Self Injury “Is it just another way of coping”


 

 

Many years ago my first job in the social care/child protection sector was in a Dublin child and adolescent detention centre. I was unfortunately under skilled and ill prepared for what lay ahead of me. This was for all intents and purposes a prison for Children and as such was an environment that was emotionally damaging to the young people who were placed there.

What I didn’t recognise at the time was how damaging it could have been for me as well.

One day a young lad of 15 arrived up direct from the children’s court, he was handcuffed to the Gardaí and had apparently given them a tough time in the squad car on the way to us, not surprising really as he was about to be locked up.

We took him in, processed the paper work and got the Gardaí to escort him to his room/cell, he fought like a young lion, and eventually he was restrained and placed in his room, as one of the Gardaí was leaving he said that we would have to watch ourselves as “that young fella is mad”. He had been charged with assault causing actual bodily harm.

He started calling for a cigarette almost immediately, and when he was told he couldn’t be allowed out on the grounds for a cigarette he went ballistic, and I mean ballistic, the room he was in was supposed to be indestructible, he set to task and deconstructed it bit by bit, from breaking the solid wood sleeping platform to tearing out the cages that protected the light bulb to trying to dismantle light switches. The power supply to his room was cut and a decision was made to go into the room and restrain him using our training in these therapeutic crisis intervention methods.

One of the team was observing him through a small porthole in the wall, he informed us that the young man had calmed and that he wanted to go to the toilet, the manager spoke to him and said that we would allow him go to the toilet and then we would give him a new room, when this was done we would get him checked by the onsite nurse.

We stationed staff on both ends of the corridor and let the young man out to go to the toilets at the end of the hall. The toilets had lockable doors but could be opened from the outside, they also had a gap top and bottom to allow staff access (observation) when working with young people who were suicidal.

He seemed to be in there for an eternity so I approached the door, when he saw me getting near he told me to back off as he has put some of the glass (broken bulb) from his room behind his scrotum. This meant we could do nothing even if he was lying we would have to think of another way to get him out of there. As the team met in the office I sat on the floor outside the toilet and just chatted with him. I asked him to open the toilet door and leave it open so I could talk face to face with him, he pushed the door open and what greeted me was a 15 year old boy with a piece of glass in his hand who was slowly but surely and very deliberately cutting small lines in his arm. I felt that I couldn’t move, I had to stay there and just be with him. I didn’t understand the nature of self-injury at that time and why someone would use self-injury to cope with their emotions.

When the manager realised what was going on she made the decision to call a psychiatrist, being that this was now after 8pm on a Friday this was something that was going to take hours. I sat with this young man and we talked about everything and anything , at no stage did I think of moving, I just stayed, I offered him first aid several times but he kept returning to the fact that he wanted a cigarette, and as that was against the rules he wasn’t getting one.

He cut his arms, legs, chest and stomach, there was blood everywhere, eventually the psychiatrist arrived and took over, I stayed nearby, at the end of the chat with the young man the doctor said “give him a cigarette”. The young man got his fag, he got his first aid, he also got some meds to calm him down and he was moved that night to a psych unit. I don’t know if he had a psychiatric illness, but I do know that we were not equipped to deal with that situation, we didn’t have the skills or training to help that young man. However emotionally overwrought he was coming into the centre he was much worse when he got there.

Many years later I went to Trinity college to study self-injuring behaviour with Dr Kay Inckle, this opened me up to the idea that this behaviour is a normal behaviour for those who use it as a coping mechanism. It focussed on the relationship component of working with those in distress and of just being there. Many things were done wrong that night, but with reflection it was one of the big learning milestones for me. Hopefully anyone entering into the care or detention system now will be met with a much more skilled and empathetic care worker than the ones that, that young man met….

Adrian McKenna is a frontline child care professional; he has worked for many years with young people and adults in residential care, detention services, mental health services and post-adoption services. He currently works with a large Dublin-based charity. All views expressed are entirely my own unless otherwise stated and are not representative of any organisation or employer past , present or future.

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4 thoughts on “Self Injury “Is it just another way of coping”

  1. Another really interesting and thought provoking piece. You mention that a lot of things were done wrong that night, with the wisdom of hindsight what would you have done differently?
    Balancing the small but vitally important rules in this case no smoking with the consequences of breaking these rules and the implication that has for the staff and centre must be a constant concern.

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    • In this case we didn’t have any crisis plan or any background info. But one thing we should have recognised was that any young person coming straight from court would be under tremendous stress. That could have been easily supported by giving him space to get use to where he was, maybe leave him one to one with a care worker and get him some food and drink, anything that would help him get his stress levels down.at the core of working with people who self injure is the relationship with those closest and the way the incident is handled..in this case there was no relationship and it was not handled well…

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