Search results

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.

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).

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.

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.

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.

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.

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.

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.

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.

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 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.

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

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.

Peer and professional support are important for women in prison to help them tackle a range of issues including self-harm. To date, research has not explored in any depth how women experience peer support provided in prison to help them manage their self-harm including peer support provided through the Listeners Scheme. The paper aims to discuss these issues.

This was a case study in one women’s prison employing mixed, qualitative methods. These included a questionnaire distributed to women and staff, a focus group with prison listeners, semi-structured interviews with women who self-harmed and semi-structured interviews with prison staff, together with a series of observations in the prison site.

While women in prison welcomed both professional and peer support their support preferences were influenced by how serious women considered their self-harm to be and the degree to which they regarded their relationships with staff as trusting and/or supportive. The therapeutic community (TC) that operated in the prison facilitated different relationships between women who self-harmed in prison and staff, than have hitherto been reported in the research literature. These relationships described by women and staff as “more open” allowed women to seek staff support when managing their self-harm behaviours. Women sought peer support from listeners in addition to staff support particularly at times when staff were unavailable for example at evenings and weekends.

The case study design was conducted in one women’s prison which operated a TC. The principles of the TC that operated in the prison are supported by the wider literature on TCs as conducive to good mental health. Findings are thus relevant for establishments with TCs .

Women opted for support from staff for helping them to manage their severe self-harm, over and above the peer support available through the prison Listener Scheme. This finding contrasts with previous research that suggests women trying to manage their self-harm in prison prioritise support from their peers because staff are often found to harbour unhelpful attitudes to women’s self-harm that makes seeking support difficult.

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

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.

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.

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.

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.

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.

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).

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

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.

The purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support.

Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines.

Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted.

This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms.

An algorithmic approach to managing self-harm has been introduced within a women's enhanced medium secure. This paper explores the experiences and perspectives of nursing staff using the model.

Purposive sampling was used to gather the experiences of a cross-section of nursing staff of different grades. Semi-structured interviews collected data relating to their experiences using the model as well as their satisfaction with the model in terms of its effectiveness and safety for staff and patients.

Nursing staff described themselves as being confident with the model and were clearly implementing it safely and effectively. They described the model as addressing the challenge of managing self-harm alongside the risk of violence, and also described the importance of effectively marrying individualised assessment and planning with the algorithmic approach. The difficulty for staff new to the ward was also described and this is a useful focus for further development and evaluation.

Nursing staff describe the algorithmic approach to managing self-harm in use on this ward as safe and effective and it could usefully be trialled in other areas which manage difficult and potentially high-lethality self-harm.

The algorithmic model is a new approach to dealing with the challenging levels of self-harm within the service, and there is a clear need to ensure that the end-users of model are confident that they are using it safely and effectively. This paper describes this work as well as expanding on some of the complexities of managing self-harm day-to-day in this challenging environment.

Research has consistently shown that staff working with people who self‐harm tend to experience a range of anxieties and negative emotions. Very little has been written on the particular issues and needs of staff in prisons, where rates of self‐harm are high. The current study gathered information about existing sources of support for staff dealing with prisoners who self‐harm, and identified positive practice examples. A postal survey was sent out to the Suicide Prevention Team Leaders from every HM Prison Service Establishment in England and Wales (139 in total). Fifty‐four surveys (38.8%) were completed and returned. Findings indicate that staff support services were reportedly in place in virtually all 54 establishments. However, the data suggest that even when present, provisions may not have adequately met the needs of staff working with prisoners who self‐harm, particularly when dealing with ‘repetitive’ self‐harming behaviours. These findings are discussed in relation to organizational health literature. Their practical and theoretical implications are considered, together with directions for further studies in this under‐researched area.