Leonard Fagin is a full-time NHS consultant psychiatrist (South Forest Centre, Leytonstone, London E11 4HU, UK. Email: leonard. fagin{at}nelmht.nhs.uk) and an honorary senior lecturer at University College London. He works as an adult psychiatrist in an area of London of considerable ethnic diversity and deprivation. His interests include social and community psychiatry, psychological and familial effects of unemployment, in-patient psychotherapy, occupational stress (in particular, professional stress in mental health), personality disorders and improving therapeutic standards in acute mental health settings. He developed one of the first community mental health centres in the UK in 1983.
Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.
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