Developing a care-ful model to reduce and protect against self-harm in male prisoners

Self-harm among male prisoners in England and Wales continues to rise in the number of incidents and number of prisoners engaging in self-harm. This increase is not solely attributable to economic austerity, the prison system structural response towards self-harm has received substantial criticism for both how the staff have applied the response and the practicality of response. This thesis employed a critical realist paradigm to investigate the experiences of self-harm by male prisoners, prison staff perceptions of and structural responses towards self-harm, retrospective experiences of care by ex-prisoners and current experiences by vulnerable individuals. These investigations will be triangulated to develop a care-ful model to reduce and protect against self-harm in male prisoners. Six participant groups participated in four studies: 1) ex-prisoners (n=5) participated in a focus group and creative engagement and vulnerable individuals and staff member (n=4) participated in a consultation group and a semi-structured interview. 2) prison staff (n=72) and prisoners (n=92) participated in surveys. 3) prison officers (n=20) participated in four focus groups. 4) prisoners who self-harm participated in semi-structured interviews (n=12) and creative engagement (n=2).
The model developed from these findings indicated three key systemic areas to focus upon to reduce and protect against self-harm: culture, individual voice and resourcing. Provisions, resources, training and support should equip prison staff with the capabilities to effectively manage self-harm. A culture of safety and security should be fostered to support the care process through the empowerment of prisoners and the development of therapeutic relationships between staff and prisoners through a relational approach. Care must be individualised. The lived experiences of the male prisoners who self-harm must be understood, including the relationship their self-harm has with the prison environment and culture, the prison system processes, prison staff and prisoners, and their conceptualisations of self-harm.