Jeremy Vine will be talking to Wedge (from FirstSigns) and Jenifer (an NHS consultant nurse) about ‘assisted’ self-harm within hospitals, mental health units and long-term care establishments, whereby a person is ‘allowed’ to hurt themselves under certain circumstances, and provided with clean implements to do so.

• Monday 16th November 2009, 1pm
• BBC Radio 2 , Jeremy Vine

We blogged a little when we noticed that the newspapers were calling it ‘assisted’ self-harm which we feel is a confusing term. No one is suggesting that health-care professionals should help a person hurt themselves, rather, we are simply saying that health-care professionals must recognise that they cannot tell a person to ‘stop‘ hurting themselves without first supporting that person to develop and learn new ways of coping with distress.

Self-injury is a valid coping mechanism, and when a person has nothing else to rely on, we should respect that the person has a right to hurt themselves, and that other people do not have a right to stop them. Other people’s care and concern should be expressed in positive support, not negative denial. Positive support includes helping a person move away from self-injurious behaviour over a period of time, learning new things to rely on, and working on the underlying issues.

We must not over-simplify this complex issue; we must focus on the underlying cause of distress and not merely the act of self-injury as a person seeks relief and release. We shouldn’t just assume this is all about cutting either – self-harm is a wide topic, and self-injury can take the form of banging and other ‘easy to do’ behaviours, so it’s not right to focus on ‘giving people razor blades’ because that’s not the whole story here.

Wedge will be saying that it’s not about being ‘allowed’ to hurt yourself, it’s about recognising that we shouldn’t tell people to ‘just stop’ before they’ve been given alternative ways of coping.

It’s a complex subject; certainly people in care need help to move away from self-harm, but forbidding people to use self-injury isn’t the only way forward.

No one is suggesting the need to hand out razor blades carte blanche. We are saying that, as a part of a written and agreed care plan with the patient, there may be times when a person hurts themselves, and that occurrence shouldn’t be punished or forbidden. No one is saying that self-injury should be an easy option, no on is saying that self-injury is the right choice; we’re saying that as a last resort, after discussion, after alternatives have been tried, after counselling, after time, after thought, after all the steps in a person’s care plan have been addressed, self-injury (and then self-care and med attention) may be a stage a person needs. The next stage would be emotional debrief, lessons learnt and counselling.

As part of a structured care plan, created with the individual for the individual, self-injury (and the reduction of reliance upon it) has to be dealt with in a positive manner, not simply denied as if it doesn’t exist.

Ingrained behaviour, habitual long-term behaviour cannot be changed  on ‘Admissions Day’ – these things take time. It is wrong to dis-empower a vulnerable person and forbid them their release and relief before supporting them to make new choices.

We can leave self-harm behind; it takes time and effort, but we can make new choices for ourselves – please help us make these choices, don’t make them for us.