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A professional nurses group is proposing that “self-harming” patients who are intent on mutilating themselves be given clean blades, bandages and “how-to” advice so they can cut themselves more safely.

The proposal for “safe” self-harm will be debated in April at the Royal College of Nursing (RCN) Congress and is expected to prove controversial.

Current practice mirrors what most people expect of the medical profession – stopping anyone from harming himself and removing any sharp objects that could be used to cut the skin.

According to the National Mental Health Association, self-harm – also termed self-mutilation, self-injury or self-abuse – is defined as the “deliberate, repetitive, impulsive, non-lethal harming of one’s self. It includes: 1) cutting, 2) scratching, 3) picking scabs or interfering with wound healing, 4) burning, 5) punching self or objects, 6) infecting oneself, 7) inserting objects in body openings, 8) bruising or breaking bones, 9) some forms of hair-pulling, as well as other various forms of bodily harm. These behaviors, which pose serious risks, may by symptoms of a mental health problem that can be treated.”

Maria Church, mother of Charlotte Church, the Welsh singer, recently revealed her 17 years of self-harming behavior. During times of depression, she cuts her arms and stomach with knives and razor blades, and it relieves “unbearable tension” for her, reports the London Times.

It’s those like Church advocates of clean blades are hoping to help.

RCN’s Jeremy Bore supports the proposal. “We should give patients clean blades and a clean environment to self-harm and then access to good-quality dressings,” he said

“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.”

Ian Hulatt, mental health adviser for the RCN, sees a parallel to the similar proposal to give hypodermic needles to drug users to prevent the spread of AIDS through shared needles.

“There is a clear comparison with giving clean needles to reduce HIV,” he said. “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 minimizes harm?”

According to one unnamed source, some nurses already do what is being proposed. “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.”

Hulatt is prepared for opposition from others in the profession. “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.”

The UK’s Patient Association has come out against the proposal. “Supplying individuals who self-harm with blades cannot be good for them,” said the group’s director of communications. “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 behavior.”

Research indicates self-harm is most common among girls aged 15 to 19, but rates are reported to be rising among men in their early twenties. For some, the condition continues for decades.


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