Navigating Self-injury through a Harm Reduction & Empowerment Lens (SHEL)
Harm reduction is most often associated with problems with substances. However, at its foundation, harm reduction is about letting go of the idea that you can control what someone else does or force them to change even if they’re doing something you believe is “bad” or “dangerous”. It means accepting that they may continue to live in that way for a long time or even forever and that you can still find ways to support them to live their best life anyway. It also means letting go of the power to decide what is and isn’t a “problem” in their life or what they should do about any of it and walking alongside them to help them clear their path of risks that might get in their way or cause them harm.
What Do We Mean By ‘Self-Injury’?
Self-injury refers to intentional injury to one’s own body in some way. Sometimes this happens in very direct and obvious ways. For example, someone might burn their arm or cut their thigh. Other times, it may be less obvious. For example, this can include when someone over exercises to the point of injury or drinks or uses drugs with the intention of harming themself. However, what’s tricky about this is that these things might look the same as someone training for a marathon or someone else drinking or using drugs because they like how it makes them feel. It can even be true that a single person may use the same thing sometimes as self-injury and other times not. For example, someone might get a tattoo on one occasion to feel the pain, while on another occasion, they might get a tattoo because the art is really meaningful to them (or both might be true in a single instance).
Things people might do to self-injure in addition to the examples provided above can include: Hair pulling, scratching, headbanging, pinching, hitting, piercing, branding, bingeing and/or purging, risky sex, getting in fights, over working, not sleeping, wearing painful or restrictive garments, not taking medications for significant medical issues and more. Again, the key here is to remember that many of these things can be self-injury for some and not for others, even though they may look the same or similar to an observer.
Many people self-injure with full awareness of their intent to cause themself harm. However, at times, this may be happening on a more subconscious level. In many instances, they might not have had an opportunity to put words to what they’re doing or unpack why or what it all means to them. It’s important to understand that people frequently begin self-injuring as an adaptation and attempt to survive trauma and other difficult things going on in their life and that instinctual adaptation may happen before it all rises to a more conscious level.
It would be a mistake to say that people self-injure specifically to cause themselves pain as opposed to harm. These words aren’t interchangeable and the reasons people self-injure can be extremely varied. Some people use physical pain as a way to release emotional pain or to feel anything at all when they’re numb, while others might use it as punishment. In some instances, someone might find the sensation grounding or a welcome distraction from something hard (for example, when they’re hearing a distressing voice). On the other hand, a person might experience a sort of high when they self-injure due at least in part to the release of endorphins. For more on why people self-injure, please check out ‘Project Why‘.
Ultimately, what this all boils down to is that understanding whether or not something constitutes self-injury or not may require understanding what’s going on for a person individually, being willing to explore that with them and hearing how they make meaning of what they’re doing. (Having this conversation typically requires establishing a trusting relationship and listening without judgement, agenda or threat of negative consequences.)
It’s also worth noting that there are several different terms sometimes used interchangeably to refer to self-injury including ‘self-harm’, ‘self-injurious behavior’ and ‘self-inflicted violence’. People have different reasons for using or not using each of these.
For example, many people don’t like ‘self-injurious behavior’ (sometimes abbreviated to ‘SIB’) because it is clinical in nature and referring to ‘behavior’ can land as disrespectful or dismissive. Similarly, many people don’t like ‘self-inflicted violence’ because the language of ‘violence’ can overshadow any potential to talk about self-injury as adaptation to use the language of ‘violence’.
In the end, understanding what’s going on for someone, why they’re doing what they’re doing and how its impacting their life is always going to be more important than applying labels and diagnoses.
What Are the Core Values and Aims of SHEL?
With that in mind, the core values and aims of SHEL include:
- Establishing that the goal isn’t necessarily to get someone to stop using self-injury now or ever
- Remembering there is no assumption that self-injury is necessarily ‘bad’ or ‘the problem’
- Making lots of space for someone to self-define what self-injury means to them, how it works or doesn’t work and if and when they want to change how they use it
- Also making lots of space for cultural differences and varying belief systems about what is or isn’t self-injury
- Remembering that the goal of a supporter will often include helping someone learn safer self-injury strategies, to self-injure in a way that doesn’t damage their relationships or unnecessarily risk negative consequences like hospitalization and so on.
Doing this work well can require a lot of self-reflection and work to get comfortable with things that feel scary or uncomfortable without going into a reactive place, as well as really unpacking what ‘harm reduction’ looks like in this context and strategies for support. And that’s where training comes in!
SHEL Training & Consultation
Types of Training, Consultation & Support
Roots Up offers a variety of trainings and consultation formats on the topic of navigating self-injury through a harm reduction and empowerment lens (SHEL). Trainings can include anything from a keynote talk to a half-day overview to a multi-day, in depth experience. Similarly, consultations can be one-time, ongoing, 1:1 or with a team. We are happy to work with you to tailor what we offer to what you need. In addition to training and consultation, we are also able to offer 1:1 support sessions to people who hear voices and/or their family members and friends.
Request Training & Consultation
Our training team includes trainers who have first-hand experience with a variety of types of self-injury themselves, as well as – in some instances – as the parent of a child using self-injury.
Some of the areas we cover include:
- Why people self-injure
- Building awareness of different types of self-injury
- Support strategies-
- The relationship between self-injury and suicide
- Relationship to systemic oppression and marginalization
- And more!
Please use the buttons below to request training or consultation or to get information about associated fees.
A Short Film about Self-injury, Harm Reduction & Empowerment
COMING SOON
Evidence for a Harm Reduction Approach to Self-injury
The Evidence in Favor of a Harm Reduction Approach
Navigating self-injury through harm reduction and empowerment lens (SHEL) is vastly under studied, at least in part because of the fear and discomfort people have with the concept of self-injury overall. However, there is a large body of qualitative data through the collecting of stories from people who have used self-injury that tells us that it is important. There are also key research studies and work done by clinicians – for example Kay Inckle – whose findings are supportive of that perspective. Some findings in alignment with SHEL include:
- Self-injury can provide at least temporary relief from suicidal thoughts (and forcing someone to stop self-injuring can, in turn, increase suicide risk) (Centre for Innovation in Campus Mental Health)
- Some people who use self-injury regard it as a form of self-care. (Inckle, Social Work in Mental Health, 2011)
- Supporting someone’s autonomy and self-determination when it comes to self-injury makes it more likely that they will reach out when they do decide they want help to stop. (Pietrusza, Rothenberg and Whitlock, Cornell University)
- Research emphasizes the importance of making space to learn why someone uses self-injury and how they make meaning of their experience which is consistent with harm reduction approaches. (Sandel et al, Suicide Research, 2020)
- Research suggests that focusing on what’s causing the distress that leads to self-injury is much more effective than focusing on the self-injury as ‘the problem’ (Inckle, Social Work in Mental Health, 2011)
- Some have argued that providers have an ethical obligation to allow for self-injury to continue as it ultimately less harmful than forcing someone to stop. (Sullivan, Journal of Medical Ethics, 2017)
- Supporting harm reduction helps facilitate access to information and tools that can support people to reduce risk when self-injuring. (Pembroke, Cutting the Risk)
Drawing from Research on Conventional Clinical Approaches
Reports from people who use or have used self-injury frequently include stories of unhelpful and downright harmful responses. For many people, this has included forced holds on locked psychiatric units, restraints, loss of relationships and large doses of shame and secrecy. Meanwhile, many people simultaneously report that conventional clinical approaches to self-injury haven’t worked for them. Some of the relevant research includes:
- Current predominant responses that are likely to increase shame or fear of judgement have repeatedly been found to reduce the likelihood that someone will reach out for support or be willing to talk about their self-injury. (Rosenrot and Lewis, Counseling Psychology Quarterly, 2018)
- Conventional clinical approaches and perspectives on self-injury appear to significantly reduce the likelihood that men will acknowledge their experiences with self-harm (even further than the for the general population). (Inckle, Men & Masculinities, 2014)
- This impact is also greater for Black and Brown people who already face reduced trust in the mental health system for a variety of reasons. (Farooq et al, Lancet Child & Adolescent Health, 2021)
- There is significant risk of someone “escalating” and using more dangerous forms of self-injury when forced to stop. (Gunnarson and Moberg, Discover Mental Health, 2025)
- Focus on conventional clinical beliefs about how to respond to self-injury and the reasons people use it interferes with discovering the wide range of explanations and experiences. (Edmonson, Brennan and House, Journal of Affective Disorders, 2015)
- Conventional clinical perspectives perpetuate biased takes on “non-socially acceptable” self-injury while continuing to treat “socially acceptable” self-injury as normal, even when the latter poses greater risk. (Davidow, Mad in America, 2013)
Research Limitations
Understandably, many people focus on “evidence-based practice”. Evidence and research are important. However, it’s also important to remember that the research base has been skewed by many of the same factors that impact all of our systems. This includes:
- It takes access to a lot of resources to make research happen. Often that means having money allotted for that purpose and/or university connections. (Ramirez, 2023, Desperately Seeking)
- At least historically, there have been clear racial skews in who gets their research published, as well as who is studied. (Roberts, 2020, Perspectives on Psychological Science)
- Similarly, research biases Western Culture (with college students in Western societies being particularly over-represented as research subjects) (Schulson, 2020, Undark)
- People with lived experience of what’s being studied are historically and ongoingly severely underrepresented which influences which impacts every stage of what’s studied, including the questions asked and priorities presumed. (Chatterjee et al, 2025, Digital Psychiatry and Neuroscience)
- More innovative approaches don’t necessarily lend themselves well to some of the approaches most familiar to the research community. (Sanbonmatsu, Cooley and Posavac, 2023, New Ideas in Psychology)
- Research of people with psychiatric histories has often caused substantial harm to those being researched, with many people now understandably unwilling to participate. (Bracken-Roche, Bell and Racine, 2016, Canadian Journal of Psychiatry)
Where self-injury is concerned, discomfort and fear of the idea of self-injury has also reduced funding access for harm reduction and empowerment approaches.