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Women, Girls and SelfHarm

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Title: Women, Girls and SelfHarm


1
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
2
  • Its an everyday thing out there.
  • Youre always seeing it.
  • Theres always someone hurting themselves.
  • - Norma

3
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

4
Inception
PHASE I
  • .
  • Need
  • Literature review

Partnership
5
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).

6
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

7
Researching By, For and With
  • Decision to conduct the research
  • Construction of interview guide
  • Resources available
  • Giving back…
  • Challenges

8
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.

9
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

10
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

11
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.

12
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.

13
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
14
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)

15
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

16
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.

17
Overcoming Challenges
  • Doing research by, for and with
  • Gaining access
  • An inclusive research team
  • Providing services versus doing research

18
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

19
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

20
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

21
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.

22
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).

23
Survey Respondents Service Providers
24
Findings Social Portrait of Women Who Self-Harm

25
Findings Social Portrait of Girls Who Self-Harm
26
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.

27
TYPES
28
COPING FUNCTIONS

29
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.

30
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

31
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

32
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).

33
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).

34
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.

35
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).

36
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).

37
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.

38
PHASE IV
  • Criminalized Adult Aboriginal Female Drug Users
    A Study of the Role of Stigma in the Healing
    Journey

39
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.

40
  • 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.

41
Contact Information
Colleen Anne Dell Senior Research Associate
Academic Liaison Canadian Centre on Substance
Abuse 75 Albert Street, Suite 300, Ottawa
(Ontario) K1P 5E7 Tel 613-235-4048 x235, Fax
613-235-8101 cdell_at_ccsa.ca Assistant
Professor Department of Sociology Anthropology,
Carleton University 1125 Colonel By Drive, Ottawa
(Ontario) K2B 5E6 Tel 613- 520-2600 x 2625,
Fax613- 520-4062 cadell_at_ccs.carleton.ca
42
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
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