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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
anaesthesia should be used. Treatment of accidental
injury and self-inflicted injury should be
identical.
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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 behaviour alone
is rarely warranted.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
