Some people who self-harm should be provided with sterile razors, says a mental health expert in the Journal of Medical Ethics. Patrick Sullivan, of the University of Manchester, argues that this approach may be more respectful of patients’ autonomy.
He suggests that a harm-minimisation strategy for self-harming individuals could include provision of sterile cutting implements, education on how to self-injure more safely to avoid blood poisoning and infection, as well as therapy and alternative coping strategies.
Sullivan argues that high rates of self-injury among people admitted to mental health units suggest that the standard method of dealing with this behaviour–forcibly stopping them–doesn’t work.
People who self-injure do so because the negative feelings they experience threaten to overwhelm them: injury reduces tension and increases control, providing a coping mechanism. Infringements of this are likely to be seen as confrontational and distressing rather than therapeutic, he contends. These patients usually understand the nature and consequences of their actions, so denying them this freedom thwarts their autonomy.
“Where the risks of serious injury are low, limitations on basic freedoms are more difficult to justify,” he suggests. Restrictions could even make the problem worse; many of those who injure themselves have a history of abuse or trauma, and stopping them from doing it could intensify their feelings of powerlessness.
“This increases the risk that individuals will self-injure covertly, in more dangerous ways, or attempt suicide,” he contends, citing anecdotal evidence indicating the increasing use of other forms of self-injury, such as hanging, among those in mental health units who prefer to cut their skin.