Access to medical care during the Covid-19 crisis remains essential for those of us who have self harmed, writes Rachel Rowan Olive.

Content warning: self harm; negative care responses

Mary called her GP to sort out a physical health problem. She has a history of mental health difficulties, but hasn’t attended A&E after self harming in over ten years. Nevertheless, her GP warned her that “nobody will be able to patch you up if you self harm in the next few weeks.”

"I am trying hard to avoid self harming and stay out of the way of the NHS frontline, but the difficulties that lead to self harm don’t just dissipate."

Sam harmed herself during a dissociative episode. When she came to, she called the crisis team. Her injury needed urgent medical attention, but the crisis team told her not to go to A&E, suggesting she attend a walk-in centre when it opened the next morning. Feeling judged and frightened, Sam just curled up on the floor and cried.

Exclusion

Those of us who self harm rarely feel welcome in Emergency Departments at the best of times; my own iatrogenic trauma means I often avoid seeking medical attention after self harm. But now, with the NHS stretched far beyond usual limits, I fear that the postcode lottery, poor communication with patients, and sometimes outright exclusion, means that gaps in care for my friends and peers are only getting bigger.

Naomi Salisbury, director of the national specialist helpline Self Injury Support shares this concern. “We are picking up a lot of anxiety and confusion,” she says. “People don’t want to be a burden, or fear being turned away or treated in a hostile way, so they are afraid to seek support.” A huge issue for those contacting her service is lack of clarity. There is a lot of good work going on at local levels - but the absence of national guidance means some, like Sam, are left with nowhere to turn, and many others just don’t don’t know where to go.

It is also harder than ever for people who self harm to access support to avoid the need for emergency medical treatment. Some are contacting Self Injury Support having had support work or therapy abruptly stopped [due to social distancing restrictions], with no idea when it will resume. Some of those have subsequently been admitted to hospital.

Accidental experts

Many of us who self harm become accidental experts in emergency wound care, but this too is harder during a pandemic. A member of service user/survivor group Recovery in the Bin told me he cannot get hold of first aid supplies he usually uses to treat himself at home - supplies which even under normal circumstances cost him more than he can really afford. Nor can he access the outpatient clinic who sometimes care for his injuries. He is stuck in his flat, frightened that if he leaves he will either infect others with Coronavirus or become infected himself.

There are clear and immediate physical risks to these situations: risks of suicide or accidental death from self harm, of infection, of long-term physical damage. But there are also psychological harms taking place here, which are less instantly evident. I am trying hard to avoid self harming and stay out of the way of the NHS frontline, but the difficulties that lead to self harm don’t just dissipate - they come out in other ways that are equally dangerous for my physical health.

Self harm is different for everyone, but a common thread is often low self-worth, a belief that you are bad, harmful, poison even. It is hard to seek help if you believe helping you would be a waste of people’s time. This is often intensified by being pushed away or treated poorly when we do seek medical attention, which drives the cycle of self-hatred faster and faster. Experiences like Mary’s and Sam’s make that cycle increasingly difficult to break.

Advice on the NHS website about seeking medical attention for common types of self harm injuries has not changed. Self Injury Support are clear that those in need of A&E treatment should still attend. They may be diverted for treatment to spaces away from those being treated for COVID-19. This is based on communications from the Royal College of Psychiatrists and the Royal College of Emergency Medicine via social media.

If you struggle with self harm yourself, I want you to know that you deserve to be cared for. You are not responsible for the catastrophic times we’re living through; the fact that others, too, are suffering does not mean that your body deserves to hurt. The direct impacts of the Coronavirus pandemic are relatively easy to quantify. Numbers of cases, numbers of deaths - however incomplete a lack of testing leaves such figures, they are still easier to count than the far reaching psychological consequences of the sudden removal of safety nets. We absolutely cannot forget those whose mental health needs don’t go away now that the rest of the world has gone mad too.

Patient interviewee names have been changed for anonymity.

The World Health Organisation advises people experiencing anxiety related to Coronavirus to put a daily limit on their consumption of news related to the pandemic.