Certain mental health patients should be allowed to self-harm to ensure cooperative participation in care and avoid more severe behavioral outbursts, according to a clinical ethics paper written by a researcher with experience in mental healthcare and published in BMJ.
In the paper, Patrick Sullivan, a PhD student at the Centre for Social Ethics and Policy at the University of Manchester in England, argues interventions designed to stop patients from self-injuring can often do more harm than good.
"The first problem with a preventative strategy is that it can exacerbate rather than contain the problem," writes Mr. Sullivan. "Self-injury is used as a coping strategy to release emotional tension ... The behavior provides a positive relief from distressing feelings that threaten to overwhelm the person. Preventing such behavior arguably deprives an individual of an important coping strategy and may increase his or her level of distress."
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Mr. Sullivan goes on to argue in favor of a technique he describes as harm minimization. This technique may involve identifying patients who would benefit from being allowed to self-harm if they agreed to participate in therapy and received education on how to harm more safely. However, Mr. Sullivan is not in favor of allowing patients to self-harm who seem likely to put their own lives in danger.
Dr. Martina Di Simplicio, a member of the United Kingdom's Medical Research Council who works with self-harm patients, argued Mr. Sullivan's proposed harm minimization techniques could allow self-harm habits to escalate over time, according to The Independent.
"As a general rule, we cannot just let self-harm just take its course — making it safer via sterile razors, for example, won't stop the risk of escalation," said Dr. Simplicio. "Harm reduction may not work for everyone: most people experience ambivalence between feeling initially better after self-harm and then worse because they've done it. Some people say that if they don't have the means, they sometimes end up not self-harming; so learning that they actually can tolerate and cope with distress better than they expected can help."
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