I am new to school nursing (worked L&D for 18+ years) and find it to be a challenge. I have a student (actually a few students) that exhibit self-harm in the form of cutting. It seems to me that this is "the new black". I had a pediatrician call me and ask if I had reported an incident to CYFD. This seems a little extreme to me. These behaviors are often a release mechanism and the student is enrolled in therapy to learn healthy coping mechanisms. How do you handle these situations? The student is 16 and lives with her adoptive father.
I work in a rural school setting...pre-k-12...380 students. I see 40-60 kids a day!
With cutting and other parasuicidal behaviors, you shouldn't draw attention to it. As stupid as cutting is, most of the time it's just scratching. If they're depressed, medicate appropriately and send to therapy. RTFs and TDTs are hot boxes of misbehavior so not the best option.
Adults I have no empathy for. I have a patient who cut apart his forehead with a box cutter. My response beyond asking his motivations was "that's definitely gonna leave a scar." I have another adult who cuts and recently too deeply. Real deep. Sliced brachial artery and spurted out until her 15 year old daughter applied direct pressure and literally saved her life. She has PTSD now. I treated her and berated the mother who gets psych care from an under informed IM guy.
Kids cutting is exhausting as are the kids who come in with parents wanting them diagnosed with and treated for mental illness after texting nudie pics around the school. They're both bad and bizarre. Both are detrimental.
Specializes in Pharmaceutical Research, Operating Room.
I wrote a response to this thread, but then I realized that I have written the equivalent of an article. Maybe I'll just submit it as such, with it's 1370 words telling my story. This really hit a nerve.
Briefly, you think it's "exhausting" dealing with cutters? What about how exhausting, frustrating and discouraging it is to deal with a mental health profession that only wants to judge you, or condemn you for being "bad", or put you on ridiculously high doses of medication and then claim that they "cured" you, all without ever addressing the underlying cause of your behavior? You shouldn't draw attention to the behavior? I guess that's why my mother never got me any help when she saw I was intentionally hurting myself at 8 years old, and why I have struggled to find the help I needed as an adult.
I have been berated as a patient because I only did it "for the attention". I have been threated with involuntary psychiatric commitment because the only reason I'd ever cut myself is obviously because I want to kill myself. I don't. It's not about that. I sought out help so that I could better understand myself, the way my brain works, and the reasons why I cope with stressful life events the way I do. My experiences with all those so-called mental health "professionals" have been extremely negative, and have left me feeling even worse about myself than I did before I tried to get help.
We don't tell morbidly obese patients who eat nothing but fast food or other processed foods that they're eating like that "for the attention". We don't tell chronic smokers that they're going to be committed because they obviously are trying to kill themselves by inhaling known carcinogens. Why is it ok to say things like this to people that self-injure? For me, at least, it's not something that I can "just stop", just like most smokers can't. It doesn't work that way at ALL, even though I KNOW it's not a healthy or "normal" thing to do. But any sort of mental health issue has become so stigmatized that it's easier just to hide my problems from everybody. Why ask for help when I could just change myself "if I really wanted to"?
After more than 10 years of being an adult trying to find help in the mental health system, I have lost ALL faith, confidence and trust in it. My last experience with a therapist was a couple of weeks ago, and the way she behaved toward me left me feeling upset, panicked, and honestly a little traumatized. I have never in my life had a "professional" react to me that way, and I'm still trying to process it. I still don't know what to think, besides the fact that I seriously, seriously doubt I will ever try to find someone to talk to again.
Specializes in Psych, Addictions, SOL (Student of Life).
I worked for several years in a acute psychiatric setting two years of that as charge of an adolescent unit. While cutting is rarely a sign of suicidal ideation it should (As Far stated) however be treated seriously and not just as something all the cool kids are doing these days. Cutting for some produces an endorphin rush very much like a chemical high which may be one of the reasons some kids do it. For others the pain of cutting is a symbolic release of some inner pain/turmoil they can't express for others as my 14 year old son told me is just "EMO Attention seeking BS" .
I am not sure placing these kids in the acute psychiatric setting is the right course as I have sometimes seen it do more harm than good however help is most definitely needed to R/O SI and then help these young people learn healthy coping skills to carry into adult life. Cutting is never harmless and yes sometimes kids do cut too deep and die because of it.
flying_ace2, thanks for sharing and SO sorry you had those experiences. Frustrating as it can be, there is a professional out there who can provide the cure you need. Praying that the hopeless tone you purvey in you post is not where you are right now. Too easy for us to judge before helping, I am definitely guilty of that, and normally shown how wrong I am.
Thank you for sharing flying_ace2. I am so sorry that you've had to deal with so many uncaring "professionals". (((flying_ace2)))
It's unbelievable that so many, many people can think that everyone does this for attention. I'm sure their are those out there that are attention seeking, but to make that your first thought is a serious disservice to those confiding in you. The first adult I told had that very reaction; I never told another. I had a 15y/o friend who helped me through it. My mom took me to the ER for a self-inflicted injury that I explained away as a clumsy accident, no one ever asked. I remember the feeling that I would get from just putting a cold blade against my skin, but no one knew. There was no attention. That is not what this is about, not always. If, just once, you can be that safe person for someone who is self harming, then you owe it to them to be open and honest and trust in what they are telling you. You do a disservice to the entire nursing profession when you brush this behavior off as "attention seeking" or see it a dramatic kid stuff. Sometimes, someone just needs one adult to take them seriously, to help them, to give them the courage to speak out. If you save one kid from cutting too deeply, one kid from feeling like they have to tackle this alone, give one kid the validation that they need to seek help-why wouldn't you?
First of all ((((hugs)))). I think you should submit your story as an article. We could all probably learn & understand this problem better.
I'm sorry you haven't been able to find help. It took me over 20 years to find someone who understands the problem & was able to help me develop better coping skills than cutting. It happened that she had been a cutter as a teenager & the help she got made her want to help others. I hope you're able to find some help so you don't have to keep suffering alone.
I went from superficial scratching to needing hundreds of stitches, surgery, blood transfusions -- probably within four years of the behavior starting. Early intervention, like early intervention for eating disorders, is going to save a lot of heartache later on.
I did DBT for teens when I was 17 and it really became the cornerstone for developing coping skills beyond SI.
Specializes in Pharmaceutical Research, Operating Room.
help is most definitely needed to R/O SI and then help these young people learn healthy coping skills to carry into adult life. Cutting is never harmless and yes sometimes kids do cut too deep and die because of it.
Hppy
I absolutely agree, my comments were only drawn from my personal experience. I absolutely think that anyone who self-injures needs to be screen for suicidal ideation, and appropriate steps 100% need to be taken if the thought or intent is there. Again, only drawing from my situation, my stuff is not about suicide at all. What has been frustrating is that everyone I've encountered automatically assumes that it is (or it's attention seeking, or other things).
That being said, I really appreciate the support found here. I'm still a functional human being, I still get up and go to work everyday, and I have a healthy relationship with my husband and friends. My husband is my biggest supporter and champion, but I have not told my friends about it, and they've never asked if they've seen the scars. It's a part of who I am, but it does not define me as a person - I won't let it.
I appreciate everyone here sharing their own experiences as well - it is nice to know that there are others that have been through similar things, and I am so, so glad that they have finally found the help they needed!
While it is not a suicidal gesture, and self mutilation instead, the problem is that these children are more prone to suicide not at that time but later on because they have lost the fear of hurting themselves. This is a problem where the entire family needs help because the child is exhibiting their emotions and trying to deal without having coping skills.
BeckyESRN
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