A summary of evidence relating to suicide and self harm in prison and how services can identify and support those at risk.
Going to prison represents a transition from the outside world to a world behind walls. This transition affects people in different ways and many struggle to adjust. Identifying who may need support, supporting those in crisis and stopping prisoners from hurting themselves, or others, is a top priority. Everyone can make a positive difference.
What we know helps to identify someone who may need support
Suicide is most prevalent in middle-aged men from lower socio-economic backgrounds, and self-harm is more prevalent in young people, though these are not the only high risk groups.
Risk factors for suicide are found more frequently among the prison population. Prisoners are a high risk population for suicide and self-harming behaviours.
Suicide can occur at any time but particularly high risk times for prisoners include:
- early days and weeks
- post transfer
- post recall
- post sentencing
Someone in crisis is likely to be:
- actively engaged in self-harm or suicide attempts
- visibly agitated
- expressing current ideas and thoughts of suicide
Identifying someone in crisis and reacting is different from identifying someone in need of support and intervening proactively. Many prisoners who complete suicide don’t present as ‘in crisis’. Sometimes they have limited risk factors beyond being male and incarcerated.
Theories of suicide suggest risk is heightened when people feel:
- a lack of connectedness
- hopeless that things won’t change
Not everyone who self-harms intends on taking their own lives. Many incidents of self-harm are unrelated to suicidal ideation or intent, but there is a link. Over half of people who die by suicide have a history of self-harm.
Self-harm may occur at any stage of custody, when prisoners are trying to deal with difficult and complex emotions. This could be to punish themselves, express their distress or relieve unbearable tension or aggression. Sometimes the reason is a mixture of these. Self-harm can also be a cry for help, and should never be ignored or trivialised.
What can we do to help someone who may need support
Adopting a whole prison approach. Taking steps to reduce suicide and self-harm reduction is everyone’s responsibility. Management visibility and leadership around suicide and self-harm prevention is extremely important.
Using the Assessment, Care in Custody and Teamwork (ACCT) case management system. ACCT is a prisoner-centred, multi-disciplinary process used for risk identification, care planning and support. Prison Service Instruction 64/2011 requires that any prisoner identified as at risk of suicide or self-harm must be managed using ACCT.
Forming positive relationships and fostering sense of connection to others. Prisoners at risk of suicide or self-harm can be supported through positive relationships. This can be staff/prisoner and prisoner/prisoner. This includes through peer mentoring schemes such as Listeners. Sustaining and improving prisoners’ relationships with their families and friends outside is important. It can help identify when someone is distressed and help them overcome it.
Supporting prisoners where appropriate through physical and mental health interventions, counselling or other support services.
Reducing a sense of burdensomeness. Helping prisoners engage in meaningful activities where they feel they are contributing, and enhancing hope for the future.
Information sharing and proactive multidisciplinary working. Communication between prison staff and partner agencies inside prison (like healthcare) and outside prison (like court and probation) must be robust. Including the prisoner themselves in all decisions and communications is important. Prisons should also ensure it is easy for prisoners’ family members to contact the prison to report concerns.
Training and support for staff. Staff should be empowered to make decisions based on the individual’s unique needs, and knowledge about best practice in addressing vulnerabilities and providing appropriate care. Ongoing training, up skilling and supervision will benefit staff and the individuals they support.
Showing we care. Effective prison officers demonstrate good listening skills, recognise people’s humanity, and pass on hope and optimism.
Self-harm by adult men in prison, Rapid Evidence Assessment (HMPPS 2018) Describes the characteristics of those who most often self-harm, identifies poor staff knowledge and a lack of confidence in supporting those who self-harm, points to the benefits of positive staff-prisoner relationships, and reports there is very little good quality evidence on what works to help reduce self-harm. Promising approaches are identified as building skills in emotional regulation in stressful situations and focus on multidisciplinary working, training for staff and early risk identification.
Preventing suicide in community and custodial settings (National Institute for Health and Care Excellence 2018). This guideline covers ways to reduce suicide and help people bereaved or affected by suicides. It aims to: help local services work more effectively together to prevent suicide; identify and help people at risk; and prevent suicide in places where it is currently more likely. It does not cover national strategies, general mental wellbeing, or areas covered by other NICE guidance such as self-harm or mental health conditions.
Learning to cope: an exploratory qualitative study of the experience of men who have desisted from self-harm in prison Small-scale, in-depth qualitative study (HMPPS Analytical Summary 2019)
Suicide prevention: resources and guidance Help for local authorities, public healthcare professionals, police forces, and others to prevent suicides in their areas. Public Health England (2019)
Learning Lessons Reports Prisons and Probation Ombudsman thematic reports on variety of subject areas.
Samaritans website containing resources, guidance and contact information.
National Suicide Prevention Alliance Alliance of public, private and voluntary organisations in England. Resources, information about action to reduce suicide, and support to those bereaved or affected by suicide.
Independent Advisory Panel on Deaths in Custody Helps to shape government policy through independent advice and expertise to the Ministerial Board on Deaths in Custody.
Safety in Custody Quarterly Statistics published by the Ministry of Justice.
Office for National Statistics Registered deaths from suicide analysed by sex, age, area of usual residence of the deceased and suicide method.