Orygen Youth Health research hears of self-harming youth having wounds treated without anaesthetic and of being abused by emergency workers

This article is more than 4 years old

This article is more than 4 years old

Young self-harm patients have reported being treated for their wounds without anaesthetic, and have told stories of being abused and judged by emergency workers, in the first comprehensive report into self-harm among Australian youth.

The report, from Orygen, the National Centre of Excellence in Youth Mental Health, said the number of young people admitted to hospital for self-harm was growing: 9,105 people aged 12 to 24 were hospitalised due to self-harm in 2013-14.

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But hospitalisation rates for self-harm revealed “only the very tip of the iceberg, as most instances of self-harm do not require medical treatment and many presentations to emergency departments do not result in a hospital admission”, the report said.

Among a number of measures, the report wants emergency departments to record the number of patients who come into their care due to self-harm so that health services can better comprehend and respond to the escalating problem.

The Calvary Mater in Newcastle, New South Wales, is the only Australian hospital to have collected this kind of data.

The head of suicide prevention at Orygen and an author of the report, Dr Jo Robinson, described the suboptimal treatment of young people who have self-harmed as “one of the most striking things to come out of this report”.

One patient’s wound was stapled without anaesthetic and the emergency department worker treating said it was because “you did it to yourself”.

“They felt like they were being punished and judged harshly,” Robinson said. “Some people can’t see past the young person’s behaviour to their distress.

“Another youth said they had been pepper-sprayed in their own home to stop them from harming themselves, even though they were not posing a risk to others.

“These are people who are young and frightened, and the abuse and judgment that comes from first responders, doctors and nurses can actually be the worst part.”

A patient quoted in the report said: “It’s a big step to talk about self-harm and you don’t want [the clinicians] to take it away from you. [You want them to] just listen and understand.”

Robinson said although there were many experienced and compassionate emergency department staff, the few who did not respond well to self-harm patients risked isolating them further.

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The report, called Looking the Other Way, calls for emergency department clinicians and other staff interacting with those who self-harm to be trained to respond more empathetically to self-harm patients. Training should then be delivered every two years to all local health organisations, police, community-managed mental health services and community and acute mental health clinical services.

Guardian Australia has contacted the Australasian College of Emergency Medicine for comment.

Self-harm refers to a range of behaviours, including poisoning and injury, and causes direct harm to the person exhibiting that behaviour, irrespective of the degree of suicidal intent.

“For some, self-harming can have an addictive element, possibly due to the natural release of endorphins in response to pain, and possibly due to a lack of alternative coping strategies,” the report said.

“While the reasons behind self-harm are diverse, for the most part the behaviour occurs in response to intense emotional pain and psychological distress.”

An emergency physician and the vice-president of the Australian Medical Association, Dr Stephen Parnis, said it was difficult for him to detect whether self-harm rates were increasing because “I see it so frequently, every day I’m working”.

“But I take comfort in the fact I’m working as part of a team,” he said. “I know the people in the mental health unit of my hospital, and I have confidence in their compassion and their skill.

“We can always look to improve our understanding, assessment and the care we provide, but we have also done a lot to improve the situation, such as having dedicated medical health workers such as psychiatry registrars and psychiatric nurses working in the emergency department.”

A senior emergency department consultant, who did not want to be named, told Guardian Australia that emergency department doctors “perhaps do not have the sympathy in the acute environment that we would have for someone having a heart attack”.

“Psychiatric patients can be perceived as taking up a great deal of time in the acute environment, but part of good management for those patients is talking to them, and in a time-pressured environment it can be very difficult when there are other patients clamouring for attention,” he said.

He said often the same mental health patients returned to emergency departments repeatedly because there were inadequate services for them in the community.

“The emergency department is a great place to come if you’ve been in a car crash, but it should be a place for people suffering from emotional crashes to come to as well,” he said.