Risk and responding to self injury: is harm minimisation a step too far?

Abstract

Purpose The purpose of this paper is to consider some of the legal implications of adopting a harm minimisation approach in supporting people who self-injure within inpatient mental health units. It is argued that a focus on risk and the increasing influence of the law and legal styles of thinking often associated with the allocation of blame have produced a more risk adverse clinical environment. As a result health professionals are more likely to err on the side of caution rather than engage in practices that although potentially therapeutic are not without their risks. Design/methodology/approach The analysis draws on the clinical, philosophical and legal literature to help understand how harm minimisation may support people who self-injure. It considers some of the complex medico-legal issues that arise in a clinical environment dominated by risk. Findings A focus on risk and accountability has produced an environment where the law and legal styles of thinking have come to influence practice. This is often associated with blame in the minds of the health professional. Given the legal obligation to prevent suicide, health professionals may take a conservative approach when working with people who self-injure. This makes the adoption of harm minimisation difficult. Originality/value This paper provides a legally informed analysis of some of the challenges associated with using harm minimisation techniques with people who self-injure. It adds to the literature regarding this area of clinical practice.

Young Peoples’ Perspectives on the Role of Harm Reduction Techniques in the Management of Their Self-Harm: A Qualitative Study

“…Similarly, participants' concerns over misuse of anatomical information were consistent with an associated study in this research program, interviewing parents of young MAB clients and practitioners (Bamber et al, in preparation), highlighting parental concerns about the potential for anatomical information to promote extreme self-harm or death. Similar professional concerns have been reported by Sullivan (2017;2019), andJames et al (2017), emphasizing the need for caution when teaching this particular strategy to high-risk populations.…”

“…This approach recognizes self-harm as a means of coping with distress (Madge et al, 2011) whilst rejecting traditional preventative strategies thought to introduce unrealistic expectations (Kelly, Jorm, Kitchener, & Langlands, 2008;Inckle, 2011) and behavioral escalation (Holley, Horton, Cartmail, & Bradley, 2012). However, there are ethical concerns about advocating 'safer' forms of self-harm, including concerns amongst professionals that failing to prevent injury might constitute a breach of duty of care (Sullivan, 2017) and encourage self-harm whilst neglecting underlying psychological causes (Sullivan, 2019). Also, whilst some clinicians feel comfortable advising on wound-care, they are less willing to provide anatomical information or sterile razors (Hosie & Dickens, 2018), due to the potential to escalate risk of harm (James, Samuels, Moran, & Stewart, 2017).…”

Should psychotherapists conduct visual assessments of nonsuicidal self-injury wounds?

“…NSSI is a significant risk factor for attempting suicide (Franklin et al, 2017) and may influence some psychotherapists to err on the side of caution (i.e., suicide prevention; Sullivan, 2019) to visually assess wounds. Indeed, recent research has revealed that many psychotherapists experience fear and anxiety about the possibility that NSSI may result in suicide or unintentional death (O’Connor & Surgenor, 2023).…”