Women, Girls and SelfHarm

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Women, Girls and Self-Harm
Colleen Anne Dell, PhD Canadian Centre on
Substance Abuse Carleton University
The Elizabeth Fry Society of Manitoba Inc.
May 4, 2006 BC Centre of Excellence for Womens
Health
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• Its an everyday thing out there.
• Youre always seeing it.
• Theres always someone hurting themselves.
• - Norma

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Outline

• PHASE I Prairie Women, Violence and Self-Harm
• Inception goals
• Methodology
• Definition self-injury / self-harm
• Holistic model of self-harm
• PHASE II
• Dissemination
• PHASE III
• Community Environmental Scan Roundtable

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Inception
PHASE I

• .
• Need
• Literature review

Partnership
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Literature Review

• 59 of federally sentenced women in Canada have
  self-injured (CAEFS 1995).
• A study of the Intensive Healing Program at the
  Prairie Regional Centre found that 73 of women
  engaged in self-injurious behaviour prior to
  admittance and 50 continued while incarcerated
  (Presse and Hart 1999).

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Community Research Team

• Federal Woman A federally sentenced Aboriginal
  woman who engaged in self-harm
• Community Woman A non-Aboriginal woman who
  engaged in self-harm
• Debbie Blunderfield Executive Director of the
  Elizabeth Fry Society of Manitoba, Aboriginal
  woman with extensive criminal justice advocacy
  experience
• Cathy Fillmore Associate Professor at the
  University of Winnipeg, history with Elizabeth
  Fry Society
• Colleen Anne Dell Assistant Professor at
  Carleton University and Researcher at the
  Canadian Centre on Substance Abuse, history with
  Elizabeth Fry Society
• Beverly Ozol Program Coordinator at the
  Elizabeth Fry Society, experience working with
  women who self-harm 
• Wendy Friesen Law student at the University of
  Manitoba
• Darlene Johnson Elizabeth Fry Society of
  Manitoba volunteer who assists women in conflict
  with the law

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Researching By, For and With

• Decision to conduct the research
• Construction of interview guide
• Resources available
• Giving back
• Challenges

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Research

• to assist women in conflict with the law
• to address the gap in the research between
  self-harm and the needs, supports and services of
  women in conflict with the law who are
  incarcerated and in the community, addressing the
  role of Aboriginal culture (includes helpful and
  unhelpful responses)
• to develop policy guidelines on self-harm as a
  serious health issue
• to information share with community service
  providers and correctional institutions that work
  with women who self-harm.

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Methodology

• Concentrated on the Prairie Region of Canada. 
• Data sources included
• interviews with community women (N 27 / n 25)
• interviews with incarcerated women (N 14 / n 12)
• focus group with incarcerated women (N 6 / n 3)
• interviews with community staff (N 4 / n 4)
• interviews with correctional staff (N 5 / n 5)
• surveys with correctional staff (N 4 / n 4)
• review of provincial and federal level
  correctional policy on self-injury
• TOTAL Data collected with 40 women 13 staff

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Definition

• Deductive inductive approach to understanding
• Account for existing literature
• Adopt traditional definition of SELF-INJURY
• concentrate on direct, physical and highly
  visible acts such as slashing, burning, head
  banging

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Definition continued

• Accounting for perspectives of the research team
  resulted in definition of SELF-HARM
• Any behaviour, be it physical, emotional, or
  social, that a woman commits with the intention
  to cause herself harm.

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Definition continued

• Inductive
• Any behaviour, be it physical, emotional,
  social, or spiritual, that a woman commits with
  the intention to cause herself harm. It is a way
  of coping and surviving emotional pain and
  distress which is rooted in traumatic childhood
  and adult experiences of abuse and violence. It
  is a meaningful action which fulfills a variety
  of functions for women in their struggle for
  survival.

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Holistic Model of Self-Harm

• Physical Self-Injury

2. Self-Destructive Behaviour
3. Destructive Relationships
4. Expressions of Suicide
5. Body Enhancement
6. Psychiatric/Medical Disorders Self-Injury
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Womens words

• Self-injury, I dont know. To me, the most you
  can get into is my drug habit because to me
  thats my way of injuring myself. I tortured
  myself so much through self-injury, I guess, that
  way. Cause when I was doing drugs, I didnt care
  about myself. I didnt do anything about myself,
  my health. And now I got this and I got that, and
  I totally destroyed my life. (Marguarite)
• I would drive at tremendous speeds down the
  highway, you know, a bush highway that had
  animals. And I would drive 160 km per hour, at
  170 km per hour. (Anne)

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Key findings

• Antecedents/origins
• Needs of women who self-harm
• Functions of self-harm
• Risk factors
• Helpful and not helpful responses to self harm
• Full report http//www.pwhce.ca/prairieWomenViole
  nce.htm

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Key findings

• A strong relationship between childhood and adult
  experiences of violence and self-harming
  behaviours
• The onset of self-harm occurred primarily in
  adolescence
• A lack of awareness of existing resources for
  self-harm in the community and in correctional
  institutions
• Specific programs and clear guidelines and
  policies on self-harm were generally lacking in
  both community and correctional settings
• A critical need for Aboriginal programs, supports
  and services designed and delivered by Aboriginal
  women.

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Overcoming Challenges

• Doing research by, for and with
• Gaining access
• An inclusive research team
• Providing services versus doing research

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Dissemination
PHASE II

• NCPC grant
• Report
• Plain language summaries
• Meeting with Ministers of Justice Health
• Meeting with Manitoba Justice
• Conferences, guest lectures
• Publishing (peer reviewed and newsletters)
• http//www.cewh-cesf.ca/en/publications/RB/v4n1/pa
  ge4.shtml

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Crossing Communities Art Project

• The Crossing Communities Art Projects (CCAP)
  goal is social development through the visual
  arts. The CCAP art studios provide a safe space
  for criminalized women and girls to visually
  express their value and collectively make work
  with artists. CCAP stages exhibits and public
  forums with this artwork to engage community
  dialogues that explore alternatives to
  incarceration.
• Cut to the Quick, Directed by Pat Aylesworth

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Community Environmental Scan Roundtable
PHASE III

• Established Winnipeg Intersectoral Committee on
  Self-Harm
• Passed resolution on self-harm as a serious
  health issue at the CAEFS AGM
• Conducted community environmental scan
  Community Mobilization for Women and Girls Who
  Self-Harm An Environmental Scan of Manitoba
  Service Providers
• Service-provider community roundtable in December
  2005

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Research

• to build a knowledge-base of the perceptions and
  awareness of self-harm among a broad
  cross-section of community and institutional
  service providers in Winnipeg and in the rural
  regions of Manitoba and to compare these findings
  with the earlier study, Prairie Women, Violence
  and Self-Harm (2001)
• to construct a database of existing resources
  (programs, supports and services) for women and
  girls who self-harm
• to identify guidelines for programs and policies
  based on the knowledge and experience of service
  providers involved in the care of women and girls
  who self-harm
• to investigate specific research questions and
  relationships that arose from the initial (2001)
  research (e.g., adult experiences of violence and
  self-harm self-harm and suicide the influence
  of peers on involvement in self-harm and
  specific programming, services, and supports for
  Aboriginal women and girls who self-harm)
• to share the findings of the environmental scan
  in a Manitoba community forum and plan the next
  steps for action with respect to developing
  program and policy guidelines.

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Methodology

• Non-random sample using community directories
  (133) and Intersectoral Committee service
  provider networks (45).
• Community service providers defined as health
  (physical and mental), justice, social service,
  Aboriginal and culturally specific,
  abuse/intimate partner violence, addictions/
  substance abuse.
• 37 response rate
• 24 applicable, 13 not applicable
• Very broad mail-out questionable timing
• Small sample size did not allow for
  distinguishing service providers (e.g.,
  Aboriginal and non-Aboriginal agencies).

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Survey Respondents Service Providers
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Findings Social Portrait of Women Who Self-Harm

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Findings Social Portrait of Girls Who Self-Harm
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DEFINITIONS

• 48 of agencies reported to have a definition of
  self-harm.
• Definitions shared 3 themes
• (1) self-harm involves a broad range of
  behaviours
• (2) it is a coping or survival response to deep
  emotional pain and
• (3) it is an intentional act without conscious
  suicidal intent.
• Service providers were generally in agreement
  with the types of self-harm identified in the
  2001 research.

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TYPES
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COPING FUNCTIONS

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POLICY

• 62 of agencies do not have a policy on self-harm
• 36 reported to have a policy
• 2 did not know if a policy existed
• Commonality between community policies harm
  reduction and protection planning model
• A harm-reduction, non-punitive response that
  requires the clients consent to follow a
  treatment plan (Survey 34).
• Institutions behaviour chain analysis, close
  and constant supervision, suicide assessment and
  intervention strategy, emphasis that self-harm
  needs to be treated differently than suicidal
  behaviour.

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SUICIDAL BEHAVIOURS

• 81 of service providers reported that their
  clients distinguished between self-harm and
  suicidal intentions.
• Although the role of self-harm in each clients
  life is unique/individualized, many clients who
  self-harm would not view themselves as having
  suicide ideations (Survey 1).
• 15 felt clients could not make the distinction
• During lengthy periods of self-loathing, there
  is no distinction (Survey 25).
• 12 do not know

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WOMENS RISK FACTORS

• COMMUNITY
• experiences of abuse and violence
• family disruption
• social isolation
• unhealthy personal relationships
• poor levels of health
• social structural factors
• INSTITUTIONAL
• separation from family
• stressful conditions of the institutional
  environment
• negative staff relations
• difficult peer relationships
• segregation
• mental health issues

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PEER INFLUENCE

• 44 uncertain about the role of peer influence in
  womens self-harming behaviour.
• 22 consider it a factor.
• 75 unsure about the role of peer influence in
  girls self-harming behaviours
• 15 felt peer influence is a contributing factor
  
• In any peer grouping there is the possibility of
  a potential for copycat effects of
• any behaviours (its) dependent upon the needs
  met by self-harm, the
• responses from others to self-harm, and the
  consequences of self-harm copycat
• effects are possible (Survey 1).

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RESPONSES TO WOMEN

• Physical self-injury
• implementation of a safety plan and counseling
• individual and group therapy
• specialized programming to facilitate healthier
  coping alternatives and distress tolerance skills
• dialectical behavioural therapy
• sexual abuse counseling
• medical support
• access to an Elder
• personal and community safety, assertiveness
  skills building, wen-do yoga, artistic play,
  sharing strength and wisdom through story, song,
  painting, photography and drama (Survey 41).

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Main guiding principles and courses of action
included

• Offer choices and information about the
  consequences of self-harm to empower women
• Provide feedback and support to women as they
  progress through the stages of their healing
• Provide support, advocacy, and access to
  appropriate community resources (shelters,
  alternative housing, transportation) and make
  referrals to them (medical appointments,
  community mental health worker, an Elder)
• Ensure that there is contact with workers
  associated with specific cultures.

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RECCOMENDATIONS FOR ADDRESSING WOMENS SELF-HARM

• Raise community awareness about self-harm (e.g.,
  the complex nature of self-harm as a coping
  mechanism)
• Increase educational opportunities about
  self-harm (e.g., self-harm and suicidal
  intentions)
• Provide more training on self-harm for service
  providers (e.g., more education and
  organizational workshops)
• Increase resources for women who self-harmfrom
  specialized programs to follow-up supports and
  services (e.g., need for more outreach services,
  follow-up, mentoring opportunities and advocacy)
• Address the broader social structural factors
  underlying womens self-harm (e.g., systemic
  issues of poverty, safe housing, adequate
  nutrition, education, child-care and employment).

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Concluding comment from service providers

• Traditionally, there has been a lack of
  understanding re the role of self-harm in the
  lives of people. The stereotypes and
  misunderstandings must be removed so that we can
  help each client who struggles/uses/requests help
  with this behaviour. The purpose served by the
  behaviour must be examined within the context of
  the individual, the environment, and within our
  society. In addition to the psychotherapy and/or
  counseling that many clients could benefit from,
  by truly understanding the purpose of self-harm,
  we can better assist our clients in reducing
  harm, developing skills to deal with pain,
  triggers, etc., find alternative coping and
  communication mechanisms and increase a clients
  mindfulness of dangers/alternatives, etc. (Survey
  1).

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Next steps

• Standardize definitions of self-harm and
  implement systematic methods of data collection
• Need qualitative research on the perceptions of
  youth and self-harm
• Service providers require greater opportunities
  to learn about their agency or institutions
  policy guidelines or common practices
• Further explore the relationship and differences
  between self-harm and suicide
• Evaluative research on treatment and healing
  approaches, programs, supports and services for
  women and adolescent girls who self-harm
• Service providers require opportunities to learn
  about the existing resources on self-harm
• Public education campaigns are necessary to
  improve both public and professional
  understanding of self-harm
• There is a persistent lack of adequate health
  care services for Aboriginal women, which
  requires immediate attention in developing
  culturally-specific healing approaches, programs,
  supports and services for self-harm these
  interventions need to be designed, developed,
  implemented and evaluated by Aboriginal women.

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PHASE IV

• Criminalized Adult Aboriginal Female Drug Users
  A Study of the Role of Stigma in the Healing
  Journey

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Research

• To address the burden of ill health of
  criminalized adult Aboriginal female illicit drug
  users.
• To generate new knowledge on the constitution and
  reconstitution of self-identity and the influence
  of associated role expectations and stigma for
  this population in their healing journey.
• To generate new knowledge on the influence of
  treatment program workers on womens constitution
  and reconstitution of their self-identity and its
  relation to healing.

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• To disseminate the research findings and
  implement knowledge translation strategies with
  treatment providers and the academic community.
• To provide a successful model of community-based
  research partnership that is rooted in research
  being done by, for and with the community.
• To facilitate mentoring opportunities among the
  diversity of partners in the study.

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Contact Information
Colleen Anne Dell Senior Research Associate
Academic LiaisonCanadian Centre on Substance
Abuse 75 Albert Street, Suite 300, Ottawa
(Ontario) K1P 5E7 Tel [phone] x235, Fax
613-235-8101 cdell_at_ccsa.ca Assistant
Professor Department of Sociology Anthropology,
Carleton University1125 Colonel By Drive, Ottawa
(Ontario) K2B 5E6Tel [phone] x 2625,
Fax[phone] cadell_at_ccs.carleton.ca
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Sources
- Fillmore, C. C. Dell (2001). Prairie Women,
Violence and Self-Harm. Manitoba Elizabeth Fry
Society of Manitoba. http//www.pwhce.ca/pdf/sel
f-harm.pdf - Fillmore, C. C. Dell (2005).
Community Mobilization for Women and Girls Who
Self-Harm An Environmental Scan of Manitoba
Service Providers. Manitoba Elizabeth Fry
Society of Manitoba. http//www.pwhce.ca/pdf/self
-harm.pdf - 2005. Record of the Manitoba
Community Service Provider Roundtable on Women,
Girls and Self-Harm. http//http-server.carleton.c
a/cadell/files_2006/Notesfromthe CommunityRoundta
bleJanuary2031.doc - Dell, C, C. Fillmore D.
Johnson (2005). Responding from Within Women
and Self-Harm, in Evidence in Action, Acting on
Evidence. Ontario Canadian Institutes of Health
Research. http//www.cihr-irsc.gc.ca/e/documents/
ihspr_ktcasebook_e.pdf