Self-harm and moral codes in emergency departments in England
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Self‑harm and moral codes in emergency departments in England Mark Cresswell1
© Springer Nature Limited 2020
Abstract This article uses a theory of ‘moral codes’ to analyse the treatment of non-fatal selfharm in emergency departments in the NHS in England. It argues that self-harm has historically been the object of various moral classifications ranging from criminality, to immorality, to mental illness. In the contemporary situation, these classifications are highlighted in two areas of health and social policy: first, in terms of the implementation of the National Institute of Health and Care Excellence’s clinical guideline on self-harm; second, in terms of the application of Section 136 of the 1983 Mental Health Act to individuals who self-harm or who are at risk of self-harm and are brought to emergency departments by the police. The main influences upon the theoretical framework employed are Durkheim, Parsons, especially his concept of the sick role, and Alexander. Keywords Emergency departments · Moral codes · Moral relativism · Self-harm · Sick role
Introduction This article uses a theory of ‘moral codes’ to analyse the treatment of individuals with mental health conditions1 in health institutions in England. It focuses upon one such condition, non-fatal self-harm, and analyses its treatment in accident and emergency departments (EDs)2 in the National Health Service (NHS). EDs are selected 1 The term ‘mental health condition’ is used in this article to refer to a wide range of mental illnesses, disorders and symptoms. 2 Accident and emergency departments will be referred to as emergency departments and abbreviated to EDs for the rest of this article.
This article is part of the following special issue - Self-Injury in Social Context. * Mark Cresswell [email protected] 1
Bath Spa University, Corston Building, Newton Park Campus, Bath, UK Vol.:(0123456789)
M. Cresswell
for analysis because they deal with high statistical rates of self-harm which elicit specific social reactions from healthcare staff. Self-harm is here defined, following the National Institute of Health and Care Excellence (NICE) as ‘acts of intentional self-poisoning or self-injury irrespective of type of motivation’ (2011, p. 5) and this includes taking an overdose of medication (self-poisoning) and the cutting of the body with a sharp object (self-injury). The source material for this analysis includes sociological research, epidemiological and clinical studies, health and social policy documents, and the literature emanating from the service user, or ‘survivor’ social movement (for example, the National Self-Harm Network [NSHN] 2000). Moral code theory draws upon a sociological tradition that began with Durkheim (1926), includes Parsons (1951), especially his concept of the sick role, and has its most recent rendition in Alexander’s (2006) cultural sociology. The theory asserts that mental health conditions are surrounded by moral attitudes and values which are expressed in social reactions to that condition. Stated as
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