Using harm reduction to treat suicidality and high-risk behaviors

Eating disorders can be deadly. They have some of the highest mortality rates among mental illnesses, both as a direct result of medical complications and the increased risk of suicide. Because of this, clients with severe symptoms often require continuous support and medical monitoring that can only be provided in higher levels of care. Active suicidality and severe malnutrition can warrant hospitalization, sometimes involuntary hospitalization.

But what happens when patients have experienced treatment trauma in higher levels of care? This question is especially painful in light of stories of abuse emerging from some of the larger treatment facilities. How do we support someone who has been traumatized by the very treatment they are now being recommended? How do we help a client who refuses higher levels of care despite engaging in life-threatening behaviors? And how do we balance the need for treatment without pushing someone into a place that has deeply hurt them before?

In this episode, Sandi James shares her experience cycling through hospital stays and higher levels of care, being subjected to a "tough love" approach while struggling with opioid misuse and disordered eating, and ultimately finding recovery through purpose and harm reduction rather than abstinence and containment. Sandi discusses how she now works with high-risk clients in outpatient settings. She explores how to navigate suicidality while creating an environment where clients can share their deepest, most painful experiences without fear of hospitalization as an immediate repercussion.

This episode contains some heavy topics that elicit strong feelings for anyone who supports someone with an eating disorder. Please take care of yourself and, as always, feel free to reach out with any reactions.

Sandi is a registered psychologist with over 20 years of experience in mental health, eating disorder treatment, substance abuse recovery, and trauma care. She takes a harm-reduction, client-centered, inclusive approach to healing.

Her primary focus is trauma recovery, especially in individuals with co-occurring substance use, food-related challenges, or compulsive exercise behaviors. She integrates evidence-based therapies with family coaching, and somatic and experiential therapies where appropriate. She is also a Certified Eating Disorder Recovery Coach through the Carolyn Costin Institute, and provides real-time support for recovery challenges.

Sandi is currently pursuing a PhD on the intersection of eating disorders, substance use, and trauma. She brings both professional expertise and lived experience to her work, offering compassionate, informed guidance through recovery.

You can find Sandi at https://www.sandijames.com.au/ or on instagram @sandi_in_the_world and @surfing_diving_psychologist