Safer self-harm resource

This resource contains information which may be useful for performing care or advocacy work, or describes overall policy and principles.

This protocol is a draft. It has not yet been accepted as protocol and may be incorrect or poorly cited. Please do not use this in your work until it has been accepted.

Please see #protocols on Slack to discuss this protocol further.

This document needs review by medical professionals before it is adopted. If you are a medical professional, please use this form to provide feedback

More documents in need of medical review can be found here.

This is a resource for people who are self-injuring, or people who are supporting someone who is self-injuring. It discusses how you can reduce the risk that this will cause life-threatening harm or long term damage.

Preventing infection

• If you plan to break the skin, wash the area beforehand with soap and water, and rinse under running water. This is to remove any bacteria which could otherwise enter the wound.

• If you are cutting, use a fresh, sterile blade whenever possible. Sterile surgical blades are available online from websites such as Medisave.

• If this is not possible, blades and other implements can be disinfected by one of the following methods:
  • Soak in 70% rubbing alcohol. If possible, it should be left to soak for 10 minutes.
  • Immerse the implement in boiling water, or steam it over boiling water. If possible, it should be left to boil for 5 minutes, but boiling for a shorter time is still better than nothing.

• If none of these options are possible, the implement should be cleaned thoroughly under running water before and after every use.

• Never share blades, even if you have boiled them.

Anticoagulant drugs

• If you are taking medication which slows the rate at which blood clots form:
  • a cut will bleed for longer than usual. This means you will end up losing a larger quantity of blood.
  • blunt force injuries will also result in more severe bruising than usual, since bruises are caused by broken blood vessels beneath the skin

• Aspirin is the most common example - try to avoid self-injuring after taking this.

• Check the packet instructions before self-injuring for the first time after taking a new medication. If it is described as an anticoagulant or antiplatelet, be aware that your injuries are likely to bleed or bruise more heavily.

• Medication prescribed after a heart-attack, stroke or deep-vein thrombosis is likely to be anticoagulant; this may also be an unintended side effect of other medications.

• Synthetic cannabinoids (drug blends which are intended to mimic the effects of cannabis) occasionally contain powerful anticoagulants.

Burns

• Try to avoid existing scar tissue. The scar of a previous burn may be less sensitive to pain, so you may end up hurting yourself more badly than you intended. Scarred skin will also be slower to heal.

• Try to avoid joints (e.g. elbows or knees). As the burn heals, the tissue may contract, restricting your ability to move. For the same reason, try to avoid burning your hands.

• Don’t burn all the way around your arm, leg, finger or toe. A burn which completely encircles a limb may constrict your circulation, risking serious permanent damage.

• If possible, leave blisters intact. Damage to a blister increases the risk that the burn will become infected.

Cuts

• Avoid major blood vessels. Arteries carry blood at high pressure from the heart: if you puncture one, this will cause life - threatening bleeding. Punctured veins can also lead to heavy blood loss.
  • It’s safest to cut the fleshy parts of the body, e.g. the outer arms, the outer thighs, or the calves.
  • In particular, try to avoid the following areas: neck, wrists, inner elbows, groin, back of knees, ankles, top of the feet.

• Try to avoid tendons. Tendons are thin cords which connect the muscle to the bone, allowing you to move. In some parts of the body they lie close to the surface of the skin. Most areas of the body which contain major blood vessels also contain prominent tendons.
  • Whenever possible, avoid the following areas: neck, back of the hands, wrists, inner elbows, groin, back of knees, ankles, top of the feet.
  • If you do cut in an area where you are likely to encounter tendons, cut longwise, rather than across. Horizontal cuts are more likely to sever a tendon and cause mobility damage.

• Try to avoid existing scar tissue.
  • Scarred skin may be tougher to cut: this means that you may need to apply more pressure, and end up cutting deeper than you intended into the underlying tissue.
  • Skin which is already scarred will also be slower to heal.

• Try to use straight-edged blades. Injuries with jagged or serrated edges will heal more slowly and be more prone to infection.