
                  A Bill of Rights for Those Who Self-Harm
                                      
    1. The right to caring, humane medical treatment.
       Self-injurers should receive the same level and quality of care
       that a person presenting with an identical but accidental injury
       would receive. Procedures should be done as gently as they would
       be for others. If stitches are required, local anesthesia should
       be used. Treatment of accidental injury and self-inflicted injury
       should be identical.
    2. The right to decide what, if any psychological treatment is
       warranted, so long as no one's life is in immediate danger.
       When a person presents at the emergency room with a self-inflicted
       injury, his or her opinion about the need for a psychological
       assessment should be considered. If the person is not in obvious
       distress and is not suicidal, he or she should not be subjected to
       an arduous psych evaluation. Doctors should be trained to assess
       suicidality/homicidality and should make decisions about further
       psych treatment in the emergency room based on those factors
       alone; the fact that the injury was self-inflicted should not be a
       deciding factor.
    3. The right to body privacy.
       No one should subject a self-injurer to a body search looking for
       evidence of self-injury. Many of us have been abused; the
       humiliation of a strip-search is likely to increase the amount and
       intensity of self-injury while making the person subject to the
       searches look for better ways to hide the marks.
    4. The right to have the feelings behind the SI validated.
       Self-injury doesn't occur in a vacuum. The person who self-injures
       usually does so in response to distressing feelings, and those
       feelings should be recognized and validated. Although the care
       provider might not understand why a particular situation is
       extremely upsetting, she or he can at least understand that it
       *is* distressing and respect the self-injurer's right to be upset
       about it.
    5. The right to disclose to whom they choose only what they choose.
       No care provider should disclose to others that injuries are
       self-inflicted without obtaining the permission of the person
       involved. Exceptions can be made in the case of other medical care
       providers when the information that the injuries were
       self-inflicted is essential knowledge for proper medical care.
    6. The right to choose what coping mechanisms they will use.
       No person should be forced to choose between self-injury and
       treatment. No care provider should demand that a no-harm contact
       be signed; instead, client and provider should develop a plan for
       dealing with self-injurious impulses and acts during the
       treatment. The client should always be free to use whatever coping
       mechanism he or she feels is best at the moment. No client should
       be afraid to tell a care provider about an incident of SI.
    7. The right to have care providers who are not afraid of SI.
       Those who work with clients who self-injure should keep their own
       fear, revulsion, anger, anxiety, etc out of the therapeutic
       setting. This is crucial for basic medical care of self-inflicted
       wounds but holds for therapists as well. A person who is
       struggling with self-injury has enough baggage without taking on
       the prejudices and biases of their care providers.
    8. The right to have the role SI has played as a coping mechanism
       validated.
       No one should be shamed, admonished, or chastised for having
       self-injured. Self-injury works as a coping mechanism, sometimes
       for people who have no other way to cope. They may use SI as a
       last-ditch effort to avoid suicide. The self-injurer should be
       taught to honor the positive things that self-injury has done for
       him/her while recognizing that the negatives of SI far outweigh
       those positives and that it is possible to learn methods of coping
       that aren't as destructive and life-interfering.
    9. The right not to be treated like a dangerous person.
       No one should be put in restraints or locked in a treatment room
       in an emergency room solely because his or her injuries are
       self-inflicted. No one should ever be involuntarily committed
       simply because of SI.
   10. The right to have self-injury regarded as an attempt to
       communicate, not manipulate.
       Most people who hurt themselves are trying to express things they
       can say in no other way. Although sometimes these attempts to
       communicate seem manipulative, treating them as manipulation only
       makes the situation worse. Providers should respect the
       communicative function of SI.
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References

   1. http://www.palace.net/~llama/selfinjury
