This week’s diary is from a specialist social worker in a deliberate self-harm unit.

Monday
Phone the office to see if any young deliberate self-harmers have
been admitted over the weekend. A young woman I saw last year who
cut her arms while at school because she was being bullied has come
in. This time she took a large paracetamol overdose. I wonder if
the bullying has started again and the thought of going back to
school today was too much? Must try and get into schools more to
discuss deliberate self-harm and bullying.

Tuesday
On the general paediatric wards I talk to a young woman and her
parents about the improbability of her taking 24 paracetamol “for a
headache”. She was admitted via accident and emergency last night.
I managed to do a joint assessment with my psychiatrist colleague
and speak to the young woman on her own. She admits she
deliberately took the tablets after an argument with her boyfriend.
Because of religious and cultural issues she does not want her
parents to know she has a boyfriend. She is over 16 so I can keep
her confidence but negotiate with her about the importance of
telling her parents about the overdose.

Wednesday
Miss my team meeting again because of the duty nature of my job.
The duty role does not fit in well with the generic work of the
team and I sometimes feel isolated in this role. The young woman
from yesterday has told one of the nurses that her uncle had
sexually abused her. Ihave to make sure all relevant child
protection agencies are informed. Because the allegations go back
over a number of years and she is 16 it may be difficult to get our
already hard-pressed child protection service to respond
quickly.

Thursday
Informed by adult crisis service that two young men under 18 were
seen at adult A&E last night. Both were under the influence of
drink and drugs and had self-mutilated. One cut his arm with a
knife and the other tried to remove a tattoo with bleach.
Unfortunately, they were allowed back home. They should have been
admitted for our assessment but boys are not seen as vulnerable as
girls and drug and drink-related self-injury is not considered
deliberate self-harm.

Friday
A young woman who has previously been seen by the child mental
health team for psychotic episodes has been admitted for taking a
load of anti-depressants. Her mother, who has mental health
problems, delayed contacting emergency services to get her daughter
to the hospital. After the assessment, it is obvious the young
woman is ill and we put her in a scarce adolescent in-patent bed.
The ward sister wants to know when the young woman will be moved.
Can only give a rough idea and arrange one-to-one supervision for
the young woman. Leave my psychiatric colleague to hunt for beds
and “discuss” with her paediatric medical opposite the importance
of keeping this young woman on the ward.