LifeSIGNS’ views on Harm Minimisation

In a bid to get more organisations and individuals with personal experience of self-harm involved in the implementation of harm reduction strategies Louise Pembroke – founder of the National Self-Harm Network – sent out an email asking for views on the topic. Below is the LifeSIGNS response to her request.

Harm minimisation is a positive step towards helping people who self-injure / self-harm in a way that is based on core values of being non-judgemental and respectful. Without condoning self-harm itself, it will help to prevent an individual from causing more damage than is intended and also could help prevent physical difficulties overtaking the emotional issues that were the original problem. By providing information on first aid we can empower people to reduce the severity of later scarring, which may have a psychological impact further down the line, or lead to a need for further medical interventions such as plastic surgery.

LifeSIGNS consider Harm Minimisation and SI Reduction techniques to be a good idea, and essential in an in-patient environment. However, whether or not patients are allowed to have tools for self-injury on their person will depend very much upon the particular situation, and each case must be assessed on an individual basis. It would be hoped that “allowing” patients to injure themselves would only be as a last resort, and the patient would agree to try to use alternate coping mechanisms first. It is also hoped that medical professionals would not have to witness an individual hurting themselves.

We think that organisations such as LifeSIGNS could play a role in educating our members and other visitors to our website on things such as first aid (which we already do, but this could be improved or expanded on perhaps). Signposting could be an effective way of providing information – first aid equipment essentials, basic anatomy, infection information, when you really need to seek help or who you can speak to for further advice.

When this issue was first brought to our attention through the news about the RCN conference, our members were all very much in favour of receiving that information, or some kind of mini first aid kit, when presenting at A&E. Surely such info could also be distributed from GP surgeries and pharmacies or through print outs from various websites?

LifeSIGNS already conducts training for healthcare professionals, including those working with inpatients, and such training appears to work best at destroying preconceived ideas of what self-injury is and how to deal with someone suffering with it. We do not currently discuss harm-minimisation to professionals but I think our training could easily be expanded to include the topic and it already drives home the idea that it is not something that can easily be stopped. It seems that once people gain a greater understanding of what self-injury is and what it is like to self-injure, they are more equipped to develop new ways of dealing with self-injuring patients. LifeSIGNS generally views no-harm contracts between patients and therapists as counterproductive.

In summary, LifeSIGNS:

§ trains professional health care workers;
§ promotes Harm Reduction Techniques / Distraction Techniques;
§ supports the concept of Harm Minimisation;
§ does not condone the use of ‘No Harm’ contracts.

As LifeSIGNS is a growing charity and hopes to be one of the UK’s leading organisations raising awareness and support of self-harm, we would hope that one of our directors or members could be part of any committee working to shape policy on this issue. We can also continue our training of healthcare professionals and others who experience self-harm in their daily lives. We could expand our website and our printed literature to include a more in-depth section on harm-minimisation, or aid in distributing already available literature.

One aspect of harm minimisation that was specifically excluded by Dr Mark Hamilton in his presentation at the National Inquiry conference was that of self-poisoning. While self-poisoning, like other methods of self-injury, can vary greatly in severity (and in some circumstances in intent), there may be room to educate people more on the risks of self-poisoning and enabling them to make safer choices. For example, encouraging people to read the leaflet inside boxes of tablets, or even going so far as to say ibuprofen is going to be marginally safer in overdose than paracetamol or aspirin. For other poisons or substances as well as drugs (legal and illegal), TOXBASE (http://www.spib.axl.co.uk/ ) could be involved – and they already link to LifeSIGNS.

All responses are being collated on http://harm-minimisation.org.uk and the LifeSIGNS response should be up in the next few weeks.