Sunday, 30 September 2012

The Bill of Rights for Those who Self-Harm

The following was created by Deb Martinson and published on her website "Secret Shame".  Sadly, each of the following rights were established because of mistreatment of individuals who self-injure by medical and mental health professionals. ~ ADMcC
  1. The right to caring, humane medical treatment.
    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.
  2. The right to participate fully in decisions about emergency psychiatric treatment (so long as no one's life is in immediate danger).
    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 realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted.
  3. The right to body privacy.
    Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient's dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks.
  4. The right to have the feelings behind the SI validated.
    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.
  5. The right to disclose to whom they choose only what they choose.
    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 team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional.
  6. The right to choose what coping mechanisms they will use.
    No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SI or be kicked out of outpatient therapy. Exceptions to this may be made in hospital or ER treatment, when a contract may be required by hospital legal policies.
  7. The right to have care providers who do not allow their feelings about SI to distort the therapy.
    Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety 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.
  8. The right to have the role SI has played as a coping mechanism validated.
    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 as well as to recognize 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.
  9. The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
    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; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality.
  10. The right to have self-injury regarded as an attempt to communicate, not manipulate.
    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 and assume it is not manipulative behavior until there is clear evidence to the contrary.
© 1998-2001 Deb Martinson. Reprint permission granted with proper credit to author.


  1. The whole issue of SI has been vilified, maligned, and dismissed in ways which re-injure and re-traumatize. At the very least, the medical professionals who encounter SI patients, if they abided by their own code of ethics and professional integrity would make #1 a moot point. How very sad that this is necessary.

  2. Agreed Susannah - it was the heartbreaking stories I encountered amongst the world-wide self-injury support community that awakened my passion to learn and educate about NSSI. It is no wonder that so many people who struggle with self-injury do not seek help to overcome it.

    I am hoping that efforts such this blog and others will provide the educational opportunities to raise awareness about NSSI not only in the mental health & medical communities, but amongst parents and peers as well.

    March 1st of each year is Self-Injury Awareness Day - I invite all to wear orange that day to show your support.