Percy came to me to tell me about a good experience at his pharmacy, and that he wished every interaction with a healthcare professional about self-harm was as non-judgemental and respectful. Percy has very kindly shared the experience, so that pharmacy professionals can learn from this.
[Trigger Warning: This article contains descriptions of crisis, self-injury, and after-care, both physical fact and emotional responses. Sources of urgent help can be found at the end of the article, along with resources for health professionals.]
Many thanks to Emily for giving me this guest post!
A while ago, after a spate of self-harm which had got slightly out of control worried me, I took stock of the situation and decided that the appropriate course of action would be to go to the pharmacist to get dressings and antiseptic. I wrapped the arm in a bar towel, picked up my crutches, and set off, obviously looking quite a state; half-dressed, bleeding profusely, distressed, faint and swaying.
Upon arrival, I skulked around the shelves, picking up an armful of supplies and shuffling up to the counter, avoiding eye contact with the pharmacist and shoving a tenner across the counter without so much as a word. She spoke first;
“Would you like me to clean that for you?”
I looked up, thought for a couple of seconds, then nodded. Saying anything would have been too embarrassing, so I just numbly followed her into the consultation room, where she put on some nitrile gloves, then started talking through what she was doing.
And, as much as it was an awful situation, her conduct was absolutely impeccable and made me grateful for my local pharmacy. On the technical front – her aseptic technique was flawless, she changed her gloves regularly, all dressings and wipes came out of sealed sterilised bags in front of me, and all surfaces had a blue paper barrier over them to protect both me and the environment.
But, beyond the technical aspects, it was the personal aspects of how she treated me as a human being that really stood out:
- Prioritised my consent and comfort, making sure to ask before investigating my injuries, and to explain what she was doing before doing anything;
“First I’m going to take the towel, then I’m going to use an antiseptic wipe. Is that all right?”
- Kept re-checking and re-confirming that touching me was all right.
“OK, I’ve wiped down everything, may I hold a swab here?”
“I’m going to take the swab away – May I apply a Steri-Strip here, here, and here?”
“Shall we take a break, or would you like to continue?”
“Those are holding well – May I put a dressing over it to keep it clean?”
- Treated me as a rational actor, rather than as either a child or as if the injury was a hapless accident.
- Prioritised immediate, practical, physical help.
- Didn’t ask any “Why?” questions, and obviously didn’t offer judgment.
- Did not insist on anything – Not A&E, not GP care, not even telling someone at home.
- Understood that there was no “One way” to deal with an episode.
- Offered distracting chatter; “Hey, how about that [recent city festival]?” but didn’t force me to interact or say anything, and asked “Is me chatting a problem, or is it helping?”, and then continued to chat aimlessly about the parade when I said it was helping, even though I didn’t contribute much.
- Didn’t compare my self-injury to anyone else’s (positively or negatively, method or situation).
- Didn’t ask too many “X or Y?” questions, used yes-no questions instead. Instead of “Would you like me to phone your GP or give you the number for the Samaritans?” which could be confusing, she asked one thing at a time;
“Would you like me to phone your GP?” “No” “Would you like the number for the Sams?” “Yes please”
- Avoided value-judgments on the injuries themselves, such as “Bad”, “Messy”, “Minor”, and used mechanical descriptions, such as, “Those parallel ones”, “That bit near the freckle”, “The leftmost one”, when identifying them to apply Steri-Strips and gauzes.
- Asked if I had anyone that I needed to contact, and if it would be easier for her to call them for me (Friends, family, GP, etc)
- Asked first if I wanted any advice or signposting to help, before offering contact details for the local MH services, as well as national helplines, rather than risking bombarding me with information that I couldn’t use.
I left the pharmacy, a bit sore, feeling a bit foolish, but not ashamed and genuinely much better than I had felt when I went in. I’d been treated with respect, I’d been given very competent help and, crucially, no fuss had been made. When I next returned to the pharmacy, she didn’t bring up the incident, and took my “Thank you, for last time” with grace and without outing me to the other staff or customers as to what “last time” had been.
I think the key to what made her treatment of me so memorably good was that she prioritised my consent and comfort over all other things; I’m almost certain that if, when she’d said “Would you like me to clean those for you?” I’d said “No”, she would have offered again, or suggested reasons that it was a good idea, but wouldn’t have insisted on intervening.
That sense of still being under my own control, and of being treated like an adult rather than a wayward child, was probably what kept me in the pharmacy and willing to seek help, rather than running for the hills. I feel like it’s the side of pharmacy that people forget far too much, the sort of immediate, community, first-response stuff, and absolutely why pharmacists are so important.
If everyone was this good and discreet in dealing with self-injury, the world would be a better place.
Huge thanks to Percy for sharing his experience with us. You can visit his blog at A Very Bitey Zebra ~ Or, one man’s long fight with both EDS and NHS (contains occasional nudity and triggering content). To protect your local pharmacy from cuts which could see 1 in 4 pharmacies closing, please click here to read more and sign the e-petition.
Resources for urgent help & support
- Samaritans – call 116 123 (open 24 hours a day), email: email@example.com or visit your local Samaritans branch
- Mind – call 0300 123 3393 or text 86463 (9am-6pm on weekdays)
- Harmless – email firstname.lastname@example.org
- National Self Harm Network forums
- YoungMinds Parents Helpline – call 0808 802 5544 (9.30-4pm on weekdays)
- Mental Health Foundation’s The truth about self-harm useful info for people who self-harm, families and professionals.
- NHS Choices: How do I apply plasters and other dressings?
- NHS Choices: Cuts and grazes, includes when to go to A&E
Suggested resources for pharmacy CPD
- Mental Health Foundation’s The truth about self-harm contains information on how and why people self-harm, myth-busting, and sources of help for pharmacy professionals to signpost people to.
- NHS Choices: Self-harm contains a video from an expert & sources of urgent help
- NICE Guidance on Self-Harm, including short-term management in primary care.
- Chemist+Druggist: What you need to know about self-harm
- Royal College of Psychiatrists guide to self-harm
- BMJ: Self harm and the emergency department, another patient’s perspective.
- Pharmacy Magazine: First aid & wound care
- NHS Choices: How do I apply plasters and other dressings?
- NHS Choices: Cuts and grazes