Tag Archives: Self-Harm

Guidance: Suicide & Self-Harm Prevention In Prison

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
  • burdensomeness
  • 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.

Read the full guidance here.

Photo by Ye Jinghan on Unsplash.

A Summary of the MOJ Safety in Custody Quarterly Bulletin: An Update to December 2018

This bulletin was published on 25th April 2019, and provides a report on the Safety in Custody Statistics, England and Wales: Deaths in Prison Custody to March 2019 Assaults and Self-harm to December 2018. Also included in these figures are Immigration Removal Centres operated by HMPPS.

Deaths – 12 months ending March 2019

In the 12 months to March 2019, there were 317 deaths in prison custody, up 18 from the previous year. Of these, 87 deaths were self-inflicted, up 14 from the previous year, representing an increase on the previous 12 month period.

There were 3 apparent homicides, down from 5 incidents in the previous year. Homicides in prison custody remain relatively rare, accounting for around 1% of all deaths over the last ten years. There were 164 deaths due to natural causes, a decrease of 11% from 184 in the previous year. Natural-cause deaths were at a rate of 2.0 per 1,000 prisoners.

Self-Harm – 12 months to December 2018

Self-harm incidents reached a record high of 55,598 incidents in 2018, a 25% increase from 2017. The number of incidents between October and December decreased by 7% to 14,313 since the previous quarter.

The number of self-harm incidents requiring hospital attendance increased by 5% on the previous year to 3,214 while the proportion of incidents that required hospital attendance decreased by 1.1% to 5.8%.

The most common method for self-harm in prison was cutting/scratching, 54% females and 68% males self-harmed by cutting.

This was an increase of 27% for males and 12% for females in the most recent year. Hanging and self-strangulation both increased by over 35% for males since 2017. Hanging decreased by 7% for females in the previous year, although self-strangulation rose by 32%.

Consistently, prisoners in male establishments who are in prison between 31 days and 3 months were the most likely to self-harm.

Prisoners in both male and female establishments had the majority of self-harm incidents when they had been in custody between 31 days and 3 months, however for the first time in 2018, the majority of self-harm incidents occurred when prisoners had been in their current prison for over one year.

Assaults – 12 months to December 2018

Annual assault incidents reached a record high of 34,223 incidents in 2018, a 16% increase from 2017. Assaults in the October to December 2018 quarter decreased to 8,150, a decrease of 11% from the previous quarter, but a 5% increase on the same quarter of the previous year.

The proportion of assaults on staff increased to 30% of all incidents in 2018, an increase from 29% in 2017, and a steady increase from 20% between 2008 and 2011. The proportion of assaults on staff (38%) in female establishments in 2018 was higher than in male establishments (29%).

In the 12 months to December 2018, there were 3,918 serious assault incidents, up 2% from the previous year. Serious prisoner-on-prisoner assaults decreased by 1% since the previous year (to 2,987), and serious assaults on staff increased by 15% (to 995) in the same period. Serious assaults (by 4%), serious prisoner-on- prisoner assaults (by 5%), and serious assaults on staff decreased in the last quarter (by 4%).

There were 24,424 prisoner-on-prisoner assaults in 2018 (a rate of 293 per 1,000 prisoners), an increase of 15% from 2017, to a new record high.

Prisoner-on-prisoner assaults in male establishments rose by 15% to 23,538 incidents from the previous year, and assaults on staff in male establishments rose by 20% in the same period, to 9,665 incidents.

Female prisoner-on-prisoner assaults increased by 10% in 2018, to 886 incidents, and assaults on staff in female establishments increased 48% to 548 incidents. The proportion of assaults on staff (38%) in female establishments was higher than in male establishments (29%).

There were 10,213 assaults on staff in the 12 months to December 2018 (a rate of 123 per 1,000 prisoners), up 21% from the previous year. This is the highest level in the time series. The proportion of assaults on staff increased to 30% of all incidents in 2018, an increase from 29% in 2017, and a steady increase from 20% between 2008 and 2011.

Prisoners aged 30-39 had the highest proportion of assailants (25%), fighters (21%) and victims (28%) in 2018.

The number of assailants aged 30-39 had increased by 26% since the previous year, to 5,254 incidents. The number of fighters aged 30-39 increased by 7% to 2,966 and the number of victims aged 30-39 increased 12% to 4,040.

The number of incidents involving prisoners who had been in prison over one year has seen the biggest increase across all roles.

The number of assault incidents involving prisoners who had been in custody for 31 days to 3 months had smaller changes from the previous year for assailants (3% increase to 5,199 incidents), fighters (3% decrease to 3,642 incidents) and victims (1% decrease to 3,591 incidents), whereas prisoners who had been in prison over one year has increased for assailants (69% increase to 3,522), fighters (46% increase to 2,131) and victims (60% increase to 2,127).

Bulletin Summary.

  • Number of deaths have increased compared to the previous 12 month period.Self-harm incidents rose to 55,598 in 2018, a new record high, but decreased in the latest quarter.
  • Incidents requiring hospital attendance rose to a record high of 3,214 in 2018, although the proportion of incidents requiring hospital attendance has decreased.
  • Assault incidents increased to 34,223, a record high level in 2018, but decreased in the latest quarter.
  • The proportion of assaults on staff continue to rise.
  • Of the 34,223 assault incidents in 2018, 3,918 (11%) were serious.

Get the full bulletin here:


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