Responding from within: Women and self-harm

Colleen Anne Dell, PhD, Carleton University and the Canadian Centre on Substance Abuse
Catherine Fillmore, PhD, University of Winnipeg
Darlene Johnson, Elizabeth Fry Society of Manitoba

Self-harm—any behaviour that a woman commits to intentionally cause herself harm—is a serious health issue, especially among criminalized women. In 2001, the Elizabeth Fry Society of Manitoba (EFS) convened an inclusive research team of community women, academics, and EFS staff to better understand and act on self-harm. The initiative resulted in a holistic appreciation of the issue and sparked a series of partnered research initiatives with multi-sector involvement. Working in a team founded on diversity and committed to shared decision making was challenging but ultimately positive, and has led to ongoing research and knowledge translation (KT) activities.

Background

The Elizabeth Fry Society of Manitoba (EFS) is a non-profit, community-based organization that actively seeks to reduce the number of women and girls involved in the criminal justice system. In past years, the EFS experienced an increase in self-harm among its adult female clientele in trouble with the law.

In 2001, the EFS convened an inclusive research team to gain an increased understanding of self-harm and to translate that understanding into action. This team, which included incarcerated and community women who had self-harmed, academics, and EFS staff, reflects an approach to KT that capitalizes on the strengths contributed by all partners and actively shares decision-making power. This approach highlights the importance of both process (e.g. effective communication among partners) and product (e.g. research findings that benefit users).

Funded by the Prairie Women's Health Centre of Excellence, the initial stage of our research focused on the experiences of women in trouble with the law, their needs and the responses of community health, social justice agencies, and correctional institutions. It resulted in a holistic definition of self-harm: any behaviour—physical, social, emotional, or spiritual—that a woman commits to intentionally cause herself harm. It is also recognized as a way of coping and surviving emotional pain and distress rooted in traumatic childhood and adult experiences of abuse and violence. We concluded that community and institutional responses to women's self-harm were often detrimental and that there was a need for policy development on self-harm as a serious health issue.

Awareness raising is a prerequisite to policy and program development.

In 2003, these findings led to the second phase of our project, funded by the National Crime Prevention Strategy (NCPS), which focused on knowledge translation activities through the development of a Community Intersectoral Committee on women's self-harm. In 2004, the third project phase, again funded by the NCPS, we developed an environmental scan. The results are due to be released at a Manitoba community roundtable, with the expected outcome being a compilation of guidelines for developing policy and programming on self harm.

The KT initiative

We recognized early in the project that awareness raising is a prerequisite to policy and program development. Our initial KT goal was therefore to increase awareness of women's self-harm through promotion of our research findings to the criminal justice, public health, social service and government sectors. Our activities included a media release event to launch our initial report, wide distribution of a plain language summary of our research, and presentations and publications in national and international academic forums and community venues.

To take our awareness raising to the next level, in partnership with the community, we then established a Community Intersectoral Committee, with representation from all our intended KT audiences: criminal justice and public health policy analysts, government decision makers, academics, front line workers, and clients. We were then able to better design our KT activities for each target audience:

  • Government decision makers: We made presentations to the offices of the ministers of Justice and Health in Ottawa, the provincial Department of Justice, and the Canadian Human Rights Commission on federally sentenced women.
  • Policy analysts: We held meetings with prison representatives from provincial correctional facilities and federal corrections.
  • Academia: We presented conference papers at several university association meetings, were guest lecturers on university campuses and published articles and research reports in academic journals, newsletters, and in a correctional encyclopaedia.
  • Front line workers: We held community workshops, extensively distributed a plain language summary of the research report, and collaborated with the Crossing Communities Art Project, a Manitoba organization that develops arts programs as a healing approach for women who self-harm.
  • Clients: We developed plain language summaries that offered short-term strategies designed to help women and their loved ones deal with self-harm.

These activities (the products) and the diligent work of our team members (the process) guided our development of the environmental scan in the project's third phase. In this phase, our KT strategy moved beyond awareness-raising to examining the perspectives of service providers in justice, health, and social services on existing resources and the effectiveness of current programming and services.

Results of the KT experience

Our KT activities led to several instances of uptake of our research findings by those outside our original collaboration and intended audiences. For example, a number of health providers who did not routinely deal with criminalized women wanted to participate on our Community Intersectoral Committee. This reinforced the importance of our research on self-harm as a health issue not only for women who were at risk, but also for women in the general community.

A second example is policy action on self-harm by the Youth Solvent Addiction Committee (YSAC). YSAC's mission is to create a healthy recovery network of solvent treatment centres for First Nations and Inuit young people, their families, and communities. YSAC adopted a self-harm policy for its treatment centres based on an understanding of self-harm developed through our research. A similar policy statement was also formulated by the Canadian Association of Elizabeth Fry Societies, which passed a national resolution on self-harm after the publication of our research report.

Lessons learned

Our research team learned many lessons from our KT activities, which shaped the directions of later phases of the project. The lessons were both positive and at times difficult.

Managing potential tensions

Some organizational representatives of the team could understandably be viewed with suspicion by some of our intended audiences.

There was recognition that some organizational representatives of the team, such as the EFS, who had been instrumental in launching a human rights complaint against the Portage Correctional Jail, could understandably be viewed with suspicion by some of our intended audiences (e.g. Manitoba Justice). As a result, we set out to address potential misunderstandings by identifying and matching presenters with various groups, or by shifting the emphasis of what we presented to different groups. The success of this approach was evident when key decision makers and policy makers from the justice system and general health care sector participated on our Community Intersectoral Committee alongside EFS staff and clientele.

Opposing views

For the most part, the team members' breadth of experiences broadened our approach. But working on a team founded on diversity and committed to the principle of equality in decision making required considerable give and take. One example of group dissension occurred over the design of the research report cover. Some members wanted to feature a picture of a restraint chair to bring attention to the inhumane treatment of incarcerated women who self-harm. Others were concerned about an adverse reaction from justice and correctional officials, which might impede our efforts to work with them in bringing about policy change. There was also disquiet over sensationalizing and exploiting the women's pain. Lengthy discussions followed on the role of research as an advocacy tool. Eventually we agreed that the report cover would feature a symbolic grey background with red lettering, and that the image of the restraint chair would be used in a separate postcard campaign by one partner—the EFS—on the plight of Manitoba women in provincial custody.

Evaluation

We did not initially set up an adequate evaluative component of the effectiveness of our KT techniques and their impact. In response to the needs of our funders (who want hard evidence that our efforts are making a difference), we collected quantitative information on the number of reports distributed, the number of media interviews held, papers published, etc. But we did not establish a framework to gain a qualitative understanding of the effectiveness of our KT efforts (i.e. did we succeed in raising awareness?). Drawing on this lesson, we are now in a position to set criteria of KT success to evaluate our efforts for the remainder of the project.

Unanticipated happenings

Working with a diversity of partners, and attempting to translate findings into awareness and action with an even broader representation of community partners, brings with it a great deal of uncertainty.

The overarching lesson of this project is that working with a diversity of partners, and attempting to translate findings into awareness and action with an even broader representation of community partners, brings with it a great deal of uncertainty. The human elements—members leaving jobs, changing governmental priorities, or even clients passing away—could not be planned for, and we learned that the most effective response was to be flexible and open to creative and collaborative solutions. In the end, these lived experiences provided considerable wisdom to the team.

Conclusions and implications

Our team is now entering a new stage of its multi-phased project on self-harm, which will involve an expansion of the research team and development of a community advisory group. This phase, which will examine Aboriginal women's drug use as a form of self-harm, will involve hosting a community roundtable to discuss the findings of our environmental scan and to action plan next steps. Steps will also be taken to map out an evaluative framework for our KT strategy.

These and related activities will remain consistent with our original KT foundation, capitalizing on the strengths and diversity of our team members and sharing decision-making powers. This is of critical importance to process as well as product, both of which are essential elements of our approach to KT.

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