An Exploratory Study of Interventions for Self-Harm in Men's Prisons

Background There is a high prevalence of self-harm in men in prison in England and Wales. Rates are at a record high, with 47,136 incidents between March 2018 and 2019. Self-harm causes physical and emotional suffering, with significant prison and NHS costs. There is no evidence-based treatment for self-harm in this population of men.

The prison environment, with stigma around self-harm, has made developing treatments challenging. The prison service and NHS have little awareness of which treatments are offered.

Aims and Objectives Aim: To examine which self-harm interventions are being delivered to imprisoned men in England and Wales and understand the treatment experiences and preferences of stakeholders. Objectives: To describe ( map ) interventions for self-harm across a representative sample of men s prisons.

To explore the experiences of self-harm for men and staff in prison. We will obtain their views on treatments they have experienced and new interventions. Methods 1.

We will conduct structured telephone interviews with staff across a representative national sample of 22 men s prisons (20% of all men s prisons) to establish what treatments are being delivered. We will interview 22 prison and 22 mental health staff using a standardised checklist and obtain written materials. 2.

We will hold 9-11 focus groups across a sample of men s prisons (one group per prison). Each group will include 5-8 health and custody staff with experience of working with men who self-harm.

Their experience of self-harm and its treatment in prison, and views on the acceptability and feasibility of a range of treatments, will be explored. Questions will be informed by the mapping exercise and the current evidence base. 3.

We will conduct 24-30 individual semi-structured interviews with a sample of remand and sentenced adult prisoners who have self-harmed in prison. They will discuss their self-harm, treatment experiences, and views on current and novel treatments. Analysis: Data on current interventions will be ordered to provide a descriptive map of self-harm provision.

Transcripts from focus groups and interviews will be analysed using framework analysis.

Timelines for delivery Months 1-4: HRA, NPC and R&D approvals; security clearance; preparation of materials Months 5-7: Mapping of current interventions Months 8-17: Focus groups and interviews; begin analysis Months 18-21: Completion of analysis, write-up and dissemination Anticipated Impact and Dissemination Mapping current treatments will influence policymakers in their support for research into evidence-based treatments.

It will also provide evidence of treatment as usual for future trials. This work will identify promising interventions.

Following this study, they can be used in feasibility and acceptability studies, succeeded by a full-scale clinical trial. Findings will be shared with policymakers in the prison service including the national prison Safer Custody group. This project is the first step in the development of cost-effective treatments for men who self-harm.

It will ultimately benefit thousands of men, staff, their peers, and families, as well as reducing NHS and prison costs.

We will disseminate findings through lay research summaries, prison dissemination events, papers, a conference presentation and social media.