Why avoid placements?
We frequently come into contact with clients who mange their distress with self harm, overdoses and who have ongoing urges to kill themselves. Often community services feel deskilled and unable to support them. When these clients are admitted due to their suicidality, the self harm that they usually use to cope is no longer an option for them. As they attempt to get the same relief they would from their usual methods of coping, the potential lethality of their coping methods increases. This is understandably responded to with increasing levels of restriction and observation and a decrease in autonomy and privacy. As this cycle escalates, return to the community becomes unthinkable and an out of area placement becomes the only option. Clients are then wrenched from their social environment, forced to engage in therapy they do not want, restrained in ways that replicate their previous trauma and struggle to make use of help that is forced upon them.
The experience of our lived experience practitioners is that when others assume responsibility for keeping you safe, all the efforts that you were making to maintain your safety are no longer required. This leads to increasingly risky behaviours and understandable conflict with staff. While we see a role for inpatient treatment it is rarely effective for our client group as wards tend not to be therapeutic, the level of acuity means that there is little respite and the hierarchy and power imbalances tend to inflame relationship issues rather than resolve them.
Because of the above, for our clients admission is rarely a safe option and can exacerbate problems. We offer intensity and an alternative relational model to maintain clients in the community.