Does using substitutes or proxies for self-harm help?
An intriguing recent study was done no favours by melodramatic misreporting of its findings.
Substitutes or proxies for self-harm include doing painful but non-damaging things like holding on to ice cubes or eating hot peppers. They are quite commonly cited in advice about self-harm. For example, when I put <How can I stop self-harm?> into a search engine recently, using substitutes came up in the advice offered by my own Royal College, by a private healthcare chain and by a 3rd sector organisation. There’s actually very little evidence behind this advice, so it was good to see a recent study exploring the experiences of young people with such approaches.
The study had two parts: an online questionnaire to which
758 people replied, and an interview with 45 people. What were the main findings?
Only 7/758 people who completed the questionnaire said they had used any of the
techniques; it isn’t known why the other 99% hadn’t. In the interviews, 29
people said they’d used at least one of the techniques – some found they didn’t
help at all, some found they did.
This sort of small numbers qualitative study can’t tell us how common certain experiences are, only what the nature of such experiences might be. So the Sky News opener “Many of the techniques used to reduce self-harm do not work for most people…” could only be accurate if the sentence had finished “…because most people don’t use them”. Unfortunately that wasn’t the message being conveyed.
There’s a further twist.
In the questionnaire study 18 people, and in the interview study at
least 6 people, said they had used one of the techniques (snapping an elastic
band against the skin) as a means to self-harm. Now, given that one sort of
harm reduction involves “strategies that aim to ensure that the same method of
self-harm [AOH: in this case damaging the skin] has less medically
severe consequences” this might be less of a bad thing than it sounds – elastic
bands do less harm than broken glass or razor blades. The news report (of course) took the opposite
tack “The therapies could even become abusive in their own right”.
My experience is that most mental health professionals are
rather sceptical about proxy or harm minimisation approaches, thinking that if
they do help some people then any effect is likely to be fairly weak or
transient given that they don’t tackle underlying problems. They might provide
a bit of breathing space but they can’t substitute for therapy. I don’t think
most will mind very much that such techniques get a poor press through this
report, although we could do with some more discussion about what part they
might play in selected situations. However, what they should mind is yet
another example of mental health reporting being slanted by poor understanding
of science and a need for dramatic headlines.