Harm Reduction and Self-Harm

A harm reduction approach to NSSI is not an endorsement or encouragement to self-harm. Rather, it accepts the difficult reality that some people are self-harming and that there are ways of minimizing the risks they consequently face, while simultaneously supporting them to address the underlying distress that is driving their behaviour. The goals of harm reduction in relation to NSSI are to have a person (Self Injury Support [SIS], n.d.-b):

• Prepare for self-harm, for example by having clean implements and first aid materials easily available
• Try to slow down the process to have as much control as possible
• Think about what wound or other care might be needed afterwards
• Try to keep what they do within limits that are safe to manage by themself

Harm reduction strategies are often used when taking a client-centered approach to NSSI, as these tactics can keep the client safe from suicide attempts or be used to cope with significant emotional dysregulation or crisis (Inckle, 2011; Klonsky & Muehlenkamp, 2007). Although there is limited research directly studying harm reduction as applied to NSSI behaviours, it is often used in conjunction with other therapeutic tools to “meet the client where they are” in recovery (Guerdjikova et al., 2014; Inckle, 2011). While the goal with clinical treatment is likely to eventually stop self-harm entirely, it is important to recognize that many individuals do not feel prepared to remove a coping mechanism that has been effective for them, and smaller steps may be required to make progress towards their goals.

To support someone who is self-harming, it is essential to understand the functionality of self-harm behaviours to that person (Guerdjikova et al., 2014; McKenzie & Gross, 2014). Building a repertoire of alternatives to self-harm, improving coping skills, and specialized therapy focused on emotional regulation and distress tolerance are important interventions to offer. Harm reduction-based alternatives to self-harming behaviours can include (SIS, n.d.-b):

• Delaying self-harm by developing awareness of triggers
• Creating a ‘safe space’ with no tools for self-harm to go/sit when urges arise
• Keeping tools for self-harm in awkward/hard-to-reach places
  • For example, the ‘15 minutes rule’ tool helps delay and reduce self-harm
• Developing awareness of how and where self-harm occurs to reduce risks
  • Small steps can include using clean equipment, reducing the length of time, making a smaller injury, or cutting away from major blood vessels and arteries
• Distract or displace the urge to self-harm, for instance by holding an ice cube in the hand or on the wrist (SIS, n.d.-a)

Harm reduction should also include planning for aftercare, including seeking medical attention if the injury is significant. If a student presents at a mental health appointment with significant injuries, they should be directed to the appropriate resource for triage and medical care (i.e. Student Health Services, the Emergency Department).