1 in 15 young people self-harm in the UK (Mental Health Foundation, 2014).
For the majority of people, self-injury is a coping mechanism rather than a genuine attempt at suicide (LifeSIGNS, 2014b). It is therefore not overly common for paramedics to be called out to life-threatening cases involving self-injury. However, this does not mean that paramedics should not be adequately prepared for situations where this may be the case, as the nature of their work means it is likely that they would find themselves the first point of contact for these patients.
Each ambulance service should have a formal process or protocol for establishing the capacity of patients to consent to assessment and to being transported for further care (Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2013). While the JRCALC guidelines cover transportation of a person subject to detention under the Mental Health Act 2007 (c.12); capacity in relation to consent to treatment and/or conveyance under the Mental Capacity Act 2005 (c.9); and assessing risk in relation to self-harm and or/suicide, there are no other paramedic approved directives or guidance statements that practitioners can refer to in order to support their clinical decision making when presented with a person with mental health needs (Elliott and Brown, 2013). It is therefore arguable that there is a developmental need for a paramedic pathway to mental health (Elliott and Brown, 2013).
As ambulance staff have an increasingly important role in the assessment and early treatment of self-injury, it is important that they receive appropriate training to equip them to understand and care for people who have self-injured (National Institute for Health and Care Excellence, 2004). This begins with the proper awareness and understanding of self-injury, encouraged by events such as Self-Injury Awareness Day.