Safer self-harm resource

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This resource contains information which may be useful for performing care or advocacy work, or describes overall policy and principles.

This resource is under review, and has not been accepted.

We are currently gathering feedback and editing this resource, and there may be errors or bad wording. Please only use this resource with caution, and if other organisations have definitive protocol, use that instead.

Please see #protocols on Slack to discuss this protocol further.

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This is a resource for people who are self-harming, or people who are supporting someone who is self-harming. It discusses how you can reduce the risk that your injuries will cause life-threatening harm or long term damage.

This page covers techniques for injuring yourself more safely. Also see 'First aid for self-harm' for more information about how to prevent lasting damage by treating injuries, and how to identify signs that you need medical help.

Preventing infection

  • If you plan to break the skin, wash the area beforehand with soap and water, and rinse under running water. This is to remove any bacteria which could otherwise enter the wound.
  • If you are cutting, use a fresh, sterile blade whenever possible. You can get sterile surgical blades online from websites such as Medisave.
  • If this isn't possible, you can disinfect your tools by one of the following methods:
    • Soak in 70% rubbing alcohol. If possible, it should be left to soak for 10 minutes.[1]
    • Immerse in boiling water, or steam it over boiling water. If possible, it should be left to boil for 5 minutes, but boiling for a shorter time is still better than nothing.[2]
  • If none of these options are possible, clean the blade thoroughly under running water before and after every use.
  • Never share blades, even if you have boiled them.

Anticoagulant drugs

  • If you are taking medication which slows the rate at which blood clots form:
    • a cut will bleed for longer than usual. This means you will end up losing a larger quantity of blood.
    • banging or hitting yourself will also result in more severe bruising than usual, since bruises are caused by broken blood vessels beneath the skin
  • Aspirin is the most common example - try to avoid self-injuring after taking this.
  • Check the packet instructions before self-injuring for the first time after taking a new medication. If it is described as an anticoagulant or antiplatelet, be aware that your injuries are likely to bleed or bruise more heavily.
    • Medication prescribed after a heart-attack, stroke or deep-vein thrombosis is likely to be anticoagulant. However, this may also be an unintended side effect of other medications.

Burns

  • Try to avoid existing scar tissue. The scar of a previous burn may be less sensitive to pain, so you may end up hurting yourself more badly than you intended. Scarred skin will also be slower to heal.[3]
  • Try to avoid joints (e.g. elbows or knees). As the burn heals, the tissue may contract, which could affect your ability to move the lim. For the same reason, try to avoid burning your hands.
  • Don’t burn all the way around your arm, leg, finger or toe. A burn which completely encircles a limb could constrict your circulation, risking serious permanent damage.
  • If you can, try to leave blisters intact. Damage to a blister increases the risk that the burn will become infected.

Cuts

  • Avoid major blood vessels. Arteries carry blood at high pressure from the heart: if you puncture one, this will cause life-threatening bleeding. Punctured veins can also lead to heavy blood loss.
    • It’s safest to cut the fleshy parts of the body, e.g. the outer arms, the outer thighs, or the calves.
    • In particular, try to avoid the following areas: neck, wrists, inner elbows, groin, back of knees, ankles, top of the feet.[4]
  • Try to avoid tendons. Tendons are thin cords which connect the muscle to the bone, allowing you to move. In some parts of the body they lie close to the surface of the skin. These are mostly the same areas that contain major blood vessels.
    • When possible, avoid the following areas: neck, back of the hands, wrists, inner elbows, groin, back of knees, ankles, top of the feet.
    • If you do cut in one of these areas, cut longwise, rather than across. Horizontal cuts are more likely to sever a tendon and cause mobility damage.[3]
  • Try to avoid existing scar tissue.
    • Scarred skin may be tougher to cut: this means that you may need to apply more pressure, and end up cutting deeper than you intended into the underlying tissue.
    • Skin which is already scarred will also be slower to heal.[3]
  • Try to use straight-edged blades. Injuries with jagged or serrated edges will heal more slowly and be more likely to get infected.

Banging/hitting

  • The safest places to bang or hit are the fleshy parts of the body, e.g. the outer arms, thighs or calves.
  • Areas where the bone is close to the surface, such as wrists, collar bones or hipbones, are more likely to be fractured.
  • Try to avoid joints (e.g. elbows, knees, ankles), since damage to the tendons here could affect mobility.
  • Punching or kicking a hard surface without padding may fracture your fingers or toes, but may also cause elbow or knee injuries due to the jarring effect of the impact.
    • To reduce the risk of a fractured thumb when punching, always make a fist with the thumb on the outside of your other fingers, not the inside.
  • Apart from the spine, the upper back is relatively safe, but a blow to the lower back could cause injury to the kidneys.
  • Blows to the front of the abdomen could also injure your internal organs.
  • It's very dangerous to hit the spine or the back of the neck: this could cause injury to your spinal cord, resulting in paralysis or even death.
  • Banging your head for a prolonged period is more likely to leave you with concussion than if you hit your head with the same amount of force but for a shorter time. Concussion develops when the brain is shaken inside the skull: the longer the period of shaking, the higher the risk.
    • If you start feeling dizzy, sick or confused, this suggests that you are hitting your head hard enough to cause concussion. If you continue beyond this point, you are likely to cause more damage.

Overdoses/poisoning

  • It isn't possible to state a ‘safe’ overdose of any drug, since each person’s reaction will be different.
  • Even if you previously took an overdose with no obvious permanent damage, you can't assume it will be safe to take the same quantity again. The previous overdose may have damaged your liver, leaving it less able to deal with the toxins.[3]
  1. 'Comparing Different Disinfectants', Stanford Environmental Health and Safety; Accessed: 2020-09-17
  2. Jennie Wilson, 'Infection Control in Clinical Practice', 2019 edition
  3. 3.0 3.1 3.2 3.3 National Self-Harm Network, 'Cutting the Risk'; Accessed: 2020-09-17
  4. 'Skills - Taking the Pulse', Nursing Times 99,14; Accessed: 2020-09-17