# 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`
- **Domain:** mental-health
- **Category:** life_threatening
- **Error Code:** `SELFHARM-SUBST-001`
- **Verification:** ai_generated
- **Fix Rate:** 75%

## 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.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| DBT Skills Training Manual (Linehan) | active | — | — |
| Safety Planning Intervention (Stanley & Brown) | active | — | — |

## Workarounds

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.** (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.
   ```
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.'** (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.'
   ```
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.'** (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.'
   ```

## Dead Ends

- **** — Suggesting 'snap a rubber band on your wrist' mimics the pain of self-harm and can escalate to cutting or burning (78% fail)
- **** — Recommending 'hold ice cubes' without screening for cold intolerance or Raynaud's phenomenon may cause frostbite (65% fail)
- **** — Providing distraction techniques (e.g., draw on skin) without addressing underlying emotional dysregulation fails to prevent recurrence (70% fail)