Treating Self-injury: A Practical Guide

In view of the fact that up to 25–30% of employees will experience some form of mental health difficulty during their working lives, it is highly likely that most occupational health professionals will see patients with suicidal ideation. Screening for suicidal ideation and self-harm remains one of the hardest clinical skills for health practitioners to undertake effectively and empathetically. Assessing the severity and managing the risk are critical skills in ensuring people are safely managed and followed up. Given that the NICE guidelines on self-harm state that it is essential that clinical and non-clinical staff who have contact with people who self-harm in any setting should be provided with appropriate training to equip them to understand and care for such people there is a need for occupational health professionals to be appropriately skilled in this field. I was hoping therefore to derive from this book greater confidence and proficiency in exploring and identifying where someone may be at risk of self-harming behaviour. Walsh, a teaching associate in Psychiatry at Harvard Medical School and executive director of a specialist mental health agency, clearly has impressive credentials in this field and his passion for this complex behaviour shines through the book. Perhaps displaying my naivety in this area I was somewhat thrown by the author’s opening comments that self-harm and suicide are separate and distinct entities and should be managed as such, although self-injury is clearly a risk factor for suicide attempts. Self-harm increases the risk that the person will eventually die by suicide to between 50 and 100 times that in the general population in any 12 month period. The book is divided into three main sections of 6, 12 and 7 chapters, respectively. Part 1 covers the definitions and contexts of self-injury and how it differs from suicide. Part 2 focuses on the clinical treatment of those who self-injure and Part 3 covers specialized areas such as school and correctional settings, asphyxial risk-taking (‘the choking game’) and management of foreign-body ingestion. It was a fascinating read, opening up a world hitherto unknown to me. However, the book’s target market is undoubtedly mental health specialists, clinicians and others working with people who self-injure. While I think my confidence in assessing someone who self-harms has improved as a result of reading this book, I do not believe it will hugely influence my practice in a field where assessing active suicidal ideation remains the paramount requirement. ✩✩✩✩ (Not recommended)