Behavioral health facilities may have heightened concerns when a patient with a bleeding disorder experiences self-injury or accidental injury, particularly given the potential for internal bleeding even in the absence of visible signs. These concerns are valid—and manageable with the right support and communication.

According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC) in Document 289 (approved October 2024), facility staff should promptly contact the patient’s bleeding disorder treatment team in the event of any injury or suspected injury to determine whether further assessment, monitoring, or treatment may be appropriate. This consultation is strongly recommended even when there is no external bleeding, as internal bleeding can still occur and may require timely intervention.

MASAC further emphasizes that having a bleeding disorder should not preclude access to quality mental health or substance use disorder treatment. Specifically, the document states that as long as the person is medically stable (as defined in Section IV) and able to maintain their established treatment protocol, they should not be excluded from receiving residential or inpatient behavioral health care.

Proactive coordination between behavioral health providers and the bleeding disorder treatment team ensures that individuals can be treated safely and effectively, while still receiving the full benefit of mental health and substance use treatment services.

Reassuring Facilities About Injury Risk and Access to Care

• "I understand your team may be concerned about the risks of self-injury or accidental injury in someone with a bleeding disorder—that’s completely valid."

• "Even if there’s no visible bleeding, internal bleeding can still occur, especially in areas like joints, muscles, or the head. That’s why MASAC recommends contacting the bleeding disorder treatment team after any injury or suspected injury."

• "We’re happy to consult in real time to help assess whether the person needs monitoring or treatment—even if the injury seems minor. This can help prevent complications and ensure safe continuity of care."

• "That said, MASAC guidance is also very clear: fear of potential injury or bleeding should not prevent someone from being admitted."
  The national recommendation from MASAC Document 289 states that as long as the person is medically stable and continuing their treatment protocol, they should not be excluded from residential or inpatient behavioral health care.

• "So if [insert patient name] is medically stable—which we can confirm—and following their bleeding disorder treatment plan, their condition should not be a barrier to admission."

• "We’re here to support you if any injury does occur, but we want to emphasize that the presence of a bleeding disorder alone—or concern about what might happen—should not prevent someone from receiving the mental health or substance use treatment they need."

Send the following to the facility:

• Introducing MASAC Guidance on Injury and Bleeding Risk: Personalize this email template to introduce the MASAC guidance on injury and bleeding risk in the facility.

• MASAC Guidance on Injury and Bleeding Risk: To support facility staff in understanding how to respond to self-injury or accidental injury in a person with a bleeding disorder, send the following:

  • Excerpt from MASAC Document 289 (Approved October 2024) – Include the section that provides national expert guidance on:

    • The importance of consulting the bleeding disorder treatment team after any injury or suspected injury,

    • The recommendation to conduct a medical assessment even in the absence of visible bleeding, and

    • The clarification that fear of potential injury should not preclude access to residential or inpatient behavioral health care if the individual is medically stable and able to maintain their treatment protocol.