Sunday, 3 June 2012

Self Harm Pt 2 of 2


This is a sensitive subject, one that many will shy away from talking about, many will even find ways to believe it doesn’t exist, it is dangerous, sensitive, misunderstood and the cause of so many judgemental criticisms. But…. I do it, you do it, we all do it… not one of us doesn’t do it. What am I talking about? Simple terms, Self Harm.

We have already explored the reality of self-harm and how it is the end result of a psychological problem, and needs to be treated as such. I want here to look in more depth at the different types of self-harm and why we all, every one of us, does it.

First of all, how do we define self-harm? Simple, knowingly doing something that is harmful, or potentially harmful, to our body. Most people will, if they admit it to themselves, be aware of cutting the arms, but there are so many ways in which we damage our bodies.

At one extreme, of course, we harm ourselves so much that we die… we commit suicide. Less drastic than that, we use a sharp implement, such as a knife or broken glass, to cut our flesh.

There is however many other forms of self-harm, activities that we al carry out, that we know will harm our bodies but we do it anyway, regardless of the damage we inflict.

So, what do we do to harm ourselves? How long have you got? The list is endless.

How often do you eat too much, drink too much (not referring to alcohol here) eat just before bed, skip breakfast… you know these are bad for you, that they will harm you, and if regularly done could do serious harm.

There are so many examples, we can only touch on some of them, one of the simple things many of us do is to bite our nails, or pick the skin around the nails… why do we do this? Speaking personally it is at moments of stress, rather like when someone with an existing severe problem will go a step further and cut him or herself.

More expensive, think about cosmetic surgery…. The facelift, the breast implants, the new nose, why do we do that? Surely it is insecurity, I have no value looking like this. Rather similar to a person suffering from depression, who has exactly the same feelings, but without harming their bodies to try to improve things for them.

How do we react to these people who undergo cosmetic surgery to ease the pain of their stresses about themselves, we either don’t care, or are fairly ambivalent about it… at the worst we say they are fools and should know better, even people like Cher and Liza Minelli, who are probably now more plastic then human, are still revered and admired. However the young lad, who has real worries, has cared for a mentally ill parent who has to take a lump out of his arm to ease the mental pain is abused by society, neglected in hospital and made to feel guilty. Which do you think is the more deserving case?

Many people have tattoos, some people have tattoos purely as a fashion feature, they like the look of them, many also have them to hide what they think are unacceptable bodies, or for the same reasons of insecurity as others have facelifts or breast implants, some also have them done because they feel the pain of undergoing a major tattoo will blank out the emotional pain for a while.

Self-harm by neglect is a common problem. Can you honestly say you brush your teeth as often as you should? Knowing that it can lead to bad teeth and gum disease.
How often do you drive to the local shop instead of walking, yet you know that the walk is necessary to stimulate the heart and keep you fit?

Self harm by apathy? What is that about? Simple… you are feeling low, don’t care if you live or die, so you do reckless things, cross roads without looking, oblivious to whether there is a car coming.

What about the Armed Forces… they put their lives on the line on a daily basis when on a tour of duty, they are trained to the ultimate level to put their lives at risk for the sake of others… they value their orders and carry them out to the full, regardless of risk to themselves. Surely this is also a form of self-harm but surely no one can condemn the individuals for that… their courage is beyond question

Finally, extreme sports… people put themselves through unbelievable stresses in the name of sport, whether bungee jumping, white-water rafting, freefall parachute jumps. All of these things they know will harm them seriously if the slightest thing went wrong. In doing this they get an adrenalin rush, which is far beyond what the body is made for, which of course is damaging.

I would ask you to think about this… how many things do you do that harm your body, to any extent, either in reality or potentially. You see now, I hope, why I say we all self-harm to some extent throughout our lives.

Clearly looking at the few examples I’ve used, some of them are acceptable to society, such as the armed forces; some are not acceptable to society… such as deliberately cutting you with a knife, whatever the reason.

I would like you to think about this… where do we draw the line between what is acceptable and what isn’t acceptable? Given that there are two extremes one of which is acceptable one of which isn’t, there must be a point somewhere between where it changes over.

The last thing is this…given that like me, you self harm in one way or another, can you really judge others who self harm much more dangerously? You self harm, they self harm… where is the difference?

There is a difference, those who self-harm in a way that society considers more seriously, frequently will have underlying mental issues, and self-harm purely to try to escape the mental pain that is totally uncontrollable… why do you self harm… greed? Vanity? Stupidity? Whatever the reason, you don’t have the right to condemn or criticise those who do self-harm seriously… I won’t push you to sympathise, though if you had an ounce of real understanding and compassion you would, but at least give them a break… if you cant help them, for god sake don’t despise and condemn… because in reality, you are every bit as guilty

Self Harm Pt 1 of 2

Mental Illness, in all it’s forms and guises has so many preconceptions and as much stigma as you can imagine… it’s little wonder it is not treated seriously by those who haven’t been involved.

So, let us look at a particular subject which will offend many people… because they have their misconceptions and prejudices about the subject and know nothing about it other than what they consider an offensive word and an occasional patronising mention on Casualty.

Self harm, yes the act of deliberately physically hurting yourself.. most of you will know that self harm is just attention seeking… and most of you are so totally wrong. No-one can condemn you for being wrong, because if you aren’t involved there is no reason you would know because it is not a subject to talk about in polite society.

So, let us blow this preconception to start with… yes there are one or two people who self harm because they want attention… the tens of thousands of others do it for a variety of reasons, primary of which is because it is so much easier to cope with the pain of cutting than the mental turmoil they face, for many it is a life saving act, as without that option, the stresses and emotional trauma can lead to suicide.

So, lets make this clear, self harming, slicing an arm, or a leg, with a knife, is not attention seeking, it is the sign of someone who is very ill, in so much turmoil that only by cutting can they find any peace from the horrors of the mental strain.

I have talked about self-harm and cutting… so let’s dispel that myth as well. Deliberate cutting is self-harm, but self-harm is a much bigger subject than cutting. There are a number of ways to inflict self harm, the first and most obvious one is by cutting, but people inflicting self harm can also burn themselves, hit heads on walls, and countless other acts that will inflict pain or damage on themselves.

The second area of self-harm is by substance abuse, there are the obvious examples of narcotics and ‘legal highs’, as well as alcohol. All frequently taken to excess to mask the emotional or mental turmoil. Simply by pouring drugs into you body you know you are harming yourself, same with excessive alcohol. We have all heard of those problems, but think about it… excess comforting eating, especially when the comfort food of choice is countless burgers, is a way of dulling the emotional pain, and is knowingly damaging the body… this is also self harm.

The final generic area is self harm by neglect, for instance refusing to drink which leads to dehydration and confusion, refusing to eat, being careless of your life such as simple things like crossing roads recklessly because you are so mentally disturbed and in so much pain that you really don’t care if that bus hits you or not.

So, in short, self harm is an extension of a deeper routed illness, often a mental illness, though not exclusively so, and needs to be treated with skill and compassion by everyone, to do that, we need to understand that the self-harmer, by which ever means, is a soul in torment, a soul who needs the support and understanding of family and friends as well as the emergency services and hospital staff.

A person presenting at Accident and Emergency with a gash inflicted deliberately by themselves needs special care, not only does the wound need attention, but there has to be a compassion, an understanding of why the person has taken this step, that issue also needs to be acknowledged and treated, it is no use stitching the wound and saying “off you go”… that is simply dealing with a symptom not the disease.
All too often, we disapprove, we tut-tut about people self harming, we see them occasionally portrayed on television, and usually as a pathetic figure who is generally cast aside for the real patients in hospital.

So, who most deserves our support and help… you young person who has a mental problem who is at the moment so racked by emotional turmoil that they have to take a knife to their arm and bleed to ease the torment, or the person who climbs on a roof and falls through the glass, inflicting similar injuries… absolutely… they deserve equal treatment for the injury… but one needs further treatment for the emotional condition, the other needs lessons in common sense.

Let us understand the torment that leads to self harm, let us please deal with those conditions and for gods sake let’s not abandon yet another generation to this suffering by continuing to treat them as second class citizens in the hospitals, by continuing to categorize them all as attention seekers, by generally relegating them to also-rans when it comes to treatment.

I know that self harm is a subject that most of us would try to sweep under the carpet because we don’t want to know about such things, I know we must never speak of it in public for fear of offending the general public, but if we continue to keep our heads buried in the sand we will never come close to dealing with this problem.

If you are not aware, it is something that is growing in epidemic proportions, as the stresses and pressures of modern life accelerate we will see more and more mental illness, more and more people self harming to ease their pain.

I don’t want that on my conscience, I want those in positions to help to get their fingers out, make sure that everyone involved understands not just the physical symptom but the causes and background, and to work with it, to help the individuals through their crises and to contribute to towards halting this epidemic of mental illness, self abuse, addiction and everything allied to it.

One final point… self-harmers are a pathetic waste of space who don’t deserve help. That is the last myth to blow away, I have worked with many committed people, fighting to bring about a better world for this, that or the other good cause, but I have seldom seen the sincerity, moral courage, enthusiasm and generosity of the group of youngsters, all carers and self harmers, I have been mixing with lately.


Young Carer Job Description


YOUNG CARER
JOB DESCRIPTION AND CONTRACT OF EMPLOYMENT

Scope

The post requires 24 hour a day 365 dayts per  annum commitment to ensure the safe ensuring safety and dignity of the person cared for and to ensure safe and smooth running of every aspect of the family, home and garden

Responsibilities

1.      To continually ensure that the service user is safe, clean, fed and medicated correctly
2.      To ensure all of the siblings are safe, clean and fed at all times
3.      To ensure the home is continually in good repair, safe and clean and that there are no potential hazards or unacceptable risks
4.      To ensure that all required shopping is bought and stored safely staying within the family budget
5.      To ensure that all domestic and family bills are paid on time on every occasion
6.      To research more economical options for all services and shopping
7.      To maintain positive relationships with Community Health Workers and Carers if applicable

Accountabilities


1. To continually ensure that the service user is safe, clean, fed and medicated correctly.
  • Get the service user up, washed and dressed in the morning
  • Change catheter bag/night bag if used and required
  • Assist service user with toileting
  • Check overall service user condition, including checking for potential pressure sores, noticing any changes and notifying service providers as appropriate
  • Prepare breakfast for service user and assist eating if required
  • Encourage service user to take required medication, up to 4 times day as required, having checked that they are correct and in uncompromised package, or administer medication if required
  • Check service user at lunchtime and prepare their lunch
  • Prepare evening meal for service user
  • Put service user to bed, checking overall condition, noting changes and advising service providers if necessary
  • To contact emergency services as required
  • To arrange all medical appointments and ensure that they are kept
  • Monitor service user health and condition continually
2.  To ensure all of the siblings are safe, clean and fed at all times.
  • Ensure siblings are up, dressed and ready to go to school daily
  • Prepare breakfasts and lunches (or provide lunch money) for self and siblings
  • Ensure everyone gets to
  •  school on time
  • In the event of sibling illness, contact doctor and inform school of non attendance
  • Collect siblings from school as required
  • Ensure siblings get to any clubs/societies on time and are collected and get home safely
  • Prepare evening meal for carer and siblings
  • Ensure carer and siblings complete all homework and other required tasks satisfactorily
·        Continue to monitor and assess service user and siblings to ensure that they are well
  • Ensure care and siblings have appropriate clean clothes available at all times
  • Ensure that if siblings have worries or concerns they are addressed and dealt with appropriately

3. To ensure the home is continually in good repair, safe and clean and that there are no potential hazards or unacceptable risks.
·        Ensure that the heating is set to most effective levels at all times balancing economy and comfort.
·        Ensure that the house is cleaned regularly to maintain hygiene and safety
·        Ensure that all carpet edges remain secure and in tact and that carpets and rugs do not wrinkle creating trip hazards
·        Ensure that all removeable rugs are secure and non-slip
·        Ensure that electricity circuits are checked as required
·        Ensure that central heating, boilers etc are serviced regularly to ensure efficiency and safety.
·        Ensure pipes are adequately lagged and secure to avoid the risk of freezing
·        Ensure all electrical cables are kept safely out of the way and are tangle free.
·        Ensure that electrical appliances are used properly and not misused
·        Ensure that faulty equipment is repaired or discarded, but not used.
·        Ensure that any broken glass, tins and anything that could be hazardous is cleared away and discarded safely
·        Ensure that all hazardous material are stored properly and used in line with the instructions.


  4. To ensure that all required shopping is bought and stored safely staying within the family budget
·        Buy food and provisions, cleaning materials and hygiene products as required, always ensuring there is an adequate supply of nourishing food available for the whole family, correct cleaning materials and hygiene materials
·        Ensure that all products are store safely and securely.
·        Ensure that all substances covered by COSHH are stored securely and safely and that implications and remedies of misuse are recorded and known
·        Ensure that replacements are bought for any required equipment or possessions are bough and that appropriate guarantees are kept
·        Ensure that spending never exceeds total income

5. To ensure that all domestic and family bills are paid on time on every occasion
·        Ensure that essential bills, such as rent, mortgage, council tax, utilities etc are paid on time
·        Ensure that utilities (water, gas, electricity) are not wasted running up unnecessary bills

6. To research more economical options for all services and shopping
·        Use comparison websites to ensure that the most economical and effective tariffs are in place.
·        Compare prices of foodstuff/groceries to ensure best deals are bought.
·        Ensure that shops used are the best value in terms of cost and convenience.

7       To maintain positive relationships with Community Health Workers and Carers if applicable
·        Liase with domestic care workers to ensure best service being provided at all times
·        Liase with all service providers to advise of any change of condition, change of medication or mood.
·        Ensure that Care workers are treating patient with dignity, courtesy and respect at all times, highlighting and reporting any exceptions
·        Arrange home medical visits as required
·        Ensure that patient attends medical appointments as required
·        Ensure that relationships between patients, family and service providers remain positive, professional and friendly       





YOUNG CARER
 PERSON SPECIFICATION

Essential Qualities

·        Young – under 25
·        No friends or social life
·        Caring
·        Patient
·        Self-less
·        Understanding
·        Hard Working
·        Organised
·        Trained in Manual Handling
·        Trained in Risk Assessment
·        Able to cope under extreme pressure
·        Calm
·        Loyal
·        Honest
·        Self assured
·        Cook
·        DIY Expert
·        Financial Manager
·        Diplomatic
·        Problem Solver
·        Excellent Communication Skills
·        IT Skills



Desirable Qualities

·        Full clean driving licence
·        Own car
·        Qualifications in medication
·        Qualified Counsellor











YOUNG CARER
Terms and Conditions
  
Remuneration:                                     >£55 per week if paid at all

Contract Start:                                   In the past

Probation Period:                               Nil

Notice Period:                                   No notice allowed. Post is for life

Retirement Date:                                Death of Cared for person or persons

Reports to:                                         No-one

Training:                                             Nil

Holidays:                                            Nil

Recognised breaks:                            Nil

Sickness provision:                             Nil – Not authorised

Pension:                                             Nil – Life expectancy reduced

Additional Benefits:                            Nil

Promotion Prospects:                         Nil

Grievance Procedure:                         Nil

Equality:                                            Fully inclusive regardless of race, creed, colour, age, sexual orientation 




 YOUNG CARER
RISK ASSESSMENT

TASK
RISK
POTENTIAL OUTCOME
STEPS TO MITIGATE
RISK LEVEL
Moving Service User
Trips,
Strains,
Impact injury:
Cuts:
Bruises:
Burns:
Fractures:
None
Very High
Changing catheter
Contact/Infection:
Conflict of Dignity
Infection;
Embarrassment:
Stress:
PPE/Gloves/Apron against infection
High
Toileting
Contact/Infection:
Conflict of Dignity
Trips,
Strains,
Impact injury:
Infection;
Embarrassment:
Stress:
Cuts:
Bruises:
Fractures
PPE/Gloves/Apron
against infection
High
Checking condition
Contac/Infection:
Conflict of Dignity
Trips,
Strains,
Impact injury:
Exposure to unpleasant sights
Infection;
Embarrassment:
Stress:
Cuts:
Bruises:
Fractures:
Nausea;
Fear
PPE/Gloves/Apron
against infection
High
Preparing food
Outdated food;
Inappropriate food
Cuts
Burns
Scalds
Infection
Food Poisoning;
Malnutrition:
Disability:
Illness:
None
High
Medication
Wrong medication:
Outdated medication:
Over medication:
Under medication:
Fear of Error
Fear:
Stress:
Depression :
None
High
Collecting siblings
Road Accident;
Stress at leaving Service User:
Injury:
Stress:
Fear:
Guilt
None
High
Cleaning
Slips:
Trips:
Falls:
Exposure/corrosive materials
Stress:
Cuts:
Bruises:
Fractures:
Skin Burns:
Eye damage
Asphyxia:
Exhaustion
PPE/Gloves for use with corrosive substances – if they are identified
High
DIY
Impact Injury
Cuts
Falls
Invasive Injury
Stress:
Cuts:
Bruises:
Fractures:
Skin Burns:
Eye damage
Asphyxia:
Exhaustion
See Risk Assessment on specific tools and tasks
High
Storage
Slips:
Trips:
Falls:
Exposure to corrosive materials:
Fear of error
Stress:
Cuts:
Bruises:
Fractures:
Skin Burns:
Eye damage
Asphyxia:
Exhaustion
Depression:
PPE/Gloves for use with corrosive substances – if they are identified
High
Caring
Exhaustion:
Stress:
Isolation:
Depression:
Illness:
Mental Illness:
Self Harm:
Suicide:
Addiction:
Crime:
None
High
RISK ASSESSMENT CONCLUSION:
All tasks involved in this role carry at least a high risk factor:
The job is deemed totally unsafe to do
Alternative arrangements for support and care must be identified immediately