Self-harmers are being failed by the NHS. At least, that is what the National Institute of Clinical Excellence said last week. It also announced that staff should be given special training on the needs of self-harmers. I am not convinced.
It strikes me that people who hurt themselves deliberately, or who try to kill themselves and then come to hospital seeking help, are the victims of many wrongs - bad relationships, unemployment, poverty, mental illness and addictions - but they are not the victims of bad healthcare. They get their wounds stitched, their overdoses treated and a psychiatric review, time and again. They get kindness and endless patience from tired, busy staff.
Where I work, I see young people who have taken huge overdoses get liver transplants, followed by months of intensive care, costing thousands of pounds a day. The NHS is one of the few institutions to give self-harmers every chance. We treat them as we treat everyone else: that is, to the best of our ability. The fact that the panel handing down this indictment was headed by a psychiatrist makes it all the harder to swallow. Any A&E doctor could tell you that in psychiatry, crisis management means rolling up at 10am the next morning, latte in hand, when the blood and vomit have been cleared away and the patient is no longer drunk and abusive.
In my current job, in addition to the people with heart attacks, gastro-intestinal haemorrhages, strokes, tumours and blood clots to the lung, I cover a whole ward full of patients who have taken overdoses or slit their wrists - about 12 each night. These patients have been medically stabilised and are waiting for a psychiatric review in the morning. What we lack on the front line is not understanding: it's time. When you are on your own trying to prevent an elderly lady from bleeding to death, it's hard to keep your temper when you are being hassled to prescribe a drug for a girl who is itchy because she has taken a methadone overdose. That is what happens when you take a lot of morphine - you itch.
In order for doctors and nurses to have more time for each patient, one of two things has to happen: fewer people have to come to hospital, or more of us need to be on duty. It is hard not to get frustrated: people who self-harm do have a choice, although it may not seem like it at the time. They could not do it, or they could do it and stay at home to deal with the consequences. Just please don't lacerate yourself, come to hospital and then complain about it. A&E is an emergency service. One imagines that people who repeatedly set fire to their own houses and then called the fire brigade would get short shrift, no matter what their mental state. Self-harmers who attend hospital habitually are unable to take responsibility for their own lives and actions, and it might be that by being so patient and non-judgmental we are fostering that destructive cycle.
Any doctor who doesn't sometimes privately think that, is no longer working at the coal face - perhaps they are spending time sitting on panels. Naturally, I understand that to say it publicly is highly controversial. I can see well-meaning liberals up and down the country spluttering into their morning coffee: "Have you seen this, darling? Goodness, they really do need extra training!" Judge me after you've walked a mile in my shoes, or even run around in them for 24 hours.
Misery is invisible. In the context of western biomedicine, and our society at large, the objective is valued over the subjective, the solid over the intangible, and the body over the mind. The pain felt by people desperate enough to take a kitchen knife to their own neck, falls into the latter categories. They are the voiceless. By translating their mental torment into raw flesh wounds they come to our attention. But the fault lies with a society in which one in 10 young people are driven to harm themselves, not with the people who care for them in the middle of the night. That one doctor who is a little tired and distracted in the small hours of the morning is at the very end of a long line of failure, cruelty and disappointment in that patient's life. Just because he is there to help does not mean that he can solve all of your problems, or that it all becomes his fault. The NHS is not your whipping boy.
It seems that we are suffering from an Oprah-fication of our culture: this will be the century of the victim. Proper argument is rarely heard about important, and therefore emotive, issues because it is drowned out by the howls of victims. "I'm upset and therefore I'm right," seems to be the winning argument. When people who see themselves as victims complain about the NHS, their premise is never challenged.
A manager, who spoke entirely in jargon, once told me that we lived in a 24/7 culture, and (seemingly under the impression that the health service was, in fact, a shop) that the customer was always right. She therefore answered complaints between 9am and 4pm as follows: yes, we are sorry we lost your dentures; we are sorry you had to wait an hour in clinic; we are sorry that the doctor in A&E was eating sandwiches while you were nil by mouth; we are sorry you felt sick after taking your overdose and had to wait for anti-sickness medicine. Almost without exception, we clinical staff are doing our best in the most challenging of circumstances - and we are not sorry.
· The author is a doctor in an inner-city NHS hospital. She is writing under a pseudonym.
