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30 October 2006 @ 06:39 am

Self-harmers to be given clean blades
Sarah-Kate Templeton, Medical Correspondent
NURSES want patients who are intent on harming themselves to be provided with clean blades so that they can cut themselves more safely.

They say people determined to harm themselves should be helped to minimise the risk of infection from dirty blades, in the same way as drug addicts are issued with clean needles.

This could include giving the “self-harm” patients sterile blades and clean packets of bandages or ensuring that they keep their own blades clean. Nurses would also give patients advice about which parts of the body it is safer to cut.

The proposal for “safe” self-harm — which is to be debated at the Royal College of Nursing (RCN) Congress in April — is likely to provoke controversy.

At present nurses are expected to stop anyone doing physical harm to themselves and to confiscate any sharp objects ranging from razor blades to broken glass and tin cans.

However, Ian Hulatt, mental health adviser for the RCN, said: “There is a clear comparison with giving clean needles to reduce HIV. We will be debating introducing a similar harm-reduction approach. This may well include the provision of clean dressing packs and it may mean providing clean ‘sharps’.

“Nurses who encounter individuals who self-harm on a regular basis face a dilemma. Do they go for prohibition? Or do we allow this to occur in a way that minimises harm?”

Hulatt admitted there would be significant opposition: “Some nurses will not support this because our code of practice says we should not do patients any harm. But this may be less harmful than patients using dirty implements. There are mental health units that already allow the use of sterile implements.”

He was supported by Jeremy Bore, vice-chairman of the RCN’s prison forum, who said: “We should give patients clean blades and a clean environment to self-harm and then access to good-quality dressings.

“My instinct is that it is better to sit with the patient and talk to them while they are self-harming. We should definitely give advice on safer parts of the body to cut. It could get to the stage where we could have a discussion with the patient about how deep the cuts were going to be and how many.”

Every year 170,000 people attend hospital accident-and-emergency departments after deliberately harming themselves. A proportion of these do so on a regular basis, sometimes over decades. Many do so to release stress or cope with traumatic events or depression.

Maria Church, mother of Charlotte Church, the Welsh singer, recently revealed she has been self-harming for 17 years. When Maria Church is depressed she cuts her arms and stomach with kitchen knives and razors. She says the harm releases her unbearable tension. Dame Kelly Holmes said she went through two months of self-harming a year before her double gold win in the 2004 Olympics. She cut herself after injuries threatened to ruin her career.

The motion to be debated at the RCN Congress has been put forward by the mental health nursing forum, an RCN division. It states: “Safe self-harm — is it possible? That this meeting of the RCN Congress discusses the nurse’s role in enabling safe self-harm.”

According to proposers of the motion, some nurses already stay with patients while they harm themselves to ensure they do so as safely as possible. One, who declined to be named ahead of the debate, said: “There are some areas of Britain where they have already explored safe self-harm. We may not like someone self-harming, but they are going to do it whether we like it or not and we will need to deal with the problems afterwards.”

If there was sufficient support among nurses and it became RCN policy, it would put pressure on local health trusts to introduce such procedures.

However, Katherine Murphy, director of communications at the Patients Association, criticised the move. She said: “Supplying individuals who self-harm with blades cannot be good for them. Nurses should not be supporting patients to self-harm.

“By giving self-harmers the tools they need, the nurses could be seen as encouraging individuals to harm themselves. We should be doing something to discourage this behaviour.”

An inquiry by the National Institute for Health and Clinical Excellence (Nice) recently found that half of all people who harm themselves are discharged from hospital without proper psychological assessment. Nice revealed doctors sometimes stitched the wounds without anaesthetic because the patients had brought the injury upon themselves.

The number of calls about self-harm to ChildLine has risen by 23% a year over the past decade, to 4,300 in 2004. It said said many children were trying to cope with problems and self-harm gave them a feeling of control or relieved stress.

This is a really interesting topic. On one hand, they're helping reducing the risk of infection for self-harmers. On the other hand, they're enabling the behavior by literally giving them their weapon. It would be less like giving sterile needles to a drug addict and more like giving the drug addict the drug itself.

It seems like it would be a better route to supply self-harmers with only bandages and rubbing alcohol, in addition to teaching them how not to puncture a vein or artery, when they need to seek medical attention, how to prevent infection, etc.

Furthermore, razor blades do a LOT of damage. The deepest cuts and most lasting scars tend to be from razor blades. A self-harmer who generally uses, say, matches or scissors, might be tempted by the idea of a free razor blade and ends up doing more damage than before.

Is it possible to practice safe SI? Do you think we should be provided with sterile razor blades?
Current Mood: pensivepensive
Current Music: Holland 1945 ~ Neutral Milk Hotel
beautifully brokenmiss__confused on November 1st, 2006 03:57 am (UTC)
thats a tought question to answer. i mean i see the importance of posing this question, since most of the things i use are probably not the cleanest methods of cutting. however, i dont use a razor anymore and if i were provided with one i would probably use it again and cause even more damage, depending on how bad i was feeling at the time of cutting. i think its possible to practice safe SI as in being informed which areas would be better to cut at so that its not as dangerous, but i dont think razor blades should be provided, seeing that more harm could come from it.
Scarlet Starletauroralynx on November 1st, 2006 06:48 am (UTC)
I completely agree. There's a lot of good they can do just by telling us what to avoid when we're cutting and how to prevent infection.

SI is impulsive, so they're just catering to the impulse by hand out blades. I don't think they can solve much by making it easier for cutters to get their hands on razor blades.
For instance, I probably wouldn't have half the scars I do today if I didn't have constant access to fresh blades (my mom is a custom framer).
Miss Nikki J: heartbreakladya_lil_spaz on November 1st, 2006 07:49 am (UTC)
i dont think there is such a thing as "safe SI"