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An interesting article from the BBC about a program in the UK… 
22nd-Mar-2006 11:05 pm
Bear
An interesting article from the BBC about a program in the UK designed to help self-harm folks to learn new coping skills

Including, that while they're under supervised care, they are allowed to continue their self harm - as removing that coping skill can be dangerous without adding replacements - but teaches them proper wound care and transitional coping skills like using ice cubes to simulate the feeling of cutting (something that worked for me fairly well).

No major triggers in the article that I saw, aside from it being about cutting.

Here's hoping this new program advances current treatments...
Comments 
22nd-Mar-2006 08:07 pm (UTC)
Including, that while they're under supervised care, they are allowed to continue their self harm - as removing that coping skill can be dangerous without adding replacements

that has always been what i thought.

i think this is a really good idea, honestly. i'm sure others would disagree... but i know that once i 'couldn't' cut anymore, i just started smoking cigarettes. now i do both.
22nd-Mar-2006 08:32 pm (UTC)
It's a lot better to help people transition away from the unhealthy coping skills than to just make them stop cold turkey.

I know that it helped me a lot to transition from cutting or burning to using ice cubes, or drawing on my arm with a ball-point pen when I wanted to cut.

It's like a nicotine patch, but for cutters. Cold turkey is possible, but man can it be hard!
23rd-Mar-2006 01:19 am (UTC)
I'm not too sure about this approach. I think there's something dangerous about making peoiple si with permission. It's like people with eds and becoming more blatant about eds (eg vomiting directly infront of people, running around mad etc). Sometimes if secret behaviour is made public it reduces the normality within a person's life. And that bit of normality is important for recovery (in those ed cases it's a really bad sign if they do previously secret behaviour infront of others- much harder to get over.)

Being in UK I was treated in hospital when I was at my worst. Not a brilliant experience - they are much more reluctant to give tranquilisers and stuff out (then again - it stops dependance. When you're si-ing to stop the pain tranquilisers are a brilliant alternative) and I wasn't able to si within hospital. It meant the first thing I did when I got out was si.

BUT there was no treatment. I'm all for not letting people si. Si-ing is no substitution for talking. An ideal treatment place would be where there were no ramifications for saying "I need to si" and someone would talk to you about why you want to do it and then distract you. At the end of the day, if you want to hurt yourself there are otherways apart from si. In hospital I stopped eating and did other things I won't specify.

I don't get why they don't have a treatment that centres around a nice run. You feel like si-ing? Ok, that's fine. But lets have a chat and a run and we'll see if we can't make you feel a bit better first.
23rd-Mar-2006 06:22 am (UTC)
Well, the don't *make* them si, they are simply allowed to continue with supervision and proper medical care to prevent them from suddenly having no coping skills (since they don't have access to the unhealthy ones) which usually results in a suicide attempt.

My guess is that by having it supervised and properly cared for, that in and of itself would deter it a bit, making it less likely that they'd use si when they have people there to talk to - know what I mean?

And I thoroughly second your idea about having programs involving running and physical activity. It can produce the same endorphines as si - and as long as it's monitored to not be unhealthy exercise, it can really help.
23rd-Mar-2006 06:56 am (UTC)
ok, that worked for you.

it's like smoking. my parents quit smoking cold turkey, and that worked out great for them. if i even thought about doing that, i'd get the worst headache of my life and go through really bad emotional withdrawal.
23rd-Mar-2006 07:27 am (UTC)
okay - making people si was the wrong expression. Allowing would have been better :)

Again - I am against this idea. And being in hospital didn't work for me. Not at all. It kept me alive but I was still hurting myself. What worked for me was the fact that I worked out that there was no point in doing it.
23rd-Mar-2006 08:33 am (UTC)
::nod:: treatment of the underlying problems that cause people to self-harm is imperative to the whole program, I think.

Hospital settings don't work well for me, either - they make me feel caged, and often make me feel worse :P but hopefully the program will help some people... I guess only time will tell
23rd-Mar-2006 06:16 am (UTC)
I am a big believer in harm reduction. Why? Because the alternatives don't work for everyone. Some people can say, "ok, I want to cut and I'm not going to," or draw on themselves, or use ice cubes, or rubber bands while they address the whys (if psychs consider them "cured" when they've worked out substitutions, though, there's an issue). Other people can't, and if the knee-jerk reaction is to put them in a hospital (which, thanks to managed care, aren't focused on treatment anyway, so just delay the behavior until release) they're unlikely to talk about it and more likely to do serious damage.

We know that our current techniques of stopping si are not always effective, and certainly not right away. In those people who it is not effective with I think teaching them to do it safely, with a minumum of scaring and infection, is an important and ethical step. Neither that or substitution addresses the real issue, which is that we want to hurt ourselves, but both approaches give us the time to work on that.

For me, my transitional stage is doing things that hurt plenty, but didn't do any visible or lasting harm. It's not about the act of cutting, it's the pain, so drawing or ice don't do much of anything. I've always practiced excellent wound care, and when some psychologist last week tried to convince me to set up a plan to go to the ER instead of si I laughed in his face and said that bandaids and peroxide were a whole lot cheaper than the $700 co-insurance I had to pay last time. I don't think he liked that answer. Don't get me wrong, I am well aware that it is not a sign of mental health, nor a good coping stratagy, but *for me* it is better than some alternatives. If there were mental health professionals who recognized that maybe I'd be less dismissive of the profession.
23rd-Mar-2006 06:40 am (UTC)
::nod:: I think that's one of the reasons I like the idea of the program - it's an alternative treatment for those whom it might work, and for those for whom the alternatives won't work, it at least teaches them how to minimize the damage.

I, personally, would much rather have someone cutting safely while addressing the underlying issue than avoid it altogether, get overwhelmed, and try to kill themselves, you know?

Cutting's not the best coping skill, but if it's all you've got in the meantime, might as well do it safely.

I wish more psych's understood that, too. Too often, it seems like the small progress some people make (like proper wound care when they do cut) gets passed over as though it's not progress at all - when any step forward is a good step, even if it only takes you an inch closer to your goal. :)
23rd-Mar-2006 08:56 am (UTC)
Well, that and too many psychs are more worried that you cut than that you need a coping stratagy like cutting. In my mind, it's a symptom. It's like; a patient has cancer, but what we care about is the fact that they are in pain. We can develop all sorts of behavioral and pharmacudical approaches to help them cope with the pain, but shouldn't we be focusing on the fact that they have frking cancer? Not that making them comfortable isn't important, but saying, "Oh, well, we'll get to treating the cancer just as soon as you don't hurt anymore" makes no sense at all.

I think society would function better if we implemented harm-reduction stratagies in other places besides drug policy (and even that it a *huge* fight). I don't think the reaction to anything someone is doing that is only hurting themself should be, "NO!!!!!" Because obviously there is a reason they are doing it. Much better to offer them support in a stigma-free environment to minimze the harm while providing resources to help bring them to a point where the behavior is no longer needed.
23rd-Mar-2006 09:27 am (UTC)
Exactly! :P

Stupid humans ::mutter:: grrr... where are my elf ears?!?
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