Most patients are told that they were trying to kill themselves (which most patient’s state that they were not suicidal at that time) and a psychiatric consult is ordered. Many say that they wait for hours in a room by themselves until the consult takes place. The patient finds this scenario ironic, because if they were trying to kill themselves then why are they left alone for so long?
It is understandable that most people usually recoil from pain, and to come across someone who intentionally harms themselves can be disturbing. When the medical staff sends negative verbal and non-verbal messages to the patient it only compounds the patient’s shame, and does not provide a positive example on how to appropriately manage discomfort.
People who injure do so as a way to manage affect states. Their self-esteem is poor and they have little impulse control. Due to their poor self-esteem, some repeatedly and intentionally subject themselves to emergency room abuse, but most go there reluctantly to receive medical treatment for their wounds. Many people who self-injure have either learned to treat themselves or just neglect their injuries in order to avoid the emergency room ridicule.
If you know or suspect that the wounds were self-inflicted, ask the patient if they are receiving psychological help. If they say “yes”, encourage them to contact their therapist. If they do not have psychological support, ask them if it would be okay to refer them to someone who can assist them in locating resources for treatment.
Ask (don’t tell them) if the self-injurious act was a suicidal gesture. If they deny any suicidal intent, tell the patient that you want to believe them, but you need to know more about the drive behind the behavior. Ask the patient if they know the difference between a suicide attempt versus a self-injury act.
Most self-injurers are quite clear in this matter and able to verbalize the difference. They are somewhat insulted when they are not believed. If you are not convinced with the patient’s self assessment, let them know that you are not comfortable with discharging them until someone can do a more comprehensive psychiatric evaluation.