Self-harm: Parents' experiences

Emergency hospital treatment and other services for self-harm

Emergency medical services may be involved after someone has self-harmed. The parents and carers we spoke to had very different experiences of their contact with Emergency Departments and other services.

Several parents made positive comments about hospital staff. Jo-Ann said the nurses were all extremely caring and non-judgemental. When Sarah Y’s daughter took an overdose the doctors and nurses were very busy, but took time to answer all Sarah’s questions and were understanding about her needs.

The staff in Accident and Emergency, Intensive Care and the children’s ward were excellent when Erica’s daughter was admitted after an overdose.

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Age at interview: 48

Sex: Female

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So she was yeah, she was very ill. She was rushed to the hospital. She was in the resuscitation room for about an hour. The A and E consultant was fantastic. He was very reassuring but it was a very [sighs] very scary thing because you arrive there in the ambulance and when we got there, it was like being in an episode of Casualty with none of the entertainment value because there were six or seven doctors waiting for us.

As we arrived, as soon as we arrived, they said, “In here.” We went into the resuscitation room. I was sent back home to check what else she could have taken. I came back and by the time I’d come back, she was still in the resuscitation room. She’d been had all her clothes taken. She’d been intubated. She’d been sedated.

And she was on her way to the intensive care. I know this was completely out of the blue because I had no idea, no idea, no idea at all that she was that depressed and that she had planned to kill herself. It wasn’t, I’m not demeaning cries for help, people who overdose for cries for help because that that’s just as bad, but it wasn’t an impulse thing. She had planned it very thoroughly, very carefully and she’s a bright thing, even if I say so and she’s very determined so, when she decides to do something, she does it thoroughly. And I think all that had saved her was that we live so close to the hospital and the skill of the doctors [sighs]. Yeah. So, she was in intensive care for two days and I knew that it was going to be a very long haul back because I knew there was something seriously wrong, [sighs] psychologically, emotionally. She was discharged from intensive care after two days and, when she was first admitted between resus and intensive care, I remember asking the consultant, “How is she?” And he said he said, “The outcome is uncertain.”

Which I’m not sure I quite grasped at the time. But I understand later that she was given a fifty fifty chance.

Yes.

Of survival. Anyway, she’s pulled through. Discharged after two days, she went to the children’s ward. The hospital has an adolescent ward, which is really good.

And she was there for four or five days, where she was all over the place emotionally. I mean the first twenty four hours, she couldn’t speak because she had been intubated and she was very dazed and confused. When she first woke up she wondered if she’d had an emergency operation.

But the nurses were fantastic because they were very honest with her. They didn’t they didn’t hide anything. They said to her, “No, you have taken something that made you very ill.”

A nurse and doctor who talked to Jane Z’s daughter in hospital were ‘fabulous’, but Jane thought an opportunity to help her and give practical advice was missed.

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Age at interview: 49

Sex: Female

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We called the paramedics out. They were very good, very practical. They, she was admitted to hospital, again, A and E nurse, he was brilliant, spot on, dealt with the facts, which was the right thing to do, and I could actually see her, opening up in a way that she hadn’t done in ages. And we had, in terms of the hospital experience, because what she’d taken, she took she, she was on a drip, basically, for two or three days to try and clear things out. Unfortunately, this all came up on a Thursday night, which meant it went into a weekend, so she ended up staying in hospital longer than she should have done, because they couldn’t send her home without, a CAMHS [Child and Adolescent Mental Health Service] clearance. So, we were left waiting around for two days, basically, for that, before somebody could come out and see her, which was a, a problem.

We had, those two first days in hospital, she genuinely wanted to go to sleep, and not wake up, and, obviously, that’s a, a massive hit for the whole family. But it’s, it was also, it was an opportunity, and if we’re talking about turning point times, that was that was the second one, and, I’m talking, eight months down the line, and I’m thinking that was a huge missed opportunity. I think that was the second time that things, could have turned around, and didn’t. So, we had an A and E sister and, actually, a registrar, who were practical, spoke to her like an adult, spoke to her as if they were listening and, she could talk to them. Somebody should have sent me away, because I, I stayed with her, and, actually, looking back, she actually needed some space on her time, on her own, whereas my instinct, as a mother, was I’ve got to be there.

Somebody should have sent me away for a bit, and given her some time on her own, so that was a look back and change things, thing. But, those two people were fabulous and I, if she could have sat and talked to, one or other of them about, and opened up at that point, she was ready to open up.

And they, obviously, they couldn’t. They’re busy and all the rest of it, you know. They, I suppose, pass on to the next person, who should have capitalised on that opportunity and that, I think, is, is where things went really horribly wrong because that was an opportunity. She was ready to talk to somebody. She was ready to accept help. She was ready to try and turn things round, and there was, obviously, a huge difficulty in how you react to a failed suicide attempt, because suddenly, you’re having to face a life that you didn’t like very much and you’re stuck with it, and you’re having to, plus the fact that everybody now knows what you did. So, there are two things there that we needed to deal with. The first thing was that, was the help that was offered, which was CAMHS, which we need to talk about.

And then, the other sort of issue, was the decision about what you say to people, about what had happened, and you’re very fragile, very vulnerable, you’re not thinking straight, you don’t, never been there before, so you don’t know what to do. We needed somebody, as a family, to sit down and talk to, myself, my husband, my oldest daughter and say, “Right, this is what you’ve got to do.” Don’t give us any choices, just say, “Right, our experience tells us that this is what you should do, one, two three.” And, it’s like being because you are in some sort of hypnotic state basically, and you just need to be told what to do, and then you can start making decisions. Not being told to just carry on doing what you are doing, everything you do is, you know, everything you’ve done is right, you know. There’s nothing you could have done any differently and you’re thinking, “Well, there must bloody well have been because otherwise she wouldn’t be in hospital.”

So, that sort of thing wasn’t helpful. So, we needed somebody to give us practical things to do, that was, that was one thing, and we needed the support to kick in immediately, and it didn’t.

Sometimes busy hospital staff may appear unsympathetic. The second time Sandra’s daughter went to hospital she felt the staff ‘treated her as another number’. Wendy overheard a nurse saying ‘It’s another self-harm’. She thought ‘It may be another self-harm to you but this is my daughter and I don’t know whether she’s fighting for her life or not.’ Susan Z told us her daughter hated the way she was treated when she took an overdose. ‘I think hospital staff don’t understand and they don’t respond very sympathetically,’ Susan explained.

Jane S felt judged when her daughter was in Accident and Emergency. No psychiatric follow-up was offered.

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Age at interview: 54

Sex: Female

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And the whole, I suppose, and this sounds mean, but the whole fact that here we go again, where, you know, it’s hard enough, life is hard enough without now having to go, you know, and sit in A and E and you know, have to, to talk about this to medics, who might be annoyed with her for wasting their time. And, and, you know, we did get that. We did get that feeling very much so, actually. They, they weren’t, I mean we were, obviously, wanting her to be seen immediately and there was a bit of a laissez faire attitude when we got to, to A and E. It was just like, “Well, go and sit there and wait” kind of thing, which alarmed me, and then there was the, the look, you know, that look of, “Oh, you know, it’s one of those teenagers.” And, and a judgment I suppose of us as parents and our family and, even though it wasn’t said. I think we were sensitive to what they might have, they might have been thinking. Perhaps we were over-analysing it but it was there was no kindness or reassurance or no. And there was actually very little follow-up. The GP did realise because they did tell, you know, it did go on the notes but nobody actually asked us afterwards. My GP didn’t either. I suppose they would wait for us to go in and say, “Do you know what happened last night?” But we, we didn’t need to so there was no follow-up.

No, no offer of psychological assessment, while she was in?

No. No. She didn’t have any psychological help with the self-harming, officially, whatsoever.

It seemed nursing staff thought Nicky’s daughter was ‘highly manipulative’. Nicky works with Samaritans to help hospital staff understand self-harm.

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Age at interview: 48

Sex: Female

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And the nursing staff were very unimpressed, very, very unimpressed because she was highly manipulative and they said as much on the ward. And that’s something else I’m very conscious of from my work as a Samaritan that often people who self-harm or attempt suicide get a very raw deal in A and E departments. That is something and it’s something certainly that locally, I know lots of Samaritans branches, you know, kind of look for ways of getting into A and E departments to talk to staff and other associated departments to talk to staff to say, you know, “Yes, we understand that it’s difficult and that you can see it as a cry for help or a waste of time, you know, a drain on resources, all the really negative stuff that people say about self-harm but, actually, you know, there’s a nicer way of treating these patients than being so dismissive.”

Jo worked in hospitals and knew sometimes young people who take overdoses are treated badly. She decided to keep her daughter at home after making sure she was not medically at risk.

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Jo worked in hospitals and knew sometimes young people who take overdoses are treated badly. She decided to keep her daughter at home after making sure she was not medically at risk.

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[Jo checked with a doctor that the number of tablets her daughter had taken was not dangerous. The doctor said ‘You could keep her at home’.]

Should I have done that or should I, at that point, have taken her to A and E, let her be seen by the on-call mental health worker? Perhaps I should have done but again, as the mother you want to try to protect your child and, having worked in A and E departments, kids that go in that have taken overdoses are often treated really badly and yes, they get the activated charcoal but then they’re perhaps not as, because often they’re distressed and they’re crying or they’re maybe drunk, they don’t always get the care that they might benefit from in an acute situation that the rowdy, noisy drunk.

That’s having a fight with another rowdy, noisy drunk in the corner has. And, you know, I’ve actually seen that from a professional perspective and it’s not something I wanted my daughter to experience. So I felt it was appropriate to try and keep her at home.

Several parents talked about the difference between adult and children’s wards in the general hospital. ‘I’d say my child had a very good experience when she was fifteen,’ Isobel told us, ‘in that she was seen very quickly and nurses’ response to her was warm and caring and friendly, which was in stark contrast to when she was over fifteen.’ Alexis’s daughter was put on an ordinary surgical ward full of older patients: ‘It wasn’t very pleasant, but the staff were very caring.’ Alexis was told to leave her daughter in the evening but she insisted on staying to look after her.

Liz felt her daughter should have been on a children’s ward. Liz had a ‘thoroughly unpleasant time’ but a ‘lovely’ charge nurse was extremely helpful.

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Age at interview: 52

Sex: Female

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So both of us went, my husband and I and her and then began a very long and very horrible night at the hospital. Because she’d told me fairly quickly that there was a delay before they could take blood tests or anything because she told me within probably half an hour of taking them. So we went up and they put her in a bed. At this point, she was, her eating disorder was probably at its worst. She was terribly thin. Her heart rate was terribly low. The monitor kept going off and all they kept doing was coming in and turning it off.

It was just a thoroughly unpleasant time. We were then transferred to what was called then the clinical decision unit. She was seventeen at the time I think. It think she was seventeen so she was young to be on what was really an adult ward and they were still waiting, they’d taken the bloods and then they were waiting for the blood results to come and she just curled up on her side, faced away from me and I don’t I don’t know if she slept or not. I don’t think she was asleep because there was so much noise going on. There was a woman with very, very bad dementia in the bed opposite and she was ranting and raving. They had to put the bed sides up and it went on for about two hours. I was sitting in the chair beside her. I was never offered a drink. I was never offered anything. Of course, my husband had gone home to deal with my other daughter so I just sat feeling not entirely welcome. Feeling not really part of the equation at all, I have to say. It it was, I felt we were in the wrong place. I felt she was too young to be in that environment, very distressing, this woman with dementia.

And, eventually, I went to the nurses and said, “Look, I don’t want to be a pain but either we’ve got to be moved or she’s got to be moved because it’s very upsetting.” And, in fact, then the doctors came along and sedated her and it was it was all right but it was, I felt that we were in the wrong place then. I couldn’t understand why we weren’t on a ward for young people. I wasn’t it wasn’t entirely made clear to me what was happening. I had to keep asking what was happening and I felt I was being a pest.

And [my daughter] was just disengaged with the whole thing. She was lying on her side, facing away from me, completely just disengaged with everything. And that night, I’m talking a lot about that night because it was very, it’s, it was the lowest, I think the lowest of the low really. But then they said we needed to wait for an assessment. It was the weekend as well so we needed to wait for an assessment and we waited and we waited. I don’t think she cared where she was. I don’t think she didn’t really care. She didn’t really care about much so I waited and I waited and a lovely, lovely charge nurse came on the ward, when everybody was having breakfast and, of course, she didn’t want any because she was full of her eating disorder and definitely, that was not on the cards. No attempt was made to encourage her or to help her or to find anything she maybe could have eaten that, people with eating disorders have very strict rules with themselves about what they will allow themselves to eat and when and nobody came and said, “Would you try this or would you try a yoghurt or whatever?” But this lovely charge nurse came on and he sat on the bed and he had time to talk to her. He, well, he made time. He made time to talk to her and me and he was just gently, he was the first person that had actually talked to us about something that wasn’t medical. He was, he was not a psychiatrist. He was a nurse and he said, it, you know, did she think there was anything she could have done to alert me that that was how rough she was feeling? And because, I don’t know whether it was because he was somebody she’d not seen before or whether it was his manner, she talked to him and she said, that she was in a such a bad place, she couldn’t talk about it and he said, he was once looking after a little boy who felt very sad and very low sometimes and he couldn’t tell his mum. He was much younger, this little boy apparently and what they had was a special teddy and when he wanted to tell his mum that he was feeling rubbish, he would appear holding the teddy and she knew not to ask questions, not to try and discover what it was, but just to distract, to sit, to cuddle, to put the telly on, to do something. And he said, “Do you think you, you and your mum could work out some kind of way that she, you could tell her so that she knows not to ask. You don’t want to talk about it but just that you’re feeling really rough.” And we didn’t then but subsequently, we talked about that same thing and we worked out that if she sent me a blank text, I knew that she was feeling rubbish.

She didn’t need to say anything in the text, but a blank text and I knew that she needed some company or that she needed a cuddle or she needed distracting and it worked. That one lovely charge nurse, who was not a psychiatrist, he was not a psychiatric nurse, he gave us something that for the rest of the time that she was ill actually worked.

National Institute for Health and Care Excellence (NICE) Guidelines (CG16) recommend that all young people coming to hospital after self-harm should receive an assessment of their mental health and social needs. While this happens in many cases, some, like Jane S’s daughter (see above), were not offered any psychiatric follow-up. Bernadette’s son went to hospital with serious burns. She told us ‘I was annoyed that they never admitted him mainly because they did have a mental health unit attached to that hospital and I thought, why didn’t they do anything? And they were just looking at me like, “Well, what a mother, you know, letting him do that.”

Parents mentioned good experiences of other services. Sharon said NHS Direct were ‘very nice. They weren’t judgemental at all. They explained everything very clearly. I felt they were very supportive.’ She also praised the paramedics who took her daughter to hospital, as did Jane Z, who said they were ‘very good, very practical.’ Isobel thought the ambulance staff were ‘really lovely people and very caring.’ Tracey was very impressed with the way the police talked to her son. She also felt reassured when the social services assessment team listened carefully to her concerns and confirmed that she was ‘doing the right things.’

Tracey called the police when her son went missing. She was pleased with how they acted when he was found.

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Age at interview: 52

Sex: Female

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The police were very good to him. They spoke to him and they told him that this is this is where he needed to be. This is where he was safe. He was protected. He was looked after, although he might feel he hated us, you know. He might he might feel that we hated him, in fact, you know, this was his kind of safe haven, if you like, the place he needed to know he could come back to and not, almost as well, “Don’t be so silly, lad. You know, who’s put those clothes on your back? Your mum and your dad have. Of course they don’t hate you, you know, stay here.” Sort of thing and we had a bit of a difficult night with him that night and it wasn’t the last time he, he disappeared again after that but he went to a friend’s house and the friend’s mother kept me in touch.

Last reviewed December 2017.
Last updated December 2017.