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Understanding the context of self-harm for women in prison

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Please describe a relationship, service intervention, program implementation, policy, or other that you initiated or know about that would be considered trauma-informed:

Between 2009 & 2012 I led a three year project in a local women’s prison with the aim of reducing self-harm.  A participatory action research approach was used to engage with both the women in prison and the staff to understand the context, function and possible alternative to self-harm. 

The trauma of those women in prison and the staff who worked within the environment was figural throughout the process. 

Self-harm was described by those who used it in the context of the trauma they had experienced, the trauma of being imprisoned and the trauma of their on-going environment. Self-harm’s utility in managing, sometimes extreme, emotional distress was fairly universal amongst the women who worked with us and most described how much easier it was to manage the physical impact of self-harm than the psychological effects of their trauma.

Trauma of staff working within the prison was described consistently by colleagues.  In particular relation to self-harm this was often the result of not only having to manage the physical effects of sometimes life-threatening injuries but also feeling ill-equiped to manage the emotional distress of women in prison and not being able to understand the function of self-harm.  For reasons of self-preservation this often resulted in staff creating a distant or them and us relationship with the women in which self-harm was often labelled as attention seeking.  Clearly this then further impacted upon the relational dynamics between ‘prisoners’ and ‘staff’.

 

What was the outcome?  

A working groups of women who used self-harm was established using a PAR approach through which we analysed the results of research undertaken and took a solution focussed approach.  Specific ‘products’ developed by the women included:

  • Implementing creative writing, dairying and other expressive opportunities for women throughout the prison to find other ways of conveying emotion.
  • Developed and delivered ‘prisoner’ led training for front-line staff about self-harm from the perspective of those who use it.  As far as I am aware this was the first time user-led training was undertaken in a prison environment.
  • Discussed implementation of safer self-harming care planning within the MOJ, this was not possible to implement however
  • Implemented Mental Health First Aid
  • Developed and implemented, with a consultant psychiatrist (TEWV) a specific trauma informed service delivered from the mental health team.  This included delivery of education around trauma, delivery of DBT and procuring specialist EMDR consultants.
  • Secured funding to build a sensory room within the Health Care wing.
  • Rates and associated costs of self-harm did reduce within the prison over the period of the project, this of course could not be causally attributed.

 

What supported the positive outcome? (systemic supports? Organizational supports? Interpersonal supports?):

I think a positive multidisciplinary approach.  The project management team consisted of Academics, Health Commissioners, Prison and Mental Health Trust staff.  All were supportive of positive risk taking (the way we were engaging with women in prison at the time was considered risky).

That we were able to engage with women in prison in a way that was sensitive to the inherent power dynamics within the system and empower them to be as fully involved as possible.  This included providing them with ‘a voice’ in which to provide personal context to their self-harm including their lived experience.

 

In what way has your example changed you, your practice or your goals:

This process absolutely changed my perspective on how to engage with people in a way that is mindful of power dynamics and ensuring that they are empowered and involved as possible.  It has also influenced my practice in ensuring that a holistic view of the person we are working with is taken and any behaviour that we may find challenging is viewed in the context of the person’s experiences and the meaning that they attach to it.

 

 

Tell us more about what motivated you to bring this example to discuss:

I think because I’m personally proud of what was achieved and especially the trust and bravery that the women in prison demonstrated by challenging prevailing practice and culture in a system in which they are disenfranchised by design.

 

Whose needs are met in the example that you outline:

I’d hope predominately those who participated in the PAR, the women in prison and the staff who were open to trying something different.  As described above I also definitely benefitted in terms of my practice and ‘consciousness raising’.

 

Was there any one person or factor that was central to the success of your example and why:

A commissioner who promoted values over outcomes and was supportive in challenging the status quo within the prison institution.

The woman in prison who was brave enough to deliver training to prison staff and openly discuss her use of self-harm.

 

What can you or others do to spread this good practice to colleagues and services:

Share and celebrate good practice where we find it.  Challenge systems which are not trauma informed where we find them.

Tags: healing interventions

Published: 2021-07-27