Coping with their lives – women, learning disabilities, self‐harm and the secure unit: a Q‐methodological study

Abstract

Deliberate self-harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities -particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and, thereby, restrict how such women can be understood. We recognize that despite this, multiple understandings about why women with learning disabilities self-harm do exist and are drawn upon by practitioners and the women themselves. In order to identify how women with learning disabilities who self-harm are understood a Q-methodological study was conducted with patients and professionals in a medium secure unit. Six distinct accounts of why women self-harm emerged. These accounts emphasized that self-harming behaviour is meaningful and that women with learning disabilities are understood to have complex needs and a range of strategies for coping with these. The study, therefore, suggests that when working with such women consideration should be given to how they understand and manage their experiences, cognitions and emotions.

Psychiatric Nurses Explanations of Self-Harming Behaviour in Secure Forensic Settings: A Multi-Method Phenomenological Investigation

“…Self-harm is a potent medium for communicating and regulating emotions, such as anger. James and Warner [12] and Pembroke [13] agree with this and report that service users sometimes hurt their bodies to release frustration and as a form self-punishment or to avenge others.…”

Women who use secure services: applying the literature to women with learning disabilities

“…(Warner and Wilkins, 2004:267) A small number of studies have looked at experiences of self harm from the point of view of women service users with learning disabilities. James and Warner's (2005) study concluded that judging women against inappropriate male standards would be to additionally penalize them for their self harming behaviour. The patients and staff in their research described self harm as a coping strategy to deal with past traumatic experiences, current relationships and issues around privation and security.…”

“…Women are often believed to contribute to staff stress and burnout due to more frequent incidents of aggression and self harm (Fish, 2000). Research within secure units (Harker-Longton and Fish, 2002;Fish and Culshaw, 2005;James and Warner, 2005;Duperouzel and Fish, 2008;Duperouzel and Fish, 2010) suggests that staff and organisational responses to these types of incident are further distressing to women and viewed as punishments, for example the use of physical restraint and confiscation of belongings to control self-harm.…”

“…Self injury in the non learning disabled population is primarily defined as intentional harm to one's own body without conscious suicidal intent and may involve cutting, self poisoning, ingesting objects, self neglect, burning, breaking bones amongst many others. These forms of self injury have been described for people diagnosed with mild/moderate learning disabilities who describe self injury in terms of a way of coping, a symptom or disclosure of distress, a physical release from frustration, or a form of self-punishment (Harker-Longton and Fish, 2002;James and Warner, 2005).…”

“…This paper will introduce research that looks at the experiences of women with learning disabilities who use secure services. Relevant research concerning women who use secure mental health services will also be included, as these women are described as having similar experiences and needs (James and Warner, 2005). Specific themes which arise in the literature, such as the 'borderline personality disorder' diagnosis, self-harm and sexual abuse will be discussed; these themes apply to many women who are detained regardless of the labels that have been applied to them.…”