Letters Self harm and the emergency department

Changing healthcare workers’ attitudes to self harm

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2443 (Published 03 May 2016) Cite this as: BMJ 2016;353:i2443
  1. Ian Hamilton, lecturer in mental health
  1. Health Sciences, University of York, York YO10 5DD, UK
  1. ian.hamilton{at}york.ac.uk

The anonymous article on self harm and the emergency department provides a frank and useful reminder of the judgments that some make about people who self harm.1 I suspect that withholding analgesia from these patients is a common practice and is more than a passive act. In effect it is a way of punishing the person for “deliberately” inflicting a wound.

These attitudes and the substandard care they produce are not a new revelation: Friedman and colleagues alerted us to this practice a decade ago.2

Clearly not all wounds are equal, and that needs to change. On the surface this seems like a straightforward ambition, but the attitudes and values that underpin these judgments of those deserving and undeserving of compassionate care will probably be difficult to change. Quick fix remedies such as training can leave some staff adopting the “correct language and approach” without changing their core beliefs and approach to patient care.


  • Competing interests: None declared.


View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial