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A bill of rights for those who self-harm © Deb Martinson 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. The right to decide what, if any psychological treatment is warranted, 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 make decisions about further psych treatment in the emergency room based on those factors alone; the fact that the injury was self-inflicted should not be a deciding factor. The right to body privacy No one should subject a self-injurer to a body search looking for evidence of self-injury. Many of us have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of self-injury while making the person subject to the searches look for better ways to hide the marks. 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. 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 other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. The right to choose what coping mechanisms they will use No person should be forced to choose between self-injury and treatment. No care provider should demand that a no-harm contact be signed; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. The client should always be free to use whatever coping mechanism he or she feels is best at the moment. No client should be afraid to tell a care provider about an incident of SI. The right to have care providers who are not afraid of SI Those who work with clients who self-injure should keep their own fear, revulsion, anger, anxiety, etc 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. 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 while recognizing 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. The right not to be treated like a dangerous person 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. 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. Top of page Webmaster: wulff@ratatosk.net |