Clinical psychologist Donna Gardiner says caring for these vulnerable patients creates a constant dilemma for staff: “Many of these women have been through traumatic experiences. The need for emotional release can be overwhelming and self harm has become their coping strategy. Staff are trying to support a woman in extreme distress but also preventing her from using the only coping mechanism she knows, which may increase distress and lead to further urges to self harm. We needed alternatives for patients and staff.”
At Dee ward and Harrington ward in Mersey Care’s Broadoak Unit, staff have trained as Dialectical Behaviour Therapy coaches. DBT is about learning to manage difficult emotions by letting yourself experience, recognise and accept them. Patients have their regular session with a psychologist but the coaches are on hand to help them use the skills as a coping strategy.
Formal DBT is traditionally a year long programme. This pilot introduces people to DBT skills by condensing it for people who may only be staying in hospital a few weeks and promotes a more psychologically informed approach to managing self harm on the wards.
A full programme of activities includes creating soothing boxes in which items that trigger calming; happy memories are gathered and kept in a box to be brought out when times get tough. Patients are encouraged to use ice packs on eyes and necks - known to produce a calming effect. Since the programme began incidences of self harm have dropped.
The self harm programme is also running in Mersey Cares secure services in Poplar ward for women at Scott Clinic and Arnold ward for men in Ashworth Hospital; with each developing their own tailored approach. Mersey Care’s Consultant Psychology Lead for Liverpool services Claire Iveson says the approach is backed up by evidence and patient feedback: “We are competing with a very powerful coping mechanism – these people get a huge release of emotion by self harming, but all the evidence is that our alternatives can work.”
Harrington Ward manager Natalie Jones agrees: “We can see it working on the ward, patients know there’s someone they can go to at any time and that in itself makes them calmer.” And Dee ward manager Nicky Kelly says the approach will improve staff confidence in their decision making. “Having psychological support available is good for the women but it provides us with the information to help us provide the right care at a given time and that’s so important.”
For further information, or to get involved, contact Tim Riding at [email protected] or on 0151 478 6580 / 07798 844 634.