We know that people with learning disabilities and autistic people self-harm at very high rates, probably at least double the rate of the general population, and even higher for people with more significant learning disabilities. Given that, I remain surprised by the lack of research, academic articles, guidance for services and training for staff.
Towards the back end of 2023 I was grateful to across this article by Beverley Samways on the Community Care website. It looks at what underpins self-harm and makes a strong plea for a trauma-informed approach.
I couldn’t agree more. Both the generic research quoted by Beverley and the learning disability-specific experience of research conducted in Bristol in 2009 pointed to the need to understand people’s self-harm, not as an organic part of their learning disability, but as a response to a range of traumatic circumstances, both past and present. These might involve the unprocessed loss of a parent, or ongoing abuse, and can be exacerbated by unsympathetic and untrained support staff who feel out of their depth. A further dimension is that witnessing self-harm can, in itself, be traumatic.
The very high incidence of self-harm (with self-neglect as an aspect of that) should, therefore, be no surprise. We know from other work that people with learning disabilities experience sexual exploitation, all forms of abuse, and domestic abuse at rates (again) at roughly double the rate as the rest of us.
We also know, as social care providers, that all behaviour is communication and that, for people with learning disabilities, communication can be a challenge. People are often hindered by a lack of access to language that describes and expresses their emotions, and by generic support services that often do not meet their communication needs.
As Beverley points out, service responses to self-harm need to include active bereavement support and address the challenges to staff it presents. The trauma-informed response that she makes a plea for lies at the heart of the self harm and self neglect training I deliver on behalf of ARC, and I am more than happy to hear from anyone who wants to discuss its possible application in their service.
Rod leads on much of ARC England’s training and project work, including Mental Capacity Act, medication, online harms and domestic abuse. He has worked in learning disability and autism services for over 40 years, and delivered training on self-harm and self-neglect for over 10 years. He also has experience of caring for someone who self harms.