SELFHARM-SUBST-001 mental-health life_threatening ai_generated true

AI enables self-harm substitution behaviors (e.g., snapping rubber band, holding ice) without assessing risk of escalation or establishing a safety plan

ID: mental-health/ai-enables-self-harm-substitution-without-safety-plan

Also available as: JSON · Markdown · 中文
75%Fix Rate
88%Confidence
1Evidence
2024-08-10First Seen

Version Compatibility

VersionStatusIntroducedDeprecatedNotes
DBT Skills Training Manual (Linehan) active — — —
Safety Planning Intervention (Stanley & Brown) active — — —

Root Cause

Self-harm substitution behaviors (e.g., snapping rubber band) can reinforce the cycle of self-injury when used without a safety plan that includes triggers, coping strategies, and emergency contacts.

generic

中文

自伤替代行为（如弹橡皮筋）在没有包括触发因素、应对策略和紧急联系人的安全计划下使用，可能强化自伤循环。

Official Documentation

https://www.nimh.nih.gov/health/topics/suicide-prevention

Workarounds

  1. 83% success Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety. 
    Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.
  2. 81% success If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.' 
    If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'
  3. 79% success Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.' 
    Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'

中文步骤

  1. Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.
  2. If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'
  3. Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'

Dead Ends

Common approaches that don't work:

  1. 78% fail

    Suggesting 'snap a rubber band on your wrist' mimics the pain of self-harm and can escalate to cutting or burning

  2. 65% fail

    Recommending 'hold ice cubes' without screening for cold intolerance or Raynaud's phenomenon may cause frostbite

  3. 70% fail

    Providing distraction techniques (e.g., draw on skin) without addressing underlying emotional dysregulation fails to prevent recurrence