I've talked to a fair number of failed suicides in ITU and A&E over the years. The reasons for self-harm are as multifarious as the human beings themselves as far as I can see. It's not possible to generalise. I've been wretched enough myself to contemplate the act, and to plan it out in great detail, but have never proceeded beyond planning, again for all sorts of reasons. To those who see the unsympathetic side of nurses, it's unfair (and unprofessional) to be judgemental about patients. The trouble is that nurses see the manipulative side of self-harm, and those are the ones that stick in the mind. The thirteen-year-old girl who OD'd on aspirin only because her friend did so, and got lots of drama and attention, and she didn't want to be left out. The tetraplegic who got that way because she thought it was safe to win an argument with a partner by throwing herself out of a ground-floor window and landed awkwardly. The woman who hung about outside the psych unit at shift-change times threatening to throw herself in front of parked cars; she was desperate for readmission and the unit was the only home she knew. The woman who OD'd on Senokot because she wanted to go live with her daughter, who didn't want her, and had nothing else to OD on. These people are just as much in need of help and support as any other self-harmer, I know that. But boy, do you sometimes want to bang their heads together.