House of Commons Committee of Public Accounts Mental health in prisons
Eighth Report of Session 2017–19. This is their (in red) summary of that report.
Summary Record high numbers of self-inflicted deaths and incidents of self-harm in prisons are a damning indictment of the current state of the mental health of those in prison and the prison environment overall. More excuses are not good enough. The Ministry of Justice, HM Prison and Probation Service and NHS England have a duty of care to those in prison, yet do not know where they are starting from, how well they are doing or whether their current plans will be enough to succeed. The current level of self-inflicted deaths and self-harm incidents in prisons is appalling and the system for improving the mental health of prisoners isn’t working as it should. Government does not have reliable or up-to-date measure of the number of prisoners who have mental health problems and existing screening procedures are insufficient to adequately identify those who need support and treatment. People in prison are more likely to suffer from mental health problems than those in the community. Yet prisoners are less able to manage their mental health conditions because most aspects of their day-to-day life are controlled by the prison. These difficulties are being exacerbated by a deteriorating prison estate, long-standing lack of prison staff and the increased prevalence of drugs in prison. Improving the mental health of prisoners is a difficult and complex task, but it is an essential step to reducing reoffending and ensuring that those who are released from prison can rebuild their lives in the community. Despite this, Government’s efforts to improve the mental health of those in prison so far have been poorly co-ordinated, and information is still not shared across the organisations involved, and not even between community and prison GP services.
MY PERSONAL EXPERIENCES…
Self Harm in prisons is rife… Don’t let these so-called ‘DO-GOODERS’, tell you any different. On every landing, in every prison that I have unfortunately had the privilege to live in. I have personally witnessed numerous men in some terrible states. Yes we have some fantastic staff in our prisons that really care. However, like everything else in our prison system these are the few, not, the many. The majority of prison staff see prisoners who ‘self-harm’, an inconvenience to their already chaotic day. These officers and institutions neglect some of these prisoners as ”Attention Seekers, Pests, Playing the system/routine to their advantage and just down right nuisances and time wasters… These are just some of the things that I have personally heard prison officers say over the years.
Yes all the studies in the world are not gonna help the men that have made up their minds. I get really frustrated, angry at some of the studies and reports these so-called academics seem to compile as factual. The reality is these men that have sadly taken their own lives and over the years some of these could of been prevented. Not every single one but, a large number of lives could of been saved.
Accordingly, with a bit more diligence in the job description and the specification. Prison officers are human beings and sadly as a human being, we are all fallible. Some just have a so-what attitude. This then has a massive effect on the way we are in our every day lives. No matter what job position or duty we have to do, we all find a way to make it as easy as possible. This means we cut corners and some how convince ourselves that those couple of steps we cut wont make much difference to the task in hand or the job/duty we have to do. Sadly not the case in the prisons where these people have taken their lives.
I was reading an academics version of suicides/self-harm in prisons and I could literally feel my anger boiling at sheer ignorance and naivety that this so-called academic was putting to heads of the judiciary. However, further reading went along the lines of another academic that brought some faith back into the subject. I then went on to mix them up and came up with the below. Hopefully it may help others to atleast understand what is going on within our prisons. Sadly I don’t think we’ll ever know why.
There are two straightforward questions that need to be answered:
Why do adult men in prison self-harm? What works to reduce and/or manage self-harm among adult men in prison? Risk factors There are a number of empirically supported risk factors for men who self-harm in prison but there is very little evidence on protective factors and limited research exploring the relationships between risk and protective factors. These include the following. Socio-demographic factors Age – younger men have a higher rate of self-harm than older men in prison, but older men (30+) who self-harm tend to do so in ways that result in more serious injury Ethnicity – self-harm rates are higher among white men Educational background – increased risk of self-harm among those lacking in formal education Relationship status – increased risk of self-harm among those who are single and/or have experienced a recent breakdown of relationship Accommodation – increased risk of self-harm among those who have no fixed abode Custodial/prison-related factors People are at increased risk of self-harm in their early days in prison There are higher rates of self-harm in prisoners who are on remand or unsentenced and those serving a life sentence Higher rates of self-harm are seen in local prisons, high security prisons, and Young Offender Institutes There are higher rates of self-harm in prisoners who have a high number of disciplinary infractions Psychological/psychiatric factors History of self-harm – having a history of self-harm is a good predictor of future self-harming behaviour both prior to and in custody Depression/hopelessness Borderline personality disorder (BPD) Substance misuse Lessons from the evidence base.
There is emerging evidence to support the separation of non-suicidal self-harm from suicide attempts/suicidal behaviours. Evidence suggests differences in lethality/severity and method, as well as intent should be considered in distinguishing and managing the risk and function of these behaviours. There is evidence to support the notion that self-harm is a form of coping with emotional distress or as a result of emotional dysregulation (the inability of a person to control or regulate their emotional responses to internal and external stimuli) for male prisoners.
One area signposted by the review which warrants further exploration is the role of rumination (the process of reflection and brooding which focuses on negative feelings or emotions) – both type and content – and its relationship to self-harm in custody. Evidence suggests there is a potential link between self-harm and violence /aggression. Further research is needed to fully explore the links. There is an absence of research on effective forms of treatment for men who self-harm in prison. The strongest evidence showing a reduction in self-harming behaviour comes from Dialectical Behaviour Therapy developed for (female) patients with BPD. Treatment is directed at developing emotion regulation skills for coping with situations that trigger self-harm. It is recommended that future research is undertaken to develop and test an intervention strategy suitable for male prisoners. Recommendations Poor staff knowledge and attitudes play a role in influencing self-harm. Evidence suggests that some staff have attitudes largely negative towards prisoners that self-harm, based on the perceived functions of the behaviour.
A lack of knowledge leaves some staff feeling ill-equipped to deal with self-harm, further endorsing negative myths about the behaviour. Good relationships between staff, and between staff and prisoners are important. Conflicts in responsibility over care planning and poor communication can leave both staff and prisoners feeling unsupported. The wider prison management system has an important role to encourage joint working and support and assist staff and prisoners dealing with self-harm. It is recommended that these problems could be addressed through staff training/peer support/safer custody leads/the ACCT process and a range of information sharing strategies.
I really believe that nothing short of a massive overhaul, of the prison policies & procedures within the whole system needs to implemented. This is before we start to see any real changes within our prison estates. The heads of the judiciary really need to stand-up and be counted for these unnecessary deaths in our prisons. It’s forward brave thinkers we need not, yes people…