Talking to your doctor about ‘feeling rough’ is just one way of getting real-life help and support

Professional looking personThere are many groups, charities, phone lines and organisations that can help with feelings of depression, anger, anxiety and self injury; visit our links page for some further web sites, and our publications page for further information.

One of the first places you can go for help is your GP Doctor. you might not feel easy about visiting your GP; you might worry about your scars and just finding the words to discuss self-injury. If you want NHS help, we’ve got some ideas about how to get what you need and want.

Your GP is not a specialist, such as a psychologist or a psychiatrist, but they do have the power and knowledge to refer you directly to a specialist to help you with your self-injury and the associated feelings.

It can feel like a big step, talking to your Doctor. It does take a certain amount of courage to discuss your feelings with anyone. The good news is that you do not have to go into detail about your mental or physical condition with your Doctor.

If you have a good relationship with your Doctor, then you may feel comfortable coming straight out with it and explaining that you rely on self injury to help you cope, but if you don’t feel confident enough to discuss your SI, then you don’t have to.

Planning

First steps with your doctorBefore you visit your Doctor, it’s a good idea to plan what you wish to achieve and get out of the visit. Will you take a family member, friend or independent advocate with you? Will you speak up if they say things that aren’t 100% as you’d like them said?

Consider, would you accept:

  • counselling from a trained professional?
  • group therapy sessions?
  • drug therapy, such as anti-depressants or anti-anxiety drugs?
  • time off from school or work on Doctor’s orders?
  • becoming an out patient of a clinic, or of CAMHS (Child & Adolescent Mental Health Services? I.e. you go to school / work and sleep at home but spend some time each week with other patients, counsellors and health care workers, for activities and therapy sessions.
  • home visits from a counsellor, or nurse? (a CPN – Community Psychiatric Nurse)
  • becoming an in patient for a set period of time? (I.e. you stay and sleep in a specialist centre.)
  • your parents / guardians getting involved?

And finally, would you accept being told to ‘cheer up’ and ‘come back in a month’?

(We suggest that you should not accept this last suggestion; by staying in the room and calmly talking further, you can ask for real help. Don’t be afraid to ask questions – you can take control of the situation and the conversation, and state what you require.)

Once you have an idea of what you wish to get from your Doctor, it’s time to make an appointment, or simply drop in and sit in the waiting room. You do not have to discuss why you are seeing the Doctor with any reception staff. But remember GP surgeries are busy and when you do make contact the person on the phone will need to get an idea of the urgency, and severity of your problem. The more you share the better the chance of seeing a GP; if you are vague you might be seen by a triage nurse (that just means a general interview). If you’re asked to come back later in the day or later in the month, be sure to do so! Don’t let yourself down.

You can ask to see a female or male GP, or a specific GP who knows you and your family. Remember they have a duty of confidentiality to you and will not immediately ring your parent/s or anyone else. But if they are really concerned about the danger to your health and life they will explain that they also have a duty to inform others.

Visiting your Doctor

When you see the Doctor, remember that they are professionals, performing their job to the best of their abilities, but that they are still human beings. They are not in control of you, nor are they your ‘last hope to get help’. Remember too that they are all different and will react differently, much depending on how you come across.

Be polite, and yet be honest and clear as to your reasons for coming. Perhaps you could tell them how nervous you feel, and how difficult it is for you to be here at all today. You may wish to explain that you use self-injury as a coping mechanism to help you deal with life, and to help you get through your turbulent emotions.

However, you may not wish to discuss self-injury at all, you could choose to explain that you are feeling:

  • depressed;
  • anxious, fearful;
  • confused;
  • despair;
  • lost;
  • numb;
  • overwhelmed.

The three questions

Choose with no regret; live as if this is all there isYour Doctor will then need to ask you three set questions, that all Doctors in the UK have to ask. These questions may be:

  1. are you having suicidal thoughts? Have you ever considered suicide?
  2. are you harming yourself in anyway? Have you hurt yourself recently?
  3. do you have the intention to hurt yourself in the future?

It is clear to see that the second two questions refer to self-injury specifically.

How should we respond to such questions? What will our answers mean to a Doctor?

It is alright to admit that you have, from time to time, experienced such despair or depression that you’ve thought about ending your life. However, if you say that you are suicidal, your Doctor may decide to hospitalise you for observation immediately. In extreme cases they can use mental health law to do this against your will. This rarely happens – it’s a law to help make sure more people are not lost to suicide. anoter law is the the Children’s Act, which is abour protecting children from abuse and neglect, and would involve a social worker and involve your parent/s or guardians.

Assuming you don’t want this to happen, you should explain to your Doctor that you use self-injury as a coping mechanism, which lets you manage your feelings. Try to imagine their concern for your well-being and their fear of doing the wrong thing for you; give your Doctor as much information as you can so they understand.

As someone who self-injures, you have to be honest about your history of self-harm, and you should tell your Doctor that, yes, you have self-injured in the past, and yes, you deem it likely that you will self-injure again in the future, but it would be sensible to go on to explain that you do not feel a danger to yourself. That you use self-injury as a tool, as a form of expression that lets you deal with the thoughts and feelings that overwhelm you.

Your Doctor is not a self-injury expert; it is your responsibility to express yourself clearly without shame. Yes, this is easier said than done but try.

Your Doctor may ask to see your scars. Remember they are a medic, so they will have seen unimaginable things so don’t think they will feel repulsed or angry with you. They will want to assess possible infection, scarring, wound-healing etc. and could prescribe antibiotics or creams, for example.

You could choose to show your scars, or you could ask “Why is that necessary please?” – It is never necessary to show your scars to receive help. Anyone who insists that they need to see your scars in order to provide mental health support is doing so out of their own fear, ignorance and lack of experience, it is wholly unnecessary to submit to ‘body checks’ or to have your privacy invaded to receive treatments.

Once you have expressed you wish for help, and your Doctor has gone through the three questions, you may be referred to a specialist. The specialist will be a professional and trained psychiatrist (a Medical Doctor who works in the mental health field) a nurse specialist (probably a Community Psychiatric Nurse) or a psychologist (not a Medical Doctor and cannot prescribe drugs).

Next steps

You may be offered crisis counselling, which is a short course of counselling sessions that might start as soon as you leave the Doctor’s surgery.

You may be given an appointment at the Hospital, or Child and Adolescent Mental Health Service (CAMHS), to see a psychiatristor psychologist which may take days or weeks to come. Your Doctor’s surgery may even have a psychiatrist or psychologist of their own.

When you see the specialist, you will have the opportunity to fully explain and express yourself. Rather than go into detail with your GP Doctor, it may suit you to wait for the specialist, and to be totally open, honest and frank with them.

You never lose control of your life, you will never be forced to do anything or take any drug against your will (apart from very exceptional circumstances where experts genuinely fear for your safety). You can walk away at any time and you should be provided with information about Human Rights Law, which can be used by a solicitor to challenge what is being proposed. Patients Support services (such as advocacy, where someone neutral can speak up for you) are becoming more common too.

There are alternatives like charities and ‘young people’s services’ that many young people prefer to go to. Such services usually have counsellors or youth workers who are skilled and sympathetic. A school nurse may be another option for you to consider, or a counsellor / pastoral care service at college or university.

Take advantage of all the help available and offered to you; this is your time to get well and improve the quality of your life.

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