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, a local anaesthetic should be used.
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 sucidality.homicidality and should realise that although referral for outpatient follow up may be advisable, hospitalisation for self injurious behaviour is rarely warranted.
Visual examinations to determine the extent of injury should be performed only when absolutely necessary and done in a way that maintains the patients 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.
Self injury doesnt 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 may not understand why a particular situation is extremely upsetting, she or he can at least understand that it "is" distressing and respect the self injurers right to be upset about it.
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. Gossiping about any patient is unprofessional.
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.
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.
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 honour the positive things that self injury has done for them, while recognising 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.
No one should be put in restraints of locked in a treatment room in an ER solely because his or her injuries are self inflicted. No one should ever be involuntarily committed because of SI; physicians should make the decision to commit based on psychosis, suicidality or homicidality.
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 behaviour until there is clear evidence to the contrary.
