Intended for healthcare professionals

Rapid response to:

Practice What Your Patient is Thinking

I am more than a body to stitch up and label

BMJ 2021; 373 doi: (Published 12 May 2021) Cite this as: BMJ 2021;373:n1003

Rapid Response:

The need for compassionate self-harm services

Dear Editor,

The anonymous author in the recent ‘what your patient is thinking’ article shares a powerful story of unfortunately feeling that their self-harm was dismissed, and this in turn affected future help-seeking. (1) Self-harm is a serious public health issue and is the strongest risk factor for suicide: it must be taken seriously by healthcare professionals and services, to avoid patients not seeking support, and thus continuing to struggle with self-harm and psychological distress.

The author described being free of self-harm when receiving regular care with one healthcare professional who employed good communications skills such as listening. This is perhaps not surprising: recent research with young people who have harmed themselves identified that continuity of GP care, with a GP who actively listened, understood, and arranged follow-up, was a key facilitator to accessing support for self-harm, and can help young people self-harm less. (2) People with lived experience of self-harm cite this relationship-based care as a crucial facet of self-harm care.

The NHS Long Term Plan commits to the development of integrated primary and community care self-harm services. (3) This represents a positive shift in services for self-harm, and there is good reason to remain optimistic that these planned services will have a positive impact for patients, families, the public, and the NHS. (4) The role of people with lived experience is vital in the upskilling and training of professionals to deliver these services, and in their evaluation. However, at the core of these services, must be a compassionate and empathetic model of self-harm care where patients’ concerns and needs are respected, and valued, along with continuity of care.

1. Anonymous. I am more than a body to stitch up and label. Bmj. 2021;373:n1003.
2. Mughal F, Dikomitis L, Babatunde O, Chew-Graham CA. Experiences of general practice care for self-harm: a qualitative study of young people's perspectives. Br J Gen Pract. 2021.
3. National Health Service. The NHS Long Term Plan. 2019.
4. Kapur N. Services for self-harm: progress and promise? Br J Psychiatry. 2020;217(6):663-4.

Competing interests: FM is funded by a NIHR Doctoral Fellowship (NIHR300957), sits on the current NICE self-harm clinical guideline committee and is on the Expert Reference Panel of the NHS & NHS Improvement funded programme ‘Improving Community based care for people who have harmed themselves’, which is part of the NHS Long Term Plan and NHS Mental health Implementation Plan 2019/20-2023/24. LQ is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003). She also works on the NHS & NHS Improvement funded programme ‘Improving Community based care for people who have harmed themselves’. The views in this letter are those of the authors, and not necessarily those of the NHS, NIHR, NICE, or the Department of Health and Social Care.

14 May 2021
Faraz Mughal
GP and NIHR Doctoral Fellow
Leah Quinlivan, Chartered Psychologist and Research Fellow, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester
School of Medicine, Keele University, Keele
School of Medicine, Keele University, Keele, ST5 5BG, UK