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- Self harm - with Karina from 42nd Sreet
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Self-harm - with Karina from 42nd Street
Karina from 42nd Street joins us in live chat to answer your questions on scars, mental health at work, confiding in someone about self harm and talking to a counsellor.
Karina: Hi there. I'm ready to answer any questions you might have around self harm. Please ask away.
piccolo: When I was in retail, I used to have a uniform which had long-sleeved and short-sleeved variations. At particular events and seasons we were pushed to wear promotional short-sleeved t-shirts. I talked my manager into letting me wear something underneath but got several lectures on uniform rules. If I'd disclosed and talked to them about it, would they have been able to force me to show my arms? At the time it was mostly just nasty scarring.
Karina: Thanks for your question Piccolo. Firstly, they shouldn't have any right to ask to see your scars. We can't give you a definitive answer here as there are some legal issues around employment laws. It's possible that sacking you, for example, would be unfair dismissal.
It might be worth getting legal advice around this area. It would certainly be illegal to sack you on the basis of the fact that you self harm but the uniform issue is slightly more complex. Does that make sense?
piccolo: Yes that makes sense to me. Thanks.
Karina: Another thing to think about might be getting a doctors note to give to the manager to explain why you wanted to wear long sleeves.
piccolo: That's a good idea. Much more sensible than the friend who suggested I claim to have converted to a conservative religion that required me to cover my arms (!)
Karina: Might be best just to get a doctors note :)
piccolo: It's not something I need urgent advice on, although someone posted on TheSite yesterday that they were facing disciplinary action because of an incident of self harm at work.
Karina: Actually self harming in work time is a separate issue really. Did you have a question focused on this area?
piccolo: Not particularly. I'm just aware it's an issue that has come up for people I know. Do you know if it's ok to discipline people over it? Or how someone should respond if they are disciplined?
Karina: Again this is a complex area legally. Under the Disability Discrimination Act, its illegal for an employer to unfairly treat someone on the grounds of having a mental health problem. But in terms of self harm, it's still a grey area. TheSite has an article on mental health at work which might be worth reading if you haven't seen it already.
It depends on the type of work, whether the self harm was in front of colleagues/customers and the specific incident. We would really need more information to answer fully, but because it is a mental health issue, disciplining the person might well be illegal under the Disability Discrimination Act.
piccolo: OK. I don't know enough about that to be more specific. I did have something else to ask about but I've taken a lot of time so I can ask later. Thanks a lot :)
Karina: Hope that makes some sense. It may be good for them to get legal advice from an employment law specialist - somewhere like the Citizens Advice Bureau (CAB). Hope we helped a bit piccolo.
piccolo: Yes. Cheers again.
Suzie: I've self-harmed for a couple of years now. Only my best friend knows and he thinks I should see someone about it. I would, but I'm scared of other people knowing about it because it's quite a personal thing for me. Is there any way I can avoid that?
Karina: Thanks for your question Suzie, and well done for opening up on here - especially about such a personal thing. Do you want to speak to someone yourself Suzie, or is it because your friend says you should?
If you did speak to someone like a counsellor or doctor then they would be bound by a confidentiality policy. You can ask to see the confidentiality policy before you reveal anything so you know where you stand.
Suzie: I know I should talk to someone because it's hard to deal with, and I know it would be better in the long run, but it was my friend saying that made me realise I should. I'm just a bit worried about speaking to someone and having to tell people where I'm going etc.
Karina: Ah right, ok. How old are you Suzie if you don't mind me asking?
Suzie: I'm 17.
Karina: Are you at college or working?
Suzie: I'm in sixth form.
Karina: Do you know if your college or sixth form has a counselling service linked to it? Many places do, so you could go in school time?
Suzie: There's a counsellor at my school.
Karina: You might find it useful to think about how you will explain where you're going - it might be just saying you're going to a friend, or explaining it's a personal reason. Would you feel comfortable talking to the counsellor?
You could always tell friends you're having a tuition/tutorial etc. It might be a good idea to think through what sort of things you are comfortable telling people and what you're not. For example, you could tell people you're going for 'support' but you don't have to tell them why. You could even say that it's not something you are able to talk about at the moment.
Suzie: That's a good idea. For the first session or so could my friend come along to help me?
Karina: With most services you would be able to go with a friend at first, but most counsellors would want to talk to you alone at some point. It sounds like a good idea to take your friend along for the first time. It's good to have some moral support.
Suzie: OK, I'll do that. Thank you so much Karina.
Karina: No problem, best of luck Suzie. Have you seen our section on self harm on TheSite.org?
Suzie: Yes I have :)
Karina: It might be really helpful to have a look through some of those articles. There's information on how to tell people and what to expect from counselling.
Karina: Shall we move on to another question now?
TryingtobeStrong: I've been getting help and support for my depression, including self harm, but I haven't told them about any cuts etc. that I've made recently. I'm worried to disappoint them and feel like I've let them down. So instead I've been covering up and lying about how I got this mark on my hand or why I've had a bandage on my arm.
Karina: Hi there Tryingtobestrong. First of all, this isn't an unusual thing to happen. It's a very hard thing to stop after all. Can I ask, are you getting support from a professional or from friends or family?
TryingtobeStrong: The CPO at my school, and a teacher. My family have recently found out and they are still getting over the shock of it I think. Oh and I'm being referred to a counsellor from CAMHS.
Karina: Right OK. I guess the first thing to say is that it's important for you to feel that you're not letting people down. These people will be aware that it's hard to stop straight away and you shouldn't feel any pressure to hide it or to feel you should have to stop immediately.
TryingtobeStrong: For me, it's mainly that they have kept supporting me and pushing me through, even when I have wanted to give up, so I feel bad for being so weak.
Karina: Going to see the counsellor sounds like a really positive move. You have a right to get good support and help and they'll understand that it can take time to stop completely so it is a good idea to be honest with them at least.
It certainly doesn't sound like you are being weak at all! It sounds like you are making really positive steps to try and stop self harming. Telling people when you still do it is really part of this process and not a weakness at all. No one expects you to be able to stop instantly and they will want to support you the best way they can.
TryingtobeStrong: I'm slightly worried about talking to a counsellor. I'm not good at talking full stop, especially with people I don't know. To tell my teacher took me a few weeks, and I only talk to the CPO because I know her well from doing my work experience with her.
"It's important for you to feel that you're not letting people down. These people will be aware that it's hard to stop straight away and you shouldn't feel any pressure to hide it or to feel you should have to stop immediately."
Karina: It sounds like keeping it a secret is making you feel worse and more down. You''re right though, talking to people can be really hard as it's often such a private thing that belongs to you.
It's all about building up trust and it's great you have been able to do this with the CPO. Hopefully you will be able to do this with the counsellor. One thing you could try would be to write things down and give these notes to the counsellor to read.
TryingtobeStrong: Yeah. I tried opening up a little today as my only friend who knows about all this is in a really bad mood with me and ignoring me, so been feeling really alone as well. Can I just ask for advice on how to approach the subject?
Karina: The counsellor will be very used to working with people who are nervous about getting counselling or find it hard to speak to them, so they will help you along the way and ask you questions. You don't need to have everything perfect and sorted in your head to tell them before you go. They will help you make sense of it and get it out.
TryingtobeStrong: I've been keeping aside the sort of diary entries I write to give to the counsellor. Thanks, that makes me feel a little calmer about the whole thing.
Karina: This is what we're here for Tryingtobestrong. We want to help.
TryingtobeStrong: Thank you :)
Karina: No problem. As a final thing, you might find it helpful to show your friend the info on TheSite around self harm - there is an article about supporting friends who self harm. Another thing to try might be writing things down to show a friend as well.
piccolo: I've had some trouble with NHS services lately, particularly to do with moving house. I was encouraged by the team in London to go to university and get on with my life but here in my university town they seem to take a dim view of me only being here for a year.
In addition to which, there seems to be a reluctance to offer me any support because I've self-harmed for over ten years and still have an eating disorder. Is that common or am I unlucky?
Karina: Hi again piccolo. You of course have a right to register with a GP and use the services in the area you live in. It shouldn't matter how long you have self harmed or that you have an eating disorder. What kind of support do you want at the moment?
piccolo: I used to have a care co-ordinator with the Community Mental Health Team (CMHT). The CMHT here want to refer me to another service. The other service is a long-term therapeutic community and we both agree that it would be unhelpful for me to start there if I'm going to leave in June. But, despite that, the CMHT won't offer me any help.
Karina: When you say 'both' do you mean you and the community?
Karina: If you're really unhappy with how the CMHT team are treating you, you could get some support and advocacy from the PALS team (Patient Advice and Liaison Service). They would try and advocate on your behalf.
piccolo: My worry is that if I complained they'd think I'm difficult and treat me accordingly.
Karina: It can be really tough when different levels of support are offered in different areas, but it's important that you are listened to about your own treatment. The important thing is that you have a right to treatment and support and sometimes that is why it is good to have someone like PALS who can do it on your behalf. The CMHT might not like your decision but this is something that you, and the community, have thought is right for you so they have to respect it. Of course it's frustrating that you have this extra thing to deal with though.
piccolo: That makes sense, thanks.
Karina: Here is the PALS website if youre interested: http://www.pals.nhs.uk/
piccolo: Great, thanks.
Karina: No worries. We have some more questions waiting I think so best move on to the next one.
yellowseahorse: I'm scared about getting help for my mental health problems because of any effect it will have on my future career, but I can't find any info about it and don't know who to ask.
Karina: Hi yellowseahorse. Hopefully we can give you some advice. No employer can discriminate against someone because of their mental or physical health. Some employers do ask to see doctors records but it shouldn't affect their decisions.
yellowseahorse: I got "jumped on" by occupational health when I declared my medical history, and so now I want help again and I don't know what they'll say.
Karina: Is this a new employer or the same one that you're worried about?
yellowseahorse: I'm training to be a doctor, and "fitness for practice" gets mentioned a lot, but yeah I don't know who to ask for further advice without telling them I have a problem.
Karina: Is there someone within the BMA who you could approach to ask for some confidential advice? Doctors are, of course, human too and many of them have issues, but it doesnt have to stop them practising.
yellowseahorse: Yeah, I'm not really sure.
Karina: Doctors do get asked to show their medical notes, but a lot of decisions about fitness for practice are based on the medical not the doctors notes. Are you a member of the BMA as a student? They might be someone to ask.
yellowseahorse: Yeah I am. I'll have a look, thanks.
Karina: No problem, and apologies for the slightly rushed answer, we don't have long left! Hope it helps a bit. Time for another question.
anna: I'm not sure if I have a problem with self harm or not because it's not that frequent and not what people who self harm usually do. I don't know where to go for help. Rather than arms or legs, that can be covered, I graze and cut my face and I'm ashamed that I do it. I stay indoors until it heals so I don't know why I do it to my face and I only do it about every three or four months.
Karina: Hi anna. I think that people sometimes have a set idea that self harm has to be about cutting. What you are describing could be self harm when you do it. Do you have an idea what triggers you to do it when you do? For example, do you do it when you are feeling a certain way or thinking certain things?
anna: I'm not sure. I'm never happy when I do it.
Karina: It's often useful to take note of what is going on for you before, during and after it happens. Try not to feel bad when it happens and recognise it as a way of coping when you are not feeling happy. Is it something you feel you need help with/want to stop?
anna: I think I kind of hate myself when I do it so I like that it hurts. I want to stop because I get worried that I could get scars on my face.
Karina: It's really down to you what you call it - it's better if you decide. For example, if you have linked it with when you are feeling down then it could be a way of coping with that.
anna: I don't think its really a problem. I think its a result of other problems so maybe I need a different kind of help.
Karina: Its good that you have recognised that you need some help. As you say, often self harm isn't the problem but a way of coping with other issues.
anna: OK, thank you.
Karina: If you can get help with the other issues, for example talking to someone about them and getting further support, this may well help with the self harm. I think we have to wrap up now, I hope that helps anna. I'd have a think about making an appointment with your GP or confiding in someone you trust about what's going on.
anna: I will try and find some help. Thank you.
Suzie: Thank you so much.