The incidence and profile of self-harm among prisoners: findings from the Self-Harm Assessment and Data Analysis Project 2017-2019

PURPOSE

Internationally, rates of suicide and lifetime self-harm are higher in prisoners compared to the general population. This study aims to identify specific characteristics of self-harming behaviour and to establish a profile of prisoners who engage in self-harm.

DESIGN/METHODOLOGY/APPROACH

Data from the Self-Harm Assessment and Data Analysis Project (SADA) on self-harm episodes in prisons in the Republic of Ireland during 2017-2019 was used. Annual rates per 1,000 were calculated by age and gender.

FINDINGS

The rate of self-harm between 2017 and 2019 was 31 per 1,000 prisoners for men and six times higher at 184 per 1,000 prisoners for women. The rate of self-harm was twice as high among prisoners on remand than sentenced prisoners (60.5 versus 31.3 per 1,000). The highest rates of self-harm among sentenced prisoners were observed among 18-29-year-old men (45 per 1,000) and women (125 per 1,000). The rate of self-harm was higher among women prisoners in all age groups. Contributory factors associated with self-harm were mainly related to mental health but also linked to a prisoner's environment and relationships.

PRACTICAL IMPLICATIONS

There is a need to ensure access to timely and suitable mental health services, including both appropriate referral and provision of evidence-based mental health interventions to address the needs of these cohorts.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first national study to systematically examine incidence and patterns of self-harm among the prison population in Ireland. The recording of severity/intent of each episode is novel when assessing self-harm among the prison population.

A qualitative study of how self-harm starts and continues among Chinese adolescents

BACKGROUND

It is essential to investigate the experiences behind why adolescents start and continue to self-harm in order to develop targeted treatment and prevent future self-harming behaviours.

AIMS

The aims of this study are to understand the motivations for initiating and repeating nonfatal self-harm, the different methods used between first-time and repeated self-harm and the reasons that adolescents do not seek help from health services.

METHODS

Adolescents with repeated nonfatal self-harm experiences were recruited to participate in individual, semi-structured qualitative interviews. The interviews were analysed with interpretative phenomenological analysis.

RESULTS

We found that nonfatal self-harm among adolescents occurred comparatively early and was often triggered by specific reasons. However, the subsequent nonfatal self-harm could be causeless, with repeated self-harm becoming a maladaptive coping strategy to handle daily pressure and negative emotions. The choice of tools used was related to the ease of accessibility, the life-threatening risk and the size of the scars. Adolescents often concealed their scars on purpose, which made early identification insufficient. Peer influence, such as online chat groups encouraging self-harm by discussing and sharing self-harm pictures, could also lead to increased self-harm. The results also included participants' opinions on how to stop nonfatal self-harm and their dissatisfaction with the current healthcare services.

CONCLUSIONS

The current study provides important implications both for early identification and interventions for adolescents who engage in repeated nonfatal self-harm, and for individualising treatment planning that benefits them. It is also worthwhile to further investigate how peer influence and social media may affect self-harm in adolescents.

Negative life events and nonsuicidal self-injury in prisoners: The mediating role of hopelessness and moderating role of belief in a just world

OBJECTIVES

The rate of nonsuicidal self-injury (NSSI) among prisoners is higher than that in the general population. However, less is known about correlates and risk factors during imprisonment. Based on Dear's model of NSSI in prison, our study tested the mediation effect of hopelessness and the moderation effect of belief in a just world in the association between negative life events and NSSI.

METHODS

A total of 1,042 Chinese male prisoners completed questionnaires concerning negative life events, hopelessness, and belief in a just world. Their NSSI was assessed in structured interviews.

RESULTS

The results showed that negative life events were positively associated with prisoners' hopelessness, which in turn was positively associated with their NSSI. Belief in a just world weakened the mediation effect.

CONCLUSIONS

These findings highlight the need to consider environmental and personal factors simultaneously when evaluating risks associated with prisoners' NSSI, and they have important implications for prevention and intervention.

Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm

OBJECTIVE

To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations.

METHOD

Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm.

RESULTS

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care.

CONCLUSION

The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.

Self-Harm in Western Australian Prisons: Differences Between Prisoners Who Have Self-Harmed and Those Who Have Not

This is the second of two studies that examined self-harm in Western Australian prisons. Data were collected from 71 prisoners who had self-harmed in the previous three days and 71 comparison prisoners for whom there was no evidence of ever having self-harmed in prison. The groups were matched on age, sex, race, custodial status (remanded or sentenced) and placement within the prison. Measures across three –domains (personal background, perceptions of the prison experience and psychological functioning) were administered in a structured interview. The self-harm group reported a significantly greater level of distress, disorder or vulnerability on almost every measure. On no measure did they report lower distress or dysfunction. Two main implications for preventing self-harm are discussed. First, prison authorities need to develop more effective methods for identifying distressed prisoners. Second, strategies should be implemented to minimize prisoners' vulnerability to distress.

Death Anxiety and Pain Catastrophizing Among Male Inmates With Nonsuicidal Self-Injury Behavior: A Comparative Study

Most of the studies concerning nonsuicidal self-injury behaviors of persons deprived of liberty were on female participants. This cross-sectional comparative study compared the levels of death anxiety, pain catastrophizing, dissociative experiences, and state-trait anger among male inmates with nonsuicidal self-injury behaviors and noninjuring controls. The results indicated high levels of death anxiety, dissociation, and pain catastrophizing in both groups of participants and the absence of significant differences between the groups. The implications of the results suggest the need of taking into consideration these variables in the behavior management plans used with inmates who engage in self-injurious behavior.

Suicidal behaviour in prisons: learning from Australian and international experiences

This article explores what progress researchers and policy makers have made towards understanding and responding to the problem of suicidal behaviour in custody over the last 15 years. It examines current program initiatives and strategies for minimising this behaviour. This has become an imperative issue for the Australian Capital Territory (ACT) as they are in the process of developing their first prison (due to open mid 2008). The authors of this article were asked to prepare a report as part of the development of the prison. In developing a prison the ACT Government wanted to learn from the experiences of other jurisdictions including international 'best practice'. Australian prison system agenda has been dominated since the 1990s by the Royal Commission into Aboriginal Deaths in Custody which made 339 recommendations. These recommendations have been important for developing programs for intervention and prevention of suicidal behaviour for all inmates. This article examines the experiences of Australian jurisdictions over the last 15 years since the Royal Commission report was published. For the ACT Government learning from both international and domestic experiences is essential in developing a new prison.

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.