Duncan Gill, MD
Sarah: A Case Against "Locking Up the Sharps"
Updated: Nov 15, 2021
A few days ago, I the mother of a 14-year-old girl (let’s call her Sarah) asked me a question. Sarah had been referred to us by the ER due to some suicidal statements after her boyfriend broke up with her. She also had done some cutting that resulted in a series of thin, superficial horizontal cuts on her arm.
Mom: “The crisis worker in the ER told us that we needed to keep a close eye on Sarah and “lock up the sharps” at home. It’s been a week -- should we keep doing that?”
For those who don’t know, “locking up the sharps” means denying any access to Sarah to items in the house -- knives, razors, scissors, etc. -- that could potentially be used to cut herself.
I realized at that point that, despite “locking up sharps” being a common recommendation made by clinicians to parents, it’s one I’ve never made before during the course of my career.
Before I continue, I should say that there are a wide variety of opinions on the subject. What’s more, just because I’ve never recommended “locking up sharps” before doesn’t mean I won’t run into a situation in the future in which it makes sense to me. I just think there are liabilities to the approach that are worth thinking about.
Also, a word about different types of cutting. The way I see it, there are two categories. The first category is superficial cutting. It’s more common, and usually represents a poor way of coping with stress, or a socially-driven habit, or an attempt to substitute physical pain for emotional pain, or an act of retribution against a boyfriend/girlfriend/parent or the world at large. The second category is cutting in an attempt to seriously injure or kill oneself. This kind of cutting often – but not always – is accompanied by more serious psychiatric conditions, like bipolar disorder, PTSD, and psychotic disorders.
Given what we know about Sarah, it sounds like the cutting has been superficial, and she likely falls into the first category. But keep both those categories in mind, as I’ll return to them later.
Let’s say mom decides to go with the “lock-up-the-sharps” approach. She takes all the knives from the silverware drawer, the scissors from the desk in the office, and the shaving razors out of the bathroom. She puts them into a cabinet and locks it up. She only gives them to Sarah when she can supervise their use, and then promptly locks them up afterward again. Let’s also assume, for the sake of argument, that Sarah isn’t a great lockpick. She can’t use those sharp objects to cut herself again.
Less access to sharps equals less chance of cutting again, so the thinking goes. Pretty simple and straightforward.
Now let’s look at some of the problems with the “lock-up-the-sharps” approach, which may not be so obvious:
Problem #1: It’s hard to lock up all of the sharp items at home.
Things that are sharp are everywhere. Not only knives and razors, but pencils, glass, broken cans, pins, you name it. It’s a nearly impossible task to keep them all out of a Sarah’s hands.
Problem #2: It may set up (or worsen) a power struggle.
Many teenagers – and maybe Sarah is one of them -- like to fight. It’s part of what teenagers do. One can easily imagine the following scenario: mom locks up sharps; Sarah brings home broken glass she found on the street; mom takes broken glass; Sarah brings in razor blade from pencil sharpener at school; mom takes razor blade; Sarah smuggles in scissors and hides them under her bed; mom starts conducting regular room searches; and so on. The power struggle between Sarah and her mom isn’t just a pain in the butt. It’s going to get in the way of their relationship. It’s going to negatively impact the chance of any kind of cooperative effort to solve whatever the real because the two are getting distracted by a sharps war.
Problem #3: It gives the message to Sarah that she can’t stop herself or control her own actions.
Locking away sharps is essentially telling Sarah that she is incapable of managing her own behavior. Worse, it suggests to her that keeping from cutting is her mother’s responsibility, not her own. Sarah may tell her therapist later on that her recent cuts are mom’s fault because mom didn’t do a good enough job keeping her away from sharps. (That’s actually one I’ve heard before.) The message mom is inadvertently giving Sarah is that Sarah is too depressed, too anxious, too angry, too defiant, or otherwise incapable of managing her own behavior. Thus, mom needs to do it for her. This is a very common message that I see parents giving kids these days, and it is a big problem. You’ll see me refer to it in other posts.
In a way, in locking up sharps, Sarah’s mom is taking a shortcut. Whatever mom gains in terms of short-term reassurance, she may lose in terms of hindering Sarah’s long-term development, learning to do things for herself, individuation from her mother, and pursuit of independence. In other words, growing up. And though a single act such as locking up sharps may not be that big of a deal for Sarah’s development by itself, it’s usually part of a larger pattern of “interventionist parenting”. It’s the pattern that can be so problematic – and even damaging -- to Sarah’s development.
Problem #4: Locking up sharps at home gives a false sense of security.
This is the biggest problem of all.
Let’s say Sarah isn’t in the superficial cutting category, but actually trying to seriously injure or kill herself. Keeping her home and “locking up the sharps” is a particularly bad idea because mom feels reassured that Sarah is somehow safe because the knives and scissors are hidden away. It won’t take Sarah much creativity to think of another way to hurt herself, or worse.
If Sarah’s mom thinks that Sarah is suicidal, hell-bent on injuring herself, or otherwise “can’t control herself,” she needs to get Sarah to the ER ASAP. Why fool around? Mom can’t keep Sarah away from all sharps (or other means of hurting herself) at home, but the hospital certainly can. It’s what inpatient units are designed to do. In this instance, trying to lock up sharps at home is a half-measure that may be worse than doing nothing at all.
Securing medication in the homes of struggling teens is a different story, and I believe it has to be done. Medications are used for only two things: medical treatment, and intentional overdose. Medical treatment needs to be supervised by parent. Impulsive overdose, in my experience, is much more dangerous than impulsive cutting. And, I would hope I wouldn’t have to say this, but firearms should always be locked up.
So will locking up the sharps protect Sarah from cutting herself again? I don’t know. But I think it’s important to consider the potential risks of both leaving sharps out as well as trying to lock them away.