Self-harm and suicide - advice for prison-based teams

Sadly, self-harm rates are at a historic high in prisons, and self-harm and suicide attempts are the strongest predictors of future suicide risk. People with histories of trauma, homelessness, substance misuse and those who have been in care are also at increased risk of suicide or self-harm.

According to Forward's own morality data, suspected suicides accounted for almost half (45%) of all mortalities among our clients in prisons over the last two years. The Office for National Statistics (ONS) also found suicides to be significantly more common than substance-related deaths in prison custody (84% vs 16%), with men in custody being nearly four times more likely to commit suicide than men in the general population.

And with many people in prisons and the community recently experiencing lengthy periods of isolation and associated mental health issues,– it has never been more important to be aware of the signs and triggers of self-harm or suicide.

On World Suicide Prevention Day, our clinical director Pamela Walters has the following advice for preventing suicide and self-harm in prison settings:

• Be alert to clients’ significant dates, such as sentencing dates and the anniversaries of the deaths of loved ones, where these are known.
• Watch for changes in behaviour, mood or demeanour, as these could be signs of the onset of mental illness. For example, those with depression may become more withdrawn, irritable and argumentative or stop engaging with services. An increase in self-harming behaviours should also alert to possible mental health problems.
• Be empathic: take the time to listen very carefully to those showing signs of distress.
• Focus on hope: fostering a sense of hope can help clients to make sense of self-harm and promote resilience and change.
• Identify mental health support: if you suspect a client has mental health issues, contact mental health or IAPT services. Ensure this is documented, including courses of action and whether these have been taken.
• Use ACCT: Assessment, Care in Custody and Teamwork. Ensure you or your team are up-to-date with ACCT training including refresher courses. Make sure you explain the ACCT purpose and process to relevant clients.
• Maintain positive relationships: good relations between staff and prisoners can help to ensure risks are spotted and addressed effectively.