National Institute of Health Research

1. A real life example of intervention retention and follow up in the community: problem solving for self-harm in prisons

2. National Institute of Health Research • This article/paper/report presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

3. The Research Team and roles • Amanda Perry and Mitch Waterman – Joint PI • Allan House –Intervention specialist • Nat Wright- Prison NHS lead • Ann Hopton – Research Fellow • Christine Butt – NHS liaison • Gerry Richardson – economic evaluation • Jo Greenhalgh – qualitative realist synthesis • Spectrum Community Interest Company

4. Evaluations of Problem Solving Interventions in the community • Use of Randomised Controlled Trials

5. Treatment of self-harm Key problem: a high prevalence of self-harm in prisons compared to the wider community. (Meltzer Gill & Pettigrew 1994,Singleton Meltzer & Gatwood 1998) Case control prison study rates 5-6% for men and 20-24% for women (Hawton et al 2014) • Generally anecdotal use of ACCT (Forrester & Slade 2014) • Renewed approach • Further training required (Hawton 2014)

6. Aim of the research To assess the feasibility of implementing a problem solving training to reduce self-harm in prisons. Two phases: • A short training programme to equip all frontline staff with an understanding of the problem solving approach. 2) Detailed training for ACCT prevention co-ordinators and RM Nurses who work with prisoners identified as at risk of self-harm and suicidal behaviour.

7. Where? Who? When? Four prisons in Yorkshire and the Humber: HMP Leeds, Newhall, Wetherby (YOI), Hull. • Researchers working in the prisons from February 2015 • 3 month rolling programme of training for staff • 3 months implementation with prisoners generally and prisoners on ACCT.

8. A problem solving intervention • MIDSHIPS is a programme of Problem solving therapy devised in New Zealand. • Modified for use in the UK by researchers at the University of Leeds and self-harm patients. • 7 clear steps to use

9. Design training materials

10. Identifying prisoners at risk: the methodology • Screening criteria: • Anyone on an ACCT in the previous two weeks • Any one with an incident of actual self-harm • 3 month period of recruitement • Reasons of opening an ACCT: • Suicide intent • Self-harm threat or behaviour • Low mood • Bizarre behaviour • Other concerns

11. An example from HMP Hull: the process Number of open ACCTS between October 7th and 7th January 2016 n=196 Number of incidents who self-harmed or attempted suicide n=146 32 (22%) individuals transferred or released. Number of people remaining in the prison at time of clinic appointment N=114 (78%) People attending clinic N=3 people too dangerous N=3 people lacking capacity/too ill N=15 people did not consent N=15 people not eligible Number of people not attending clinic after call up N=29

12. The intervention measurement Pre measurement – outcomes of depression –PHQ-9 • Physical and mental health – EQ5-D • Resource questionnaire • Demographic background

13. Follow-up consent form

14. Data provided on consent forms • Telephone numbers • Address to be released to • Name of parent/carer/professional • Address of parent/carer/professional

15. Summary Thank you for listening For more information contact Amanda Perry, Amanda.perry@york.ac.uk