Abstract
Since 2011, self-harm amongst men in prison has risen, and by the end of 2015 the rate per 1000 male prisoners had increased by 90 per cent. Due to the increased statistics within this prison population, who have previously received little attention in academic literature, a Rapid Evidence Assessment (REA) was undertaken. Its purpose was to improve the understanding of self-harm, and to develop and inform thinking towards the management and treatment, as well as improving the outcome, for those who self-harm. The REA was created to assess the distinct characteristics and motivations of the men who self-harm and reference is made to the definition of self-harm by the HMPPS. To support these aims, the primary research questions addressed by the REA were: ‘Why do adult men in prison self harm?’ and ‘What works to reduce and/or manage self-harm among adult men in prison?’
The methodology used was taken from a range of databases and studies for relevant literature. From a sample of 2137 papers, 14 studies met the inclusion criteria and findings from these studies were drawn upon in developing the recommendations. The REA offered a note of caution as the literature was found to be contradictory in places, which limited the generalisation of some findings.
The key findings revealed that there were several empirically supported risk factors for men who self-harm in prison, although there was little evidence of protective factors. Moreover, there was limited research exploring the relationships between risk and protective factors. The research separated the factors into categories: Socio-demographic factors Custodial/prison-related factors Psychological/psychiatric factors.
Whilst there were numerous risk factors identified, it is interesting to note that self-harm rates were higher amongst white men. Relationship and accommodation issues were also identified as contributory factors. Additionally, there are higher rates of self-harm for prisoners who are either on remand, unsentenced or serving a life sentence. According to the findings, it was found that there were higher rates of self-harm for prisoners who have a high number of disciplinary infractions, and that having a history of self-harm was identified as being a good predictor of future self-harming behaviour.
Reference is made to the emerging evidence to support the separation of non-suicidal self-harm from suicide attempts/suicidal behaviour. There was also evidence to support the thought that self-harm is a form of coping with emotional distress or because of emotional dysregulation. There were areas found that required further exploration. These were seen with the role of rumination and its link with negative feelings or emotions, and its relationship to self-harm in prison, as well as violence and aggression. The findings highlighted that the research was lacking in effective forms of treatment for men who self-harm in prison. However, it referred to the positive treatment that showed a reduction in self-harming behaviour. This was from the Dialectical Behaviour Therapy (BPD), which is aimed at developing emotional regulation skills in coping with situations that are linked to self-harm. It was therefore recommended that future research be undertaken to develop and test an intervention strategy suitable for this prison population.
Further evidence revealed that poor staff knowledge and attitudes played a role in inducing self-harm. Reference was made to some staff with negative attitudes towards prisoners who self-harm and that a lack of knowledge left some staff feeling ill-equipped to deal with situations. The importance of good relationships between staff working together and between staff and prisoners was identified. Therefore, care planning and communication were highlighted as necessary components to provide support for both staff and prisoners. The findings identified that there is an important role for the wider prison management system to encourage support and to help both staff and prisoners dealing with self-harm. This was an interesting paper, which recognised that additional research is required about self-harming behaviour in prisons, particularly given its significant increase.
Self-Harm by Adult Men in Prison: A Rapid Evidence Assessment (REA), by Laura Pope, HMPPS, Ministry of Justice Analytical Series 2018, is available at: https://www.gov.uk/government/publications/self-harm-by-adult-men-in-prison-a-rapid-evidence-assessment