Harm minimisation and self-harm
‘Harm minimisation’ approaches aim to reduce the damage that happens when someone engages in behaviour that could negatively affect their health . Although the approach has its origins in the field of substance misuse , it has since been used in other areas – including the treatment of self-harm.
Harm-minimisation techniques for self-harm are varied. Commonly recommended techniques include snapping an elastic band against the wrist, holding ice cubes and drawing on the skin in red pen. These techniques are encouraged across a range of platforms, including websites, self-help materials and some clinical practice. NICE clinical guidelines cautiously recommend the use of a harm-minimisation approach when self-harm is likely to be repeated .
This may seem like ‘common sense’ – after all, if somebody self-harms then surely it is better to encourage ways that will cause the least damage as possible? But there has been little work exploring whether harm minimisation techniques help people to recover from self-harm, and it is risky to encourage treatments that have not been well researched. There is no clear idea of what a harm ministration approach to self-harm constitutes of, or what it should involve – which may lead to large differences in the support people are offered.
Exploring young peoples’ views
Researchers from the University of Nottingham and the University of York recently re-analysed data from two different studies to investigate young peoples’ experiences of using harm minimisation techniques for self-harm.
The first study used an online questionnaire to explore whether young people viewed harm-minimisation techniques as a way of coping instead of self-harm, or as an alternative way of self-harming.
The second study asked what young people thought about using harm-minimisation techniques to help recover from self-harm. This was asked as part of a semi-structured interview into their experiences of self-harm, stopping self-harm and support services available.
What do young people think?
When asked to list ways in which they had recently self-harmed, almost three percent of participants mentioned a harm-minimisation technique. Less than one percent of participants described using harm minimisation techniques instead of self-harming. This suggests that young people can view harm minimisation techniques as a method of self-harm, rather than a different way of handling challenging events and emotions. Many of those who mentioned using harm-minimisation techniques as a form of self-harm said that they had hurt themselves in this way ‘between 1 and 1000’ times, with one participant writing that they were “snapping… with an elastic band continuously”. This suggests that such techniques can end up being used for a long time, rather than in the short-term to reduce the physical damage that would otherwise happen during self-harm.
The majority of participants interviewed said that harm minimisation techniques were not helpful in recovering from self-harm. Even when participants said that harm minimisation techniques were helpful, they said that this was limited to certain situations where self-harming was more difficult (e.g. school) or as a way of delaying – not stopping – self-harm. Some young people explained that these techniques did nothing to address the underlying emotional distress that was driving their self-harm. As with the first study, participants also described using harm-minimisation techniques as a method of self-harm (e.g. to break the skin) rather than an alternative. Only two of the twenty-nine young people whose data was analysed talked about harm minimisation techniques in a completely positive way.
Most young people do not find harm minimisation techniques helpful in stopping self-harm. When such techniques are used, they are often viewed as a method of self-harm rather than an alternative to it. Even when viewed as an alternative to self-harm, most young people say that harm minimisation techniques do not help their recovery. When harm minimisation techniques are considered helpful, this is generally in times when self-harm is not possible or as a way to delay self-harm.
This is important for several reasons. When young people are encouraged to use coping strategies that they do not benefit from, they may become less likely to seek help in the future. This is especially significant as most young people seek help for self-harm from friends rather than professionals  and many materials available to the public encourage a harm minimisation approach. Focusing on recommending harm minimisation techniques may also prevent attention being given to more effective treatments, wasting resources and resulting in greater harm occurring overall. Whilst harm minimisation techniques may help some young people, the researchers suggest that they should be recommended with caution and only as an ‘add on’ to other support.
For more information, check out the paper:
Wadman, R., Nielsen, E., O’Raw, L., Brown, K., Williams, A. J., Sayal, K., & Townsend, E. (2019): “TheseThingsDon’tWork.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach. Archives of Suicide Research. https://doi.org/10.1080/13811118.2019.1624669
 James, K., Samuels, I., Moran P. & Stewart, D. (2017). Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners. Journal of Affective Disorders, 214(1), 67-73. doi: 10.1016/j.jad.2017.03.002
 Canadian Paediatric Society. (2008). Harm reduction: An approach to reducing risky health behaviours in adolescents. Paediatrics and Child Health, 13(1), 53–56. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528824/?report=classic
 National Collaborating Centre for Mental Health. (2011). Self harm: Longer term management. National Clinical Guideline Number 133. London: National Institute for Health and Clinical Excellence. Retrieved from https://www.nice.org.uk/guidance/cg133
 Rowe, S. L., French, R. S., Henderson, C., Ougrin, D., Slade, M., & Moran, P. (2014). Help-seeking behaviour and adolescent self-harm: A systematic review. Australian and New Zealand Journal of Psychiatry, 48(12), 1083–1095. doi: 10.1177/0004867414555718
Katherine Brown (@Kat_E_Brown) is an Honorary Research Associate, with an MSci in Psychology from the University of Nottingham. She also works in a psychiatric hospital providing low-security care to women aged over eighteen.