I have been self-injury free for 15 months but I don’t feel free from self-injury.
Looking at the Cornell Research Program on Self-Injury and Recovery website’s page on The Recovery Process I have reached the stage of Stability:
‘self-injury free for 1 year or more and unlikely to injure again; might still have thoughts or urges but does not act on them’ (The Cornell Research Program on Self-Injury and Recovery 2016)
According to this model of progress I won’t be classified as Secure until I reach 60 months’ self-injury free, which puts my current status into perspective. Furthermore, consider that I have reached the stage of Secure previously having had 8 years’ self-injury free between my first period of self-injury in late adolescence to the re-emergence of the behaviour in adulthood. Recovery is a slippery term and a non-linear process.
Last year I moved to a new city and I submitted my PhD thesis which examined my experiences with nonsuicidal self-injury. During my PhD I had been fortunate enough to have access to the university provided free counselling service. My counselor there was excellent – it was my first experience feeling that I was given the agency to make decisions about the support that I needed and the approach taken to my care*. The level of access I had to the service and the fact that it was a free service was amazing! After moving, and submitting, I was aware that my access to professional mental health support would change.
I used Beyond Blue’s, Find A Professional online directory to try to find the type of professional support I was seeking. My specifications – a psychologist preferably with an understanding and perspective on self-injury that aligned with mine, who offered an ACT approach to treatment. The other catch was of course, that I needed to be able to afford the treatment.
After some research into the names offered up by my search results I made an appointment. The psychologist I saw was likable and I felt comfortable with them. Their pricing was also reasonable however because I was seeing them as a private patient I would not receive a Medicare rebate or subsidy, meaning the sessions would be a significant financial outlay (and one very hard to justify given my income). The psychologist followed the weekly/fortnightly schedule for appointments – an approach which is common but one that does not align with my desired approach to my care. They only operated one day a week in my area which also meant I’d have to regularly negotiate with my workplace to have that day off (this can be a difficulty in some workplaces where you do not necessarily wish to disclose that you need time off to consult a mental health professional). After two sessions I decided that I’d hold off on making more appointments. Consequently, not long after I received a notice that the psychologist would no longer be working in my area, meaning I was back to square one.
Parallel to this, I had attempted to obtain a mental health care plan from my GP. Since moving I had found a GP that I was very happy with, although I’d only had a couple of previous appointments with them. When I first brought up the issue the GP ordered blood tests to check if my symptoms related to anything physical (turns out I had become iron deficient again, so at least some of my depression red flags were likely to be related to this). When making this initial appointment I had forgotten to book a longer consultation time, which meant I was required to schedule a new longer appointment time to discuss my mental health in more detail. I left the appointment slightly irritated, I knew that many medical centres had this requirement and knew that I was mentally strong enough to have to wait, but I also knew that this GP didn’t necessarily know that about me. I was frustrated that someone else who may approach their GP seeking help, might be faced with this issue and the result might mean that they don’t pursue professional support.
It took three appointments to get a referral to a psychologist and be placed on a mental health care plan. These appointments were spaced out due to work scheduling, the cost of seeing a GP when on a low wage without a concession card and a repeated error in booking a lengthy enough appointment (not something you always remember to ask for when your thinking is clouded). I called the new psychologists’ office to make an appointment only to find out that there was a 3-month wait for sessions. Again, I was disheartened.
I wrote about my frustrations and concerns about the way the mental health care system works in Australia in my PhD thesis. While the Australian health care system as a whole is enviable in comparison to other countries systems, there is much room for improvement in the approach to mental health. In a blog post for The Huffington Post Australia, Pat McGorry discusses the issue of mental health care access in Australia:
‘A mere 40 percent of Australians with a genuine need for care receive access to any level of care. Only 11 percent get minimally adequate evidence-based care. Imagine the outcry if only 11 percent of people with breast cancer were accessing evidence-based care.’ (McGorry 2015)
On my current mental health care plan I’m eligible for 10 subsidised sessions with a psychologist per calendar year. That might sound like a reasonable amount to some people, and it can be. When you consider that this equates to 10 hours in total and depending on the psychologist they may be scheduled over a 10-week period that can leave an individual with 42 weeks a year where they have to get by without professional support, or alternatively will be looking at a cost of $100-$200+ per session with a private provider.
Self-injury awareness has a way to go in Australia. Predominantly it is only discussed in relation to the broader topic of self-harm or deliberate self-harm. In an Australian context the term self-harm generally includes a broader range of behaviours and does not differentiate on the intention of the act. I take issue with this as I believe it impacts approaches to treatment and creates some misunderstanding of the issue. Many mental health organisations within Australia provide some information on self-injury/self-harm but there is no dedicated organisation or support resource within Australia with self-injury as its prime focus (or at least I haven’t found one yet… if you know of one please let me know). Such organisations exist in North America, the United Kingdom and Scandinavia and information for these organisations can be found online.
While I am “self-injury free” I am not free from self-injury urges. I still think about cutting myself. There are still certain objects that I avoid as I have used them in the past to self-injure. I still have to walk quicker down certain aisles of the grocery store because those objects are displayed there and if I’m having a bad day, I might buy one and take it home. I still have to see such objects at other people’s houses or at work and I have to try to not think about how I’ve used those objects to damage my body tissue in the past. I’m still faced by situations, conversations, memories and triggers that in the past I have coped with by self-injuring. To continue to be self-injury free I have to remain vigilant, I have to actively work to change my behaviour and my thinking. It gets tiring, it gets frustrating and I will have to keep it up for some time to come.
Though I am self-injury free, I am not free from self-injury. I made the conscious decision to start talking (and writing) about my self-injury and doing so has been incredibly helpful. I’ve had one session with my new psychologist on my mental health care plan and was relieved to find that they seem to be a good fit, and most importantly are happy to let me determine my approach to care. I am doing well and I want to keep doing well but to do so I need support. And that is my take away message for SIAD 2016, more support is needed.
I hope that research into the behaviour continues, particularly within Australia. I’d really like to see an Australian based self-injury/NSSI organisation created to provide detailed information, resources, guidance and support. I’d like to hear the conversation about the issue go beyond simply stating “increased rates”. I hope that I can find research scholars to collaborate with on the issue (researchers – you can find me on academia.edu and Linked In).
For now, I’ll just keep on maintaining.
*This may fit the definition of person-centred care which is a concept I wish to research further
Get help & get information within Australia
Lifeline for immediate support call 13 11 14
Self-injury specific online resources available from LifeSigns UK