Self-Injury Charter

This charter is a bit like Deb Martinsons's "Bill of Rights" but was drawn up for NSIAD2003 by UK service users (mostly those on the nsiaduk@yahoogroups.com list, with the final version written by Chris O'Sullivan of See Me Scotland) and was also published by SAMH (see their article.)

Self Injury Charter

This charter for people who self injure has been drafted by a group of people who self injure, experts by experience in this field. We hope that providers of services and other people in the community who stigmatise and invalidate people who self injure will take it on board. The bottom line is:

• We should be able to live free of stigma, where we are judged on personality and ability, and not on label or scar.
• We should get the support we need when we choose to seek it.
• We should be treated more gently, not more brutally than people with accidental injuries.
• We should have access to a range of flexible services in the community, including self-help structures.

When living in the community:

• We should not be excluded from education or employment opportunities through being considered a risk to health and safety, a danger to other people, or an unsightly mess.
• We should be able to buy razor blades or painkillers, without being publicly humiliated by people who assume we want to use them to self-injure.
• If people see our scars, they should not comment, or make embarrassed comments for example, about vicious pets. They should treat us as they would treat anyone else. We should therefore be able to wear our choice of clothing, without fear of negative reaction.

When seeking support for self-injury, we would like:

• When reasonable, to choose when, where, how, and if we wish to seek support for self-injury.
• To have more specialist services available, so that we are able to seek support in environments in which we feel comfortable.
• To disclose only the information we feel comfortable with, and at a pace that we set and feel at home with.
• To speak to medical staff who have proper training and understanding of self-injury, in primary care and in hospital settings, and not to have our level of injury seen as a barometer for our level of distress.

When presenting at A&E with acute injury, we believe that:

• Self inflicted injuries should be treated in precisely the same way as accidental injuries, for example we:
  • Shouldn't be deliberately overlooked in queues or triage.
  • Shouldn't be sutured without anaesthetic.
  • Shouldn't be searched for proof of our identity.
  • Shouldn't be used as a case study for students unless asked.
  • Shouldn't be called a drain on NHS resources or an attention seeker.
  • Shouldn't be joked about or invalidated by comments by staff.
• We shouldn't as a matter of course be examined in detail for further evidence of self-injury, especially given the fact that many of us have experience of abuse and are not comfortable with nudity or being touched.
• It should not be assumed that we want to commit suicide, nor that we are not feeling suicidal. Instead, we would like the opportunity to talk about suicidal feelings in an appropriate environment.
• If we end up in this department regularly, we should be channelled for better support, not labelled as a “persistent offender” and given worse treatment.
• If we choose not to accept an offer of a chance to talk, we should be able to leave the department without prejudice.
• If we are so unwell that we need to be detained under the Mental Health Act (1984) “sectioned”, that this should be done as soon as possible, and we should be taken to a place more appropriate for psychiatric care.
• “Sectioning” should never be used as a weapon of coercion to make us talk about issues so delicate we may never have talked about them before. Likewise negative attitudes towards SI should not prevent us from accessing inpatient psychiatric care when required.
• It is wrong to be de-prioritised at triage when presenting at A&E for other things, just because evidence of SI comes up.
• Our rights need to be explained clearly and objectively, by someone who knows what they are talking about. If possible, we would like the option of talking to an advocate.

When we seek follow up support, we think:

• That we should have access to a number of support methods, so that we can use the support we can identify best with.
• That we should be able to tell who we want, what we want, when we want. Unless we are sectioned, we want to choose who hears about us and when.
• That communication between GPs, A&E, and mental health services should be good enough that we don't have to keep re-telling stories, or end up at appointments where messages haven't got through.
• That people who self injure can provide themselves with good support in self-help groups, and that these should receive support and funding.
• That we shouldn't be forced to just stop injuring ourselves. We should be given information on less damaging methods of self-injury and encouraged to think about other methods of control and expression as well.

About Self Injury

• Self-injury (SI) involves causing deliberate hurt to ones own body, to cause pain, or other effect that communicates with the person (like seeing blood). The classic image of self-injury is cutting, but many other methods also exist. These include burning, scratching hair pulling, or deliberately hitting oneself to cause pain.
• People self-injure for a number of reasons. Most commonly, self-injury is a method of coping with the emotional pain of psychological trauma such as abuse. The key thing to remember is that everybody's experience is different, and that all are valid.
• Self-injury is used in order to either create a physical manifestation of the negative feelings which can then be dealt with, or alternatively to punish oneself.
• Self-injury is not the same thing as attempting suicide, though some people who self injure do attempt suicide.
• It is extremely rare for people to self injure to seek attention. Most people who self injure will take extreme care to hide their self-injury from other people.
• Because self-injury is usually hidden away from view and does not require or does not receive medical treatment, statistics are not forthcoming. However, 10% of medical ward admissions in the UK are for self-harm.
• The stereotype of the “cutter” as a teenage girl just does not hold up. People of all ages, backgrounds and of both genders self-injure.
• People who self injure feel isolated, and alone. There are some specialist services in the UK in which people feel comfortable and are able to learn other coping strategies to move forward.
• The vast majority of people who self injure never access services. When people do access services, they often meet discrimination and poor service. The problem is not necessarily growing. The number of people willing to talk about it is.

© Chris O'Sullivan of See Me Scotland, 2003.