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Writing:

   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 anaesthesia 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 psychological evaluation. Doctors should be trained to assess between 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 self-injury. Many of us have been abused, the humiliation of a strip search is likely to increase the 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 self-injury validated.
Self-injury does not occur in a vacuum. The person who self-injures usually does so in response to distressed feelings and those feelings should be recognised and validated. Although the care provider may not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurers right to be upset about it.

5. The right to disclose to whom they choose and 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 self-harm contract should 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 mechanisms she or he feel best at the moment. No client should be afraid to tell a care provider about an incident of self-injury.

7. The right to have care providers who are not afraid of self-injury.
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 a 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 the care providers.

8. The right to have the role of self-injury 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 self-injury as a last ditch effort to avoid suicide. The self-injurer should be taught to honour the positive things self-injury has done for him / her while recognising that the negatives of self-injury far outweigh those positives and that it is possible to learn methods of coping that are not as destructive or life threatening.

9. The right not to be treated as 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 self-injury

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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 these attempts to communicate seem manipulative, treating them as manipulation can make the situation worse. Providers of care should respect the communicative function of self-injury.