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NHS Pilot Project: Medically Supervised Self-Harm

The BBC’s Radio 4 Saturday morning reported on NHS plans for a pilot project in Staffordshire which would allow patients engaging in self-harm to continue to do so under medical supervision. With the radio interviewers seemingly intent on ferreting out whatever controversy they could discover, it seemed to me that important points were missed about the role of self-harming as a coping mechanism.

Both BBC Radio 4‘s regular morning news and the Today programme included coverage of a National Health Service pilot project designed to allow patients who self-harm to continue to do so under medical supervision. You can hear the reports for yourself at the BBC’s website; I just wanted to highlight one particular feature of self-harm which seems to have been missed in the ‘controversy’ which the Today programme’s interviewer in particular seemed so intent on fomenting.

Specifically, most mental health professionals — and self-harmers — would probably agree that self-harming fulfils an important role for those who do it. Typically, self-harming acts as a coping mechanism, helping the person to manage or express difficult emotions: self-harm such as cutting is not something that someone does just for the fun of it. The accepted view is that stopping self-harming thus depends on finding some other ways of managing or expressing the difficult emotions, finding some other coping mechanisms or strategies. What happens while that process is occurring? Simple: usually, the individual continues to self-harm.

The Radio 4 interviewer did not seem to recognise this and seemed instead to be pressing the view that the NHS should not be allowing self-harming at all, and that permitting it under NHS care was somehow deeply disturbing.

To my mind, however, offering medically supervised self-harm makes a great deal of sense, as one part of an overall process whereby the individual can develop alternative coping mechanisms. If continuing to self-harm is a recognised part of an overall process by which the person can stop self-harming, why not offer medical attention and supervision of that process?

That’s not to say it should necessarily be the standard approach for every single person who self-harms: I have no idea whether it is clinically effective. But my point is simply that prima facie, the idea has some merit, and arguing against it on the basis that the NHS just shouldn’t allow such things ignores clinical reality.