The First Cut Is the Deepest: A Harm-Reduction Approach to Self-Injury

Abstract

The 2004 guidelines published by the (UK) National Institute for Health and Clinical Excellence (NICE) recommend the use of harm-reduction for people who hurt themselves (self-injure) in primary and secondary health care settings. Nonetheless, harm-reduction is not widely understood or implemented and prevention remains the primary approach of most health care providers. In this article I draw on the experiences of my research participants to explore the ways in which prevention policies not only fail to prevent self-injury but also to meet the basic care and support needs of individuals who hurt themselves. Indeed, confusion around the meaning and purpose of self-injury, and consequently service-provider anxiety, is often at root of prevention policies. I explore self-injury from the perspective of those who experience it and outline some of the basic principles of harm-reduction. I demonstrate that harm-reduction has both physical and emotional benefits and offers practical, meaningful, and constructive responses to those who self-injure.