On 15th May 2019, the Government published guidance relating to the issues of suicide and self harm in prison.
The guidance acknowledges that the transition of going to prison affects people in different ways as they vary in their abilities to adapt and adjust in what may be a new environment. What should also be recognised is that fact that it also affects people in different ways when they are returning to what can may be considered be a familiar environment, which again can be viewed in either a positive or negative sense.
Either way, what is clear is that the risk factors for suicide are found more frequently among the prison population. Prisoners are a high risk population for suicide and self-harming behaviours. Those high risk times include:
- early days and weeks (in local/remand prisons)
- post transfer
- post recall (in local/remand prisons)
- post sentencing (in local/remand prisons)
Note the common theme above in the concentration of risk factors faced in local/remand prisons.
The guidance recognises that someone in crisis is likely to be:
- actively engaged in self-harm or suicide attempts (although some may not be)
- visibly agitated (although some may not be)
- expressing current ideas and thoughts of suicide (although some may not be)
Identifying someone in crisis and reacting is different from identifying someone in need of support and intervening proactively. Many prisoners who complete suicide don’t present as ‘in crisis’. Sometimes they have limited risk factors beyond being male and incarcerated.
Theories of suicide suggest risk is heightened when people feel:
- a lack of connectedness
- hopeless that things won’t change
Not everyone who self-harms intends on taking their own lives. Many incidents of self-harm are unrelated to suicidal ideation or intent, but there is a link. Over half of people who die by suicide have a history of self-harm.
Self-harm may occur at any stage of custody, when prisoners are trying to deal with difficult and complex emotions. This could be to punish themselves, express their distress or relieve unbearable tension or aggression. Sometimes the reason is a mixture of these. Self-harm can also be a cry for help, and should never be ignored or trivialised.
Steps To Take For Those Who Need Support.
Taking in account the probability of risk factors and the degree to which they may apply in the general sense, it could be suggested that each person be supported according to his or her own individual needs. Those step outlined within the guidance include:
- Using the Assessment, Care in Custody and Teamwork (ACCT) case management system. ACCT is a prisoner-centred, multi-disciplinary process used for risk identification, care planning and support. Prison Service Instruction PSI 64/2011 requires that any prisoner identified as at risk of suicide or self-harm must be managed using ACCT – but for how long? When does a period of crisis end?
- Forming positive relationships and fostering sense of connection to others. Prisoners at risk of suicide or self-harm can be supported through positive relationships. This can be staff/prisoner and prisoner/prisoner. This includes through peer mentoring schemes such as Listeners. Sustaining and improving prisoners’ relationships with their families and friends outside is important. It can help identify when someone is distressed and help them overcome it.
- Supporting prisoners where appropriate through physical and mental health interventions, counselling or other support services.
- Reducing a sense of burdensomeness. Helping prisoners engage in meaningful activities where they feel they are contributing, and enhancing hope for the future.
- Information sharing and proactive multidisciplinary working. Communication between prison staff and partner agencies inside prison (like healthcare) and outside prison (like court and probation) must be robust. Including the prisoner themselves in all decisions and communications is important. Prisons should also ensure it is easy for prisoners’ family members to contact the prison to report concerns.
- Training and support for staff. Staff should be empowered to make decisions based on the individual’s unique needs, and knowledge about best practice in addressing vulnerabilities and providing appropriate care. Ongoing training, up skilling and supervision will benefit staff and the individuals they support.
- Staff showing that they care. Effective prison officers demonstrate good listening skills, recognise people’s humanity, and pass on hope and optimism.
Suicide prevention initiatives are more effective when establishments adopt a whole prison approach. Taking steps to reduce suicide and self-harm reduction is everyone’s responsibility. Management visibility and leadership around suicide and self-harm prevention is extremely important.
Whilst the guidance is undoubtably helpful, identifying probable risk factors alone offers no reassurance for the prison officers and healthcare staff in keeping those within their charge, safe. If only it was that easy.
Photo by Ye Jinghan on Unsplash.