Applying harm reduction to self-harm

Harm reduction is most often used in reference to addictions.  The idea is to accept that the user is continuing to use because that is what’s currently most able to meet their needs, and then identify ways in which they can do so that minimizes associated harms.  Harm reduction is a widely accepted public health approach, and in addiction can include safer smoking/injecting supplies, opioid substitution therapy like methadone, and supervised consumption sites.

The concept of harm reduction is also applicable to self-harm.  Harm reduction strategies can decrease associated complications while ideally working on the underlying problems that contribute to the self-harm behaviour.  A journal article I found on self-harm said that while harm reduction is a beneficial approach, service providers may be reluctant to embrace it because they don’t want to come across as encouraging self-harm or giving people ideas about the most dangerous places to cut themselves.  The thing is, though, those ideas are already there well before the health care provider starts talking about them.  In my work as a nurse I’ve done some harm reduction teaching before with clients who self-harm, and it seemed like a way to acknowledge and accept their reality and their struggles.

The National Self-Harm Network publishes a guide called Cutting the Risk: Self-Harm, Self-Care and Risk Reduction.  The guide covers anatomy, including the locations of major veins and arteries and different types of tissue, including the consequences of cutting through each type.  It is not sensationalistic about this, but rather very matter-of-fact.  Other topics include wound care, infection prevention, ways to manage bleeding, caring for burns, and advice on when to seek medical help.  The guide recommends first aid supplies to have on hand.

The National Self-Harm Network also has a Harm Yourself Less Workbook that is written by people who self-harm.  It asks a lot of reflective questions to help people explore all aspects of their self-harming experience.  This can be used as a personal learning and growth tool, or it can be worked on with a therapist to enhance the impact.

For harm reduction to happen, the first step is that we need to actually talk about self-harm.  There is so much stigma around it, and it tends to dwell in the shadows because many people don’t understand it and aren’t willing to hear about it.  And of course if people aren’t willing to hear about it, then it’s pretty hard for anyone to talk about it in a constructive way.

In the spirit of talking about it, I’ll share my own, albeit limited, experience.  I went through a phase of self-harm during my first episode of depression over 10 years ago.  It began when I was in hospital, and wanted to distract myself from distressing thoughts, particularly thoughts of suicide.  I didn’t have access to much on the ward, so I would use staples that I picked off a bulletin board.  I used the staples to scrape lines across my skin.  I figured out that if I did it close to joints, especially my shoulders, I would get a distracting twinge of pain every time I moved.  It was certainly a maladaptive behaviour, but in the moment it was effective.  I continued the self-harm for a few weeks after discharge, but as the depression improved, the suicidal thoughts decreased, and I no longer felt the need to self-harm in order to cope.  It wasn’t something that ever made a reappearance in subsequent episodes of depression.

I think there was only ever one person I ever told about my self-harm.  I disclosed it to a coworker/friend that I was close to and who already knew about my depression.  We’d been talking about a client self-harming.  For whatever reason I decided to bring up my own experience with it, and he quickly cut me off, saying he didn’t want to hear that from me.  Um, okay.

Silence is not a good thing when it comes to mental health.  Self-harm happens.  Even if people don’t like it, it’s reality.  It’s a reality that needs to be talked about rather than buried under a layer of fear.  Addressing self-harm is complicated and multi-faceted, and harm reduction can be one way to help keep people safer while getting at the core issues.

Is self-harm something you’ve struggled with?  Have you incorporated harm reduction strategies?

 

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24 thoughts on “Applying harm reduction to self-harm

  1. BeckiesMentalMess.wordpress.com says:

    Interesting post, Ashley.
    Ever since I met with my therapist last week, and she said that my Trichotillomania was a form of self-harm (After she saw my nails), I honestly never saw that as a form of self-harm. After reading your post, I understand now (Even more so) that it is.
    I saved “The Harm Yourself Less” to my desktop in order to read through more thoroughly. Thank you, for sharing this valuable information!

  2. yourroyalhealness says:

    Thank you for sharing! This was very insightful. I agree, self-harm needs to be talked about….there’s so much stigma and fear surrounding mental health still, people often don’t realize how common it really is. Thank you so much for sharing your story and talking about this important topic!

  3. Meg says:

    Your coworker sounds like a jerkface. Grrr.

    I agree that self-harm needs to be brought into the light. I have scars all over my wrists and my forearms. Fortunately, I haven’t wrestled with it for over ten years. God bless.

    Thank you for sharing your story!!

  4. lavenderandlevity says:

    “Stereotypical” self-harm that might leave a visible scar was, well, visible. I always knew that and the risk of discovery scared me away, so I never engaged in those behaviors even at the age of highest risk for starting them while living in the 9th Circle of Hell as a kid. I did/do understand the commonly stated motivations, though. I also was always very indifferent to my own well-being to the degree that, even without chronic illness, I would be jeopardizing my own health. With the added clumsiness and lack of proprioception of undiagnosed EDS, I could easily neglect myself into pain levels high enough to snap me back to reality, and probably unwittingly was using that as a version of dissociation management in the worst periods for periods of my life. No one, including me, was the wiser. Only last year did I really start actively processing that connection. Does that count as SH? Not in the traditional sense, which is why it never drew attention and it was so easy to default to. Unlearning those behaviors and trying to actually *practice* the self-care and illness management required to have a future with diagnoses that progress without such active management has turned out to be *really* hard, though between ADHD in general and that link that I defaulted to literally just neglecting myself into a flare to counteract emotional numbing. It’s hard to manage dissociation in ways that don’t exacerbate pain and further injury when just being indifferent to the point that the pain from “unintentional” injury wouls snap me back to reality was my default. I’ve seen articles on places like The Mighty about “Behaviors I didn’t realize were SH.” I check an uncomfortably high number of boxes on those types of checklists if I’m being honest with myself. So, I guess I don’t know whether I feel like I have personal experience or how to engage with the topic of “SH” as most often discussed, exactly. But, in a lot of ways *unlearning* active self-neglect and trying to replace it with active self-care feels like harm reduction. I still am not great at it, but given the prognosis if I don’t start to change my default habits, I’m trying to minimize old habits and also learn ways of dealing with crises and trauma that don’t end up compounding physical issues. If you are diagnosed with an autoimmune disorder, you might have to go through the same difficulties when your depression is at its worst. It’s *not* fun, but important. Hugs.

    • ashleyleia says:

      Even though self-neglect doesn’t often make it into typical discussions about self-harm, it all falls under the same umbrella of maladaptive coping strategies. I think unlearning “bad” strategies is even harder than learning new ones.
      Hugs back at you.

  5. Carol Anne says:

    Yes! We’ve struggled a lot with this. Self harm was a way of life for us for many many years. Its not so much now. Occasionally we slip, but not doing it on a regular basis now. The urges are still there though for some insiders. xx

  6. Barb says:

    I’ve struggled with this off and on, usually during depressive episodes. I agree — self-harm should be brought into the open.

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