Scenario: The person I am supporting appears to have seriously harmed themselves - emergency

The scenario

You are a disability support worker meeting Joyce to provide transport support. 

Joyce has a physical disability which requires her to use a wheelchair. She lives independently and is a good communicator.

Joyce is picked up every Monday to go to her place of employment. You are her regular support worker and you are required to assist Joyce to exit her house, and to access and leave the vehicle.

You knock on her door and enter, as Joyce has given permission for you to always meet her in the hallway. Joyce isn’t there and doesn’t respond to your call. You look into the next room and see Joyce on the couch. Her eyes are open, and there seems to be blood everywhere. When you approach Joyce, you see it is her arm that is bleeding and that there is a knife on the floor out of her reach. Joyce says, “I am alright, don’t call an ambulance.”

Tips for responding in the moment

It is not up to you to make any medical judgement. It is not expected of you, and you are not qualified to do so.

How you react is important:

• Stay calm and don’t panic.
• Speak and move in a quiet and unhurried way.

What you could say:

• Tell Joyce that you understand she does not want an ambulance. Tell her she seems to have lost a lot of blood and needs medical help that you are not qualified to provide.
• Tell Joyce you will have to call the ambulance. Explain that you are concerned about her and that her injury looks severe. Explain that you have a legal obligation to tell someone who can keep her safe.

What approach you could take:

• This is an emergency situation, so you need to call an ambulance (000).
• Stay with Joyce until the ambulance arrives.
• While waiting for the ambulance, and if you feel comfortable to do so, ask Joyce if there is anyone she would like you to call.
• If Joyce wants to talk, listen. Don’t interrupt or express judgement. Reflect back what she says, summarising in your words, to show you are listening and to check that you have understood. For example, if she says, “I only did it to stop the pain, I wasn’t trying to kill myself”, you could say, “I understand, you were not trying to kill yourself, you just wanted to stop the pain you were feeling”.

What you should avoid doing and saying:

• Don’t use statements that do not take Joyce’s pain seriously like, “But you’ve got a great life” or “Things aren’t that bad”.
• Don’t try to solve Joyce’s problems.
• Don’t touch Joyce (for example, hug or hold hands) without her permission.
• Don’t accuse Joyce of attention seeking.
• Don’t make Joyce feel guilty about the effect her self-injuring is having on others.

Support escalation:

• It is an emergency situation, so call 000.
• Do not put yourself in any danger while offering support in an emergency situation e.g. if the person you are supporting has a weapon, and you feel their or your safety is at risk then you need to call the police. When contacting the police, inform them of the details to help them respond appropriately e.g. that you believe the person is suicidal or that they are injured.

Tips to help prepare for next time

• Contact your supervisor and provide the details of what occurred in order to obtain advice on future contact.
• If Joyce remains at home after receiving medical treatment and you are concerned about her emotional wellbeing, contact the Mental Health line on 1800 011 511 to find out what support is available.
• Always follow your organisation’s policies and procedures regarding your own and client safety.
• Look after yourself. Speak with your supervisor and ask for help if the situation has left you with feelings of unease. Many organisations will have an Employee Assistance Program where you can talk to someone confidentially.

Resources

Mental Health First Aid: Suicidal thoughts & behaviours: first aid guidelines
This guideline includes outlines how to respond to someone who you think is suicidal.
Type: Guidelines (PDF)
Length: 4 pages
Produced by: Mental Health First Aid

Mental Health First Aid: Non-suicidal self-injury
This guideline provides more detail about self-injury, including what to say and what to avoid saying.
Type: Guidelines (PDF)
Length: 4 pages
Produced by: Mental Health First Aid

Everymind: Conversations Matter
This site provides basic tips to help you talk to someone who may be thinking about suicide. Resources include factsheets, videos and podcasts.
Type: Web page with various resources
Length: Video (15 mins), Fact Sheet (reading time 30 mins), Podcasts (vary between 4 and 16 mins) 

Produced by: Everymind (funded by NSW Health)