Discussion of harm minimisation for self-harm in Recovery in the Bin


“Harm-minimisation is about far more than clean blades which has a place but I can’t support what Sophie Corlett of Mind says about DBT being a method of harm-minimisation. Cessation of self-harm is often the overt or covert aim of DBT, harm minimisation was never pioneered through service user/survivor activism as a professionally devised behavioural treatment as DBT is.
Professional allies such as the late Chris Holley (fab mental health nurse) also didn’t promote harm minimisation via DBT. She led the Royal College of Nursing debate on ‘safer self-harm’ 11 years ago and consulted activists who had initiated harm minimisation work, their thinking was in unison”.

“For me harm minimisation about recognising that it’s not a standalone approach, it’s not a substitute for emotional/psychological/social support. It should never be forced but offered, as no approach suits everyone. It can cover a wide number of areas such as; exploring our own ways of how we look after ourselves, what constitutes care to us (self/others). What presses on us to SH. Plain language & diagrams of anatomy & physiology – to attempt damage limitation you have to know what you’re looking at & basic function ie tendons attach muscle to bone. ‘Safer’ SH such as direction (deep latitudinal injuries can be riskier than longitudinal), blunt implements on leather-like scar tissue can be more dangerous with increased pressure, slowing down, being sober.
Knowing the limits of harm minimisation i.e. with overdoses there’s no ‘safe’ amount, sometimes people are not aware of cumulative damage or lack of symptoms & potential life changing/threatening damage occuring. First aid, wound care, blood loss, infection, temporary makeshift dressings, knowing when it really is advisable to get medical attention”.

“Scar minimisation with wound care, after care, scar minimising products, Skin Camouflage makeup (making it clear that the option doesn’t mean we shouldn’t feel OK about and wear our skin however it looks), creative dressing for scars for people who want options for concealment. Managing others reactions to scarring in social situations and especially with health profs as they tend to be the most judgemental. Scarring in relation to further injuries and the options & limits of surgical scar revision. Crisis planning (for A&E, MH), the use of harm description and treatment and needs proforma’s, and exploring potential personal compromises with one’s self-harm ie placing blade other side of visible structure which if damaged could mean surgical repair or worse. These are a few example areas”.

“For professionals, harm min is not throwing dressings at people and telling them to get on with it, everyone has the right to have their wounds (regardless of surgical severity) to be medically attended to”.

“Harm min has no age or diagnosis limit, the principles are the same whether a person has a diagnosis of depression, BPD or psychosis. Self-harm occurs in people of ALL diagnoses (or none). Obviously with a child it has to be age appropriate. A psychologist once referred to the need to ‘give permission’ to a boy under 10 who was harming his genitals which is of course very dangerous, to harm elsewhere.
I remember her also referring to changing a teenagers ligature to stretchy socks & support workers being taught how to cut them down, so she was not prohibited from harming but assisted to stay alive with practical and psychological support”.

“Even with suicide, harm minimisation has a place, most people whether they’re self-harming or attempting to die don’t typically want to be left with life changing disability such as loss of mobility”.

“No self-harm is risk free but harm minimisation can assist some people in having increased choices without prejudice or judgement as to where they are and where they want to be. Demanding cessation is unhelpful because unless we have something better to offer what right do we have to make that demand. The lifesaving function of self-harm is often overlooked, as in self-harm can prevent suicide, but equally people who self-harm do die by suicide and can be left with no support despite the high correlation between experience of self-harm and suicide. There’s also ‘overlap’ between self-harm and suicide, and there is often ambivalence even with the most (expected) lethal methods”.

“Harm minimisation is NOT the holding of ice cubes or Dialectical Behaviour Therapy (DBT). DBT is a spurious diagnosis specific behavioural intervention which can seek cessation as a goal.I resent DBT being framed as a form of harm minimisation, and mental health services are now driven by an approach of endless ‘distraction lists’ as a ‘therapy’, standalone intervention, or in the name of harm minimisation. This has influenced service user groups”.

“Harm minimisation also isn’t ‘method sharing’ or promoting self-harm as a ‘lifestyle choice’ or ‘sitting in a sick role’. There are examples of harm minimisation within addiction services although I wouldn’t personally define self-harm as addiction, be that psychological or endorphin provoking (which makes unevidenced assumptions about intent and experience of pain)”.

“Thank you I really appreciate your sharing this. It’s empathetic, de-shaming as far as possible ,if that’s a word, fact-based and responding in detail to people’s actual needs. What I got from the article was business-as-usual, but replacing confrontations with offers of clean blades. Not acceptable clearly”.

“Yes I think just dishing out clean blades is a travesty. That has a place (secure services/prisons notably) but WITH an awful lot more around it!”.

“To me harm minimisation is a very personal and progressive process where someone is supported to think about what they want to change/stay the same and then time taken to explore what self-harm means for them and what if anything they would like to do differently and can this be done more safely. Only agenda to support and validate, no mention or aim of stopping”.

“Yes, that’s it!
I really hope we never go back to “no self-harm contracts” ever again where support was withdrawn or forced if the service user self-harmed”.

“Treating the person with respect and never making them feel ashamed might help reduce harm escalation?”

“Most definitely, I’ve always felt that poor or punitive responses actually increase the risks”.

“I think this is so important – providing information so people can make informed choices which might be to SH, to SH more safely or not”.

“A&E tend to see cutting as performing some kind of hobby. I think as well as the physical wound care we also deserve to have the psychological support that tends to be withdrawn where there is repetition of self-harm. The original article and research paper doesn’t make clear that self-harm, and to a severe extent, does happen outside of inpatient settings and there is next to no support for this let alone an admission where anyone stops or allows self-harm”.

Some further reading: