Self-harmers to be given clean bladesSarah-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.
