Self-harm: misunderstandings about harm minimisation

This blog post is the text of a thread originally posted on Twitter by @jaunty_aphorism on 06/09/2023, published on the NSUN blog with the permission of the author.

Content warning: self-harm

There are currently some discussions online about harm minimisation as a strategy for self-harm, & unfortunately, as usual, there are some profound misunderstandings & a refusal by professionals to hear survivors.

Harm minimisation has deep roots within survivor communities & Mad activism & comes from a place of true peer understanding, acceptance & solidarity. It is the recognition that self-harm may for some be a valid method of survival, until survival is possible by other means.

It is not the snapping of elastic bands, ice cubes clenched in hands, or butterflies drawn up our arms. It is not the black and white intolerance of self-harm that leaves us in vacuums of despair, with nowhere else to turn.

Harm minimisation accepts reality. It understands that self-harm may fulfil a deeply important, even vital, role for some people in moments of need. It is aware that the removal of self-harm as a possibility can be catastrophic, even fatal, for some.

Working with this knowledge, harm minimisation aims to support people to survive by the least harmful means possible in that moment. To avoid death, serious injury, disability, infection, and to promote self-care, self-compassion, and acceptance.

While professionals falsely believe stigma is reduced or even eradicated in the treatment of self-harm, survivors understand the reality that a trip to A&E for self-harm could be deeply traumatic, & may lead to seriously abusive, distressing, painful & even unlawful treatment.

Harm minimisation counters this by reducing the need to seek medical care – empowering & equipping survivors with wound care knowledge, & an understanding of how to limit serious physical damage to ourselves. It keeps us safe not only from our actions, but from professionals.

Harm minimisation is a radical & brilliant aspect of survivor communities. While professionals struggle to contain their disgust & moral outrage at our methods of survival, Mad peers sit with one another without judgement, sharing our knowledge, providing hope and comfort.

I owe so much to harm minimisation & to the people within Mad communities who have campaigned & fought for its recognition for longer than I have been alive. I have so much respect for them, for their dedication, for their strength, for their humanity.

To see their work being trashed now is painful. To hear professionals condemn harm minimisation as “unevidenced” and “unsafe” while they support positive risk-taking for suicide (entirely unevidenced and frequently fatal) is hard. I have never seen harm minimisation referenced in a coroners regulation 28 report – the same cannot be said for positive risk-taking. I know no-one who has died from harm minimisation. The same cannot be said for positive risk-taking.

This hypocrisy says to me that professionals who are refusing to accept harm minimisation as valid are doing so not because of concern for risk, but because they morally object to self-harm. But they cannot have it both ways. They cannot leave us to die when we are asking for help, AND deny us the right to survive by whatever means we have left.

I wrote this article for Asylum Magazine earlier this year, about my experiences of self-harm & harm minimisation. I hope any professionals reading will try & truly hear me & reflect on their understanding of harm minimisation & their underlying beliefs about self-harm.