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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…

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: 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

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Article
Publication date: 13 November 2017

Rebecca Hargate, Sharon Howden, Emma Tarpey and Tammi Walker

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Forensic Practice, vol. 19 no. 4
Type: Research Article
ISSN: 2050-8794

Keywords

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Article
Publication date: 18 November 2013

Chris Beeley and Jaydip Sarkar

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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.

Originality/value

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.

Details

Journal of Forensic Practice, vol. 15 no. 4
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 1 April 2007

Lisa Marzano and Joanna R. Adler

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…

Abstract

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.

Details

International Journal of Prisoner Health, vol. 3 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

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