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Article
Publication date: 14 March 2016

Hans Wolff, Alejandra Casillas, Thomas Perneger, Patrick Heller, Diane Golay, Elisabeth Mouton, Patrick Bodenmann and Laurent Getaz

Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating…

Abstract

Purpose

Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a “deprivation state.” The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm.

Design/methodology/approach

This cross-sectional study took place at Geneva’s pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014).

Findings

Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment.

Research limitations/implications

The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio – and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential.

Practical implications

The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior.

Originality/value

This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

Details

International Journal of Prisoner Health, vol. 12 no. 1
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 May 2005

Karen Gough

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a…

Abstract

Previous research has established that guidelines to facilitate a non‐judgemental, consistent approach to self‐harm management would be useful to staff working in a forensic psychiatric setting. In the preparation of these guidelines, a literature search was conducted to examine the evidence on clinical effectiveness for managing self‐harm. Overall, the evidence for defining a definitive treatment approach to self‐harm is extremely limited. However, a number of studies/reviews have identified aspects of treatment and care that are considered to be effective. Guidelines have been produced that capitalise on this information and provide front‐line staff (such as nurses) with advice that can be used on a daily basis when working with a service user who self‐harms.

Details

The British Journal of Forensic Practice, vol. 7 no. 2
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 1 December 2000

Karen Gough and Andrew Hawkins

Identified risk factors and clinical experience suggest that self‐harm is a common and very significant problem in forensic psychiatric settings. Sparse training on…

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Abstract

Identified risk factors and clinical experience suggest that self‐harm is a common and very significant problem in forensic psychiatric settings. Sparse training on self‐harm given to staff throughout professional development is a concern for staff who can be left feeling dissatisfied and powerless as how to manage the patient who self‐harms. Consequently, staff often have to rely on idiosyncratic beliefs about self‐harm and its management to guide their practice. This survey investigated staff attitudes towards self‐harm in a forensic psychiatric service. The results highlight much variation in attitudes and a sub‐population of staff holding relatively more punitive/negative beliefs. In addition, the survey drew attention to the difficulty of managing self‐harm in forensic settings‐especially in relation to issues around facilitating safe self‐harm.

Details

The British Journal of Forensic Practice, vol. 2 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 14 October 2021

Laura Ramsay, Cheyenne M. May, Priscilla Kennedy and Erin Lucy Fitzakerley

The purpose of this paper is to outline qualitative research into what influences, maintains and reduces prolific self-harm within women’s prisons across England.

Abstract

Purpose

The purpose of this paper is to outline qualitative research into what influences, maintains and reduces prolific self-harm within women’s prisons across England.

Design/methodology/approach

Semi-structured interviews were conducted with participants who were identified as engaging in prolific self-harm. Thematic analysis was applied to two data sets, and analyses were combined to generate final themes.

Findings

Six overarching themes were identified which served to explain what influences the repetitive nature of prolific self-harm and also what helps to reduce it. The themes were reasons for self-harm, trauma, being in prison, support, other support and interventions: management and rehabilitative.

Research limitations/implications

Owing to the sensitive nature of the research a stringent exclusion criteria was applied which limited the data sample from the original pool. Variance in detail was observed from the interviewer transcripts. The data sample was not large enough to examine the influence of protected characteristics.

Practical implications

Responsivity in the support offered by staff is critical to a reduction in repetitive harm. A re-focus on staff training, plus support mechanisms for staff supporting people in women’s prisons who self-harm prolifically has been recommended.

Originality/value

This paper has focussed specifically on prolific self-harm within women’s prisons. This has not been an area that has been investigated separately to the general self-harm literature in prisons. This paper provides insight into factors which influence, maintain and reduce prolific-self harm in women residing in prison.

Details

The Journal of Forensic Practice, vol. 23 no. 4
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 12 July 2021

Melanie Boyce

Self-harm can affect people of all ages, yet the high prevalence rate in adolescents and the potential risk factor of suicide in adults 60 years and above has meant…

Abstract

Purpose

Self-harm can affect people of all ages, yet the high prevalence rate in adolescents and the potential risk factor of suicide in adults 60 years and above has meant research has tended to focus within these areas. Therefore, the purpose of this exploratory study is to examine the experiences of self-harm in people from early adulthood to late middle age to gain greater insight and understanding in this underexplored area.

Design/methodology/approach

An online open-ended survey was used to collect the data from a UK user-led moderated online forum that supports people who self-harm.

Findings

Thematic data analysis indicates that feelings of shame and guilt were intensified, due to the double stigma participants face as adults that self-harm. Although most participants had seen a reduction in the frequency of their self-harm many experienced an increase in the severity of harm. In not fitting the assumed typical profile of someone that self-harm participants often struggled to gain formal support.

Research limitations/implications

This was a small-scale online survey; hence, it is not possible to generalise the findings to all adults who self-harm.

Practical implications

The findings from this research provide evidence that greater recognition needs to be given to the reality that self-harm can affect people of all ages. As a result, access to support needs to be widened as a means of supporting those who do not fit the typical profile of someone who self-harms.

Originality/value

This exploratory online study provides insights around the tensions and challenges facing adults that self-harm, which remains an under-researched and largely ignored area.

Details

Mental Health Review Journal, vol. 26 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 6 August 2021

Alexander Challinor, Kathryn Naylor and Patrick Verstreken

Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide…

Abstract

Purpose

Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated.

Design/methodology/approach

This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm.

Findings

This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends.

Practical implications

This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm.

Originality/value

This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

Details

The Journal of Forensic Practice, vol. 23 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

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Article
Publication date: 2 February 2021

Alessandra Girardi, Elanor Lucy Webb and Ashimesh Roychowdhury

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to…

Abstract

Purpose

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention.

Design/methodology/approach

Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database.

Findings

START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without.

Practical implications

The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm.

Originality/value

To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.

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Article
Publication date: 12 November 2020

Louise Griffiths, Di Bailey and Karen Slade

Without exception, research on the contribution of the Prison Listener Scheme as a form of peer support for those who self-harm in custody has focussed on men in prison…

Abstract

Purpose

Without exception, research on the contribution of the Prison Listener Scheme as a form of peer support for those who self-harm in custody has focussed on men in prison. Women’s experience of custody is shaped by their experiences of hegemonic masculinity that also mediate through women’s roles as mothers and caregivers. Women’s self-harm is similarly influenced by these gendered experiences. The purpose of this paper is to explore how the Listener Scheme as a form of peer-to-peer support for women contributes to women managing their self-harm in a female prison.

Design/methodology/approach

The paper used a case study design with a mixed-methods approach using a quantitative questionnaire with prison staff (n = 65) and women in custody who had self-harmed (n = 30). Qualitative methods included a focus group with Prison Listeners (n10) and semi-structured interviews with women who self-harm (n10) and prison staff (n10). Four days were also spent observing the prison environment.

Findings

Findings suggest that women seek support from other women as peer Listeners for three main reasons; their previous difficult experiences with men, a displacement of the mother role and their attachment needs in custody. Research suggests that women often have significant addictions and mental health concerns and are more likely than their male counterparts to engage in self-harm (Prison Reform Trust, 2017). In addition, women’s self-harm acts as a coping method for “intrapersonal issues” which documents self-harm as a result of frustration and lack of control in custody as opposed to “interpersonal issues” which documents self-harm as a result of relationship difficulties with partners (Walker et al., 2017). This paper suggests that peer support schemes internationally should be tailored to providing support for these types of gendered experience to support women who self-harm in custody. This has implications for the training and support of Listeners in women’s prisons.

Research limitations/implications

This exploratory research was conducted in one female prison and while can be considered to test proof of concept is limited in its generalisability.

Originality/value

This paper suggests that Listeners providing peer-to-peer support for women in custody who self-harm may encounter triggers for this behaviour based on women’s experiences including; how women relate to men; women’s experience of the way custody displaces their role as mothers and women’s need for safe attachments in custody. These gendered experiences have implications for the training and development of peer support schemes in women’s prisons, such as the Listener scheme. Further research is needed to compare the gendered types of support Prison Listeners provide depending on whether they are in male or female prisons.

Details

The Journal of Mental Health Training, Education and Practice, vol. 15 no. 6
Type: Research Article
ISSN: 1755-6228

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Article
Publication date: 12 March 2014

Jennifer Jane Barton, Tanya Meade, Steven Cumming and Anthony Samuels

– The purpose of this paper is to examine the predictors of self-harm in male inmates.

Abstract

Purpose

The purpose of this paper is to examine the predictors of self-harm in male inmates.

Design/methodology/approach

Male inmates with and without a background of self-harm (i.e. suicidal and non-suicidal) were compared across two distal (static and trait) and two proximal (environmental and current/state psychological) domains. The factors from the four domains which may accurately classify self-harm history were also examined.

Findings

The two groups were significantly different across the four domains, particularly on psychological characteristics. The self-harm group was associated with childhood trauma, violent offences, institutional misconducts and lower levels of social support significantly more than the non-self-harm group. Being single, childhood abuse, impulsivity, antisocial personality disorder and global psychopathology were the five key predictors that contributed to 87.4 per cent of all cases being correctly classified.

Practical implications

The high levels of psychiatric morbidity and childhood trauma in the self-harm group indicated a need for interventions that address emotional and interpersonal difficulties and optimization of adaptive coping skills. Also, interventions may require a focus on the behavioural functions.

Originality/value

A novel approach was taken to the grouping of the variables. A comprehensive range of variables, was assessed simultaneously, including some not previously considered indicators, and in an understudied population, Australian male inmates. The lower levels of agreeableness, conscientiousness and generalized anxiety disorder which distinguished the self-harm and non-self-harm group, were newly identified for self-harm.

Details

Journal of Criminal Psychology, vol. 4 no. 1
Type: Research Article
ISSN: 2009-3829

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Article
Publication date: 13 July 2015

Kerri Garbutt and Helen Casey

The purpose of this paper is to report on the internal consistency, convergent validity and test-retest reliability of the Attitudes to Prisoners who Self-Harm scale…

Abstract

Purpose

The purpose of this paper is to report on the internal consistency, convergent validity and test-retest reliability of the Attitudes to Prisoners who Self-Harm scale (APSH). The latter have yet to be examined.

Design/methodology/approach

Participants were prison staff with prisoner contact (N=97). Internal consistency of the APSH was examined using Cronbach’s α. Convergent validity of the APSH was examined by comparing it to the Self-Harm Antipathy Scale, a reliable and valid measure of healthcare staff attitudes to self-harm. Test-retest reliability was examined by re-administering the APSH one week after initial assessment (n=75).

Findings

The measure demonstrated adequate levels of internal consistency, convergent validity and test-retest reliability.

Originality/value

The findings support use of the APSH within custodial settings. It could be used to guide recruitment and training of prison officers that care for prisoners who self-harm and to evaluate the efficacy of their training. This would influence good practice.

Details

Journal of Aggression, Conflict and Peace Research, vol. 7 no. 3
Type: Research Article
ISSN: 1759-6599

Keywords

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