Harm minimisation after repeated self-harm: development of a trust handbook

Repeated self-harm without suicidal intent occurs in approximately 2% of adults (Meltzer et al , 2002). Service users report that professionals can respond to self-harm with unhelpful attitudes and ineffective care. Although evidence for effective treatments is poor (Hawton et al , 1999), this therapeutic pessimism is not found in the self-help approaches promoted by voluntary organisations such as Mind: ‘If you feel the need to self-harm, focus on staying within safe limits' (Harrison & Sharman, 2005). User websites frequently offer advice on harm minimisation: ‘Support the person in beginning to take steps to keep herself safe and to reduce her self-injury – if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure)’ (Bristol Crisis Service for Women, 1997).