What can you do if a colleague self harms?

When a social worker appealed for advice on Community Care’s CareSpace forum on what to do about a colleague who self harms, it attracted thousands of readers and hundreds of responses. But what do the experts think? An experienced social work manager and a psychiatrist advise.

The question

I have a colleague who self harms. She keeps her arms covered most of the time, but I noticed last week that she has cuts all up her forearm. I asked her about it when no one else was around, and she said it helps her to cope with stress.

I am not sure whether to let the team leader know so we can keep a closer eye on her and support her more, or should I just let it be? She said she didn’t want people to know as she is scared of losing her job. I don’t feel it affects her work at all; she is one of our best social workers. The job can be stressful, but we have a great team so support is always on hand. So far her self harming hasn’t affected her work or dealings with service users.

What the experts say

John Nawrockyi, secretary of the Association of Directors of Adult Services’ workforce development network, says: Of course the team leader should know about this situation; we have a primary duty of care to our staff, but we also have to be mindful of our responsibility to service users. This is not meant to sound unfeeling, but we need to support our staff in a way which does not compromise the service we provide.

The social worker involved is clearly in a great deal of distress, but we are not given any indication why. Exploration would reveal whether the problems were work-related, or located in personal life. Ideally the social worker should talk to the team leader herself. This is an important first step in terms of gaining some control over the situation.

The best her colleague could do would be to enable the social worker to talk to her manager, either alone, with some personal support, or even, in the first instance, through a third party such as a GP or trade union representative.

The manager needs to work out a strategy with the worker, giving them as much control as is reasonable or possible. The council may have its own employee assistance service; there may be access to specialist support through occupational health or mental health services. Either way, the solution should not in itself create additional pressures, such as unrealistic targets or recovery times.

Dr Paul Blenkiron, consultant in adult psychiatry, says: Recurrent self harm by injury is common, affecting at least 2% of the population at any one time. The person does not want to end their life, but risk should be assessed carefully. The person often copes with emotional distress by cutting, burning, pinching or other methods. Usually the pain and sight of blood causes relief, but this is only temporary.

Self harm can be linked to psychological problems such as low self esteem, and some individuals may have suffered from abuse in their past, which makes them vulnerable to respond to stress in this way. Feelings of guilt, as well as scarring and stigma, can grow over time, so more helpful ways of coping should be encouraged, such as exercise or confiding in friends or family. Unless the person is also clinically depressed or highly anxious, medication does not normally have a role to play.

Cognitive behaviour therapy is a talking treatment that helps a person feel better by changing the way they think about situations and react to them. This may be helpful to some of those who self harm, alongside other psychological therapies and practical strategies for coping. Addressing alcohol and drug excess (another form of self harm) is also important.

Do you agree with the advice above? Join the debate on CareSpace

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This article is published in the 1 September 2011 edition of Community Care under the headline “My colleague self harms”