Sexual Abuse Reading Centre
A Bill of Rights for Those Who Self-Harm
Self-injurers should receive the same level and quality of care that a person
presenting with an identical but accidental injury would receive. Procedures
should be done as gently as they would be for others. If stitches are
required, local anesthesia should be used. Treatment of accidental injury and
self-inflicted injury should be identical.
When a person presents at the emergency room with a self-inflicted injury, his
or her opinion about the need for a psychological assessment should be
considered. If the person is not in obvious distress and is not suicidal, he
or she should not be subjected to an arduous psych evaluation. Doctors should
be trained to assess suicidality/homicidality and should make decisions about
further psych treatment in the emergency room based on those factors alone;
the fact that the injury was self-inflicted should not be a deciding factor.
No one should subject a self-injurer to a body search looking for evidence of
self-injury. Many of us have been abused; the humiliation of a strip-search is
likely to increase the amount and intensity of self-injury while making the
person subject to the searches look for better ways to hide the marks.
Self-injury doesn't occur in a vacuum. The person who self-injures usually
does so in response to distressing feelings, and those feelings should be
recognized and validated. Although the care provider might not understand why
a particular situation is extremely upsetting, she or he can at least
understand that it *is* distressing and respect the self-injurer's right to be
upset about it.
No care provider should disclose to others that injuries are self-inflicted
without obtaining the permission of the person involved. Exceptions can be
made in the case of other medical care providers when the information that the
injuries were self-inflicted is essential knowledge for proper medical care.
No person should be forced to choose between self-injury and treatment. No
care provider should demand that a no-harm contact be signed; instead, client
and provider should develop a plan for dealing with self-injurious impulses
and acts during the treatment. The client should always be free to use
whatever coping mechanism he or she feels is best at the moment. No client
should be afraid to tell a care provider about an incident of SI.
Those who work with clients who self-injure should keep their own fear,
revulsion, anger, anxiety, etc out of the therapeutic setting. This is crucial
for basic medical care of self-inflicted wounds but holds for therapists as
well. A person who is struggling with self-injury has enough baggage without
taking on the prejudices and biases of their care providers.
No one should be shamed, admonished, or chastised for having self-injured.
Self-injury works as a coping mechanism, sometimes for people who have no
other way to cope. They may use SI as a last-ditch effort to avoid suicide.
The self-injurer should be taught to honor the positive things that self-
injury has done for him/her while recognizing that the negatives of SI far
outweigh those positives and that it is possible to learn methods of coping
that aren't as destructive and life-interfering.
No one should be put in restraints or locked in a treatment room in an
emergency room solely because his or her injuries are self-inflicted. No one
should ever be involuntarily committed simply because of SI.
Most people who hurt themselves are trying to express things they can say in
no other way. Although sometimes these attempts to communicate seem
manipulative, treating them as manipulation only makes the situation worse.
Providers should respect the communicative function of SI.
Reprinted with permission
[ Forums ] [ Book Reviews ] [ Writing Collection ]
[ Resource Links ] [ Offline Resources ] [ Reading Centre ]
[ Recovery Canada Main Page ] [ Postcard Depot ] [ Inspiration of the Day ]