Royal College of Nursing to discuss whether “Self-harmers” should be given fresh blades

http://www.selfharm.org.uk/index.php?section=new&show=News

This story has been discussed quite recently in a number of newspapers and there are some conflicting views on it. In some ways it is quite a controversial move – should nurses who are caring for a patient really be seen to be almost encouraging their patients to hurt themselves?

I think that it is a brave move and I am in favour of it, but I feel the reasoning behind it is a bit confused.

One of the reasons put forward is that it will reduce infection. I’m not sure that infection from using unclean equipment is really known to be that great a problem among people who self-harm. Some people have likened the idea to that of needle exchange schemes, where heroin addicts can obtain fresh needles from pharmacies – thus confusing both the question of addiction by associating heroin addiction with self-harm, and the real extent of the problem of infection. Nor is sharing of blades a known issue in self-harm. It is documented that many people who self-harm know how to take care of their wounds, and will always use a clean blade. However, if the concern really is about infection I would suggest that providing first aid kits or training in wound care would be more appropriate.

Another suggestion made is that when the patient wants to harm themselves another healthcare professional can sit there when they do it, and have the patient talk them through it. I don’t understand this as it appears to forget the fact that self-harm is a highly personal act. That might even be a strong enough deterrant to stop anyone from wanting to do it, though of course it wouldn’t fix the problem. To be expected to allow someone to watch you self-harm is so intrusive that it could well make things worse.

What appears to have been overlooked in the debate is the simple fact that knowing you can have access to blades if you need them may stop you from worrying about the fact that you can’t self-harm. In an inpatient enviroment for instance you can’t just stroll out to buy whatever you need, and it is clear that being told you can’t self-harm does not help anyone actually move on from it. Knowing that you are allowed to self-harm can stop you from focusing on the behaviour and allow you to look at the reasons why you want to do it – instead of feeling the pressure of having your coping mechanism cut off from you, this action will at least validate it until you can find a better way to cope.