self-harm and self-inflicted death in prison in england and wales morag macdonald centre for research into quality un

3. Aim To describe the current suicide and self-harm policy that operates in the English and Welsh prison system. To report on a study of the self-inflicted death and self-harm policy. To look at the barriers to successful implementation of self-harm and suicide policy.

4. Section 1

5. Context The Director of the Prison Service prioritised the importance of �providing a safe and decent environment for prisoners and looking after them with humanity� Time of change, with developing partnerships between the Prison Service and the National Health Service.

6. The extent of the problem

7. The suicide and self-harm policy � To enable prisons to become safe environments at all levels by �taking a whole prison approach� to the prevention and management of self-harm and suicide

8. Holistic approach should involve Establishment of a Suicide Prevention and Awareness Team in each prison; Monitoring prisoners considered to be at risk of suicide; Provision of a programme of staff training; Establishment of the prisoner listener scheme; A suicide co-ordinator and suicide liaison staff in each prison.

9. Section 2

10. Sample 6 prisons including: Young offenders Women Men Open High Security

11. Key findings: Suicide Prevention and Awareness Teams (SPAT) Considerable variations in the operation of the SPATs. Not all teams operating at a strategy level. The need for a senior manager to lead the response to self-inflicted death and self-harm prevention work. The variable use of monitoring forms.

12. Training Training focuses on monitoring forms. Training tends to ignore skill development. Training does not occur consistently and is often cancelled. Trainers do not necessarily have an understanding of the issues that relate to self-harm and suicide, (often having basic �presentation skill� training rather than having knowledge of the particular subject matter).

13. Staff attitudes and practices Staff tend to see self-harm as: a precursor to suicide; manipulative behaviour (to gain improved conditions) or attention seeking. a limited range of activities (hanging or cutting). Prisons� cultures impact in a variety of ways: approachability of prison staff; bullying of both staff and prisoners, sexism; lack of understanding amongst staff about prisoners with learning difficulties.

14. Provision of a safe environment Anti-bullying and drug strategy often excluded from SPAT agendas Some establishments did not see self-harm and suicide awareness as multi-disciplinary or as �whole prison� issues. Insufficient time out and a lack of meaningful activities tended to lead to a greater occurrence of bullying. Environmental factors old Victorian prisons overcrowding.

15. Prisoner Listener Scheme Prisoner listeners tend to be seen as a major answer in the drive to prevent suicide. Not all staff were enthusiastic about the listener scheme. The support for prisoner listeners varies across the prisons. Listener training does not necessarily include self-harm awareness.

16. Role of Health Care Self harm tends to be identified as a medical issue rather than a �whole prison� issue Some prisoners on monitoring forms were automatically housed in health care, which was not always seen as being the appropriate place for them by some staff. Less access to activities when on health care.

17. Section 3

18. The research demonstrates No single component is likely to effect change but a crucial role played by: Leadership and management Staff understanding and attitudes towards the issues surrounding self-harm and suicide. The need to tailor strategy to meet the special requirements for YOI, women, men and juveniles. The impact of external factors on women prisoners (childcare responsibility is not always taken into consideration).

19. The research demonstrates (continued): All levels of staff need to embraces the principles of �good practice� Access to community resources. A joined-up approach to developing strategies is required. Appropriate evaluation of �outcomes� need to be developed (beyond mere audits of procedures) to ensure the issue is fully understood across the prison.