Self-harm: Parents' experiences

Mental health assessment, diagnosis and treatment

Young people who self-harm may need assessment by a mental health specialist, particularly if they have been admitted to a general hospital following self-harm. An assessment can help to identify any mental health problems so that the young person can receive appropriate help or support. The mental health specialist will try to work out if the young person is still at risk from self-harm and what help they need. In some cases, the young person may be given a specific mental health diagnosis. 

Sarah Y was keen for a psychiatrist to assess her daughter when she was admitted to a general hospital after an overdose. Alexis worried that her daughter was ‘labelled’, but she thought her daughter wanted a diagnosis. ‘I think my daughter wanted to be bipolar’, Alexis told us. She wondered whether her daughter ‘at that stage needed a reason for why she was feeling like she was feeling’. Susan Z’s daughter was diagnosed with borderline personality disorder, but at first refused to accept this as she thought she was depressed. Susan was pleased when she did accept the diagnosis because then she could get the right treatment.
Joanne’s daughter was given several different diagnoses. ‘I think you could tick every diagnosis in the mental health dictionary and she’s probably had it’ Joanne told us, ‘but at the moment we’re hoping to get a second opinion because we want to make sure that the care she’s getting is right for her.’ Jane S and Sharon both thought that their child’s depression gave rise to the eating disorders they developed. Jane said, ‘If only that could have been looked at and understood and perhaps treated earlier then she might not have had to go through the whole life-threatening eating disorder.’ Fiona wanted help for her son but psychiatrists ‘decided he was fine’ and discharged him from hospital. Other young people did not need treatment for mental health problems. Roisin consulted a private psychiatrist who decided that her daughter didn’t have a mental illness and didn’t need any therapy. 
Treatment
Parents told us about different treatments their children had received for mental health problems (see ‘Mental health problems’). Apart from medication (see ‘Medication’), the main treatments mentioned were cognitive behaviour therapy* (CBT) and dialectical behaviour therapy** (DBT). CBT ‘really helped’ Roisin’s daughter and she hasn’t harmed herself for over a year. Erica thought DBT was ‘absolutely amazing.’ It taught her daughter techniques which she still uses for coping with thoughts and emotions.
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Philip and Mary’s son was offered ‘mentalisation’ and use of the complex needs service, but he was not keen on this. Debbie’s daughter had counselling through her school but Debbie thought it didn’t target the main issues. It was more about building her self-esteem and confidence, but the self-harm continued. Her daughter later had six sessions of help for obsessional compulsive disorder, and is now on a DBT programme, which Debbie says is very good. 

Other sources of help
Some people find other sources of help outside the NHS.  Fiona said the most helpful thing for her son was a Christian rehabilitation community. Sometimes people turn to ‘alternative therapists’. Susan Z took her daughter to a kinesiologist. Sarah Z’s daughter was helped by a hypnotherapist who was one of Sarah’s friends.
A few parents told us about private treatment they had organised for their children. Charles’s son was seeing a private clinical psychologist once a week for CBT, in addition to his treatment from the Child and Adolescent Mental Health Service team. Charles said one of the advantages of private therapy was that he and his wife could have a session for themselves where they could talk about their son in his absence. Sarah Z and Nick didn’t want to go through their GP, so they arranged for their daughter to see a psychologist privately. They said she was ‘enormously helpful’ and gave their daughter a ‘tool-kit’ of strategies to avoid self-harm. The CBT which was so helpful for Roisin’s daughter was provided in a year of weekly sessions paid for by her husband’s health insurance (see clip above). Jackie wanted urgent treatment for her daughter but was horrified at the cost of private counsellors. She was prepared to pay, but her daughter decided she wasn’t ready.

Experiences of mental health specialists
Some people told us about their experiences with clinicians and others involved in the young person’s care. When Alexis’s daughter started self-harming she saw a private psychiatrist. Alexis described her as ‘a crazy person’: ‘She just wasn’t helpful. She just sort of looked at me, she goes, “Well, the way I deal with this is just tell her, ‘look at your beautiful body, you know, you don’t want to do this, do you?’” And you’re thinking, that is too simplistic. I just could tell that my daughter was not going to be able to relate to this woman.’ Jane S’s daughter had a ‘really nice psychologist’ who was very helpful and understanding. Audrey’s young husband was treated by two very different doctors, one of whom was ‘brilliant’.
Jo-Ann praised the community psychiatric nurse who looked after her daughter. Audrey thought the woman from a mental health charity who helped her husband alongside the GP, psychiatrist and mental health worker was ‘indispensable’.
* CBT is a psychological treatment in which the links between thoughts, behaviour and feelings are identified. Young people are encouraged to develop strategies to manage unhelpful thinking processes and behaviour.

** This is a form of therapy (using individual and group work) that helps the young person to learn skills to manage their emotions, cope with distress and improve their relationships. DBT helps the young person see that their suicidal and other unhelpful behaviours are part of their way of coping with problems and encourages them to develop more helpful behaviours and solutions.
 

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