Self-harmers to be given clean blades
Sarah-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 RCNs 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 nurses 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.
