Self-injurious behaviour (SIB) in people with learning disabilities has been the subject of a number of research studies over the years with interesting and varied findings. All acknowledge the prevalence of SIB, but estimates vary in terms of the number of people it occurs in, from around 9% to over 25%, depending on the study.
Those of us working with people with learning disability will probably have witnessed episodes of face slapping, head banging, biting hands, eye poking and gouging, ingesting foreign objects and picking and scratching of skin, among others.
The reasons offered to explain this behaviour range from frustration, to boredom, to communication issues, through attention-seeking and chemical reactions in the brain. What is clear is that most people who witness an episode of severe self-injury in a client do not come away unscathed from the experience themselves.
As one carer described in a recent training session on safeguarding, to experience a physical assault from a service user in crisis is a difficult and frightening experience for staff. However, she felt that it was more distressing for her as a carer to be confronted with an episode of self-injury on the part of a person she was supporting. She explained that to deal with the former required the staff to move away from harm; in the case of the latter, she felt powerless and helpless to prevent the hurt that was being inflicted. Unless staff restrained the person, and even in the process of doing so, further harm was inevitable.
If staff are affected in a negative way by observing and managing self-injurious behaviour, the cumulative effect over time can create risk of ‘burnout’ which impacts on the consistency and quality of care. Employers need to be aware that they have a responsibility to guard against this, and one way to reduce the negative impact of challenging behaviour such as SIB on staff teams is to offer more in-depth training about the causes and management of this with people with learning disabilities.
Research has shown that more enlightened staff, for example where whole-team training in the use of functional behavioural assessment and techniques is in place, the reaction of staff is more measured and the feelings of helplessness reduced. By enabling staff to understand the causes and drivers for SIB, they are more able to rationalise the incident and seek ways to help the service user manage it.
Responsible employers must ensure that their staff are equipped with the skills and knowledge they need to cope with the emotional demands of the job, and are offered the time, space and environment to talk about their feelings when service user’s behaviour puts them under pressure.
Virginia Tyler, RNLD DipNHM MSc – QCS Expert Contributor on Learning Disabilities
