How to prevent suicide in prison and beyondPosted: May 18, 2016
Highlights from the 2016 suicide prevention roundtable with Cambridge University
The Prison Watch UK team were live at HMP Altcourse today at the 2016 suicide prevention roundtable. We bring you the highlights…
“It is clear too many people are committing suicide in the care of our criminal justice system. A response on what we must do better must come from everyone together.”
Amy Ludlow, lecturer in criminology at Cambridge University, opened the discussion for a day of challenging and constructive debate.
10.15 Poly-victimisation of women in prison
Dr Tammi Walker, principal lecturer in psychology at Manchester metropolitan university, began by outlining the scale of the problem.
- In the past year we have seen 100 suicides across the prison estate
- There has been a 20 per cent rise in assaults in the second half of 2015
- The UK suicide rate has risen gradually, since 2007
“We are aware of the influx of legal highs, a more challenging mix of prisoners, and staff shortages but these factors alone cannot take the full blame for this rapid deterioration of safety inside jails”
Dr Walker explained how imprisoned women often describe episodes of poly-victimisation (multiple trauma) throughout their lives, including chronic and severe abuse.
“Women coming in have extensive victimisation backgrounds – from childhood, physical and sexual abuse. In adulthood, sexual exploitation and domestic violence. In addition many women are dealing with PTSD and substance misuse, often a coping mechanisation.”
The environment of the prison estate
The policies and practices of prison environment can trigger past experiences of victimisation Dr Walker.
“The environment of the prison estate is making these vulnerabilities worse. Routine strip searches can provoke re-traumatisation. A lack of privacy exacerbates helplessness and feelings of worthlessness”
Lack of support for staff
Staff need training to improve the way they handle vulnerable women but also for their own psychological wellbeing said Dr Walker. “Suicide prevention training is not mandatory training. It should be.”
What can we do?
Dr Walker called for a collaborative approach:
- Looking after the interests of the women imprisoned
- Creating “enabling environments”
- Supporting the psychological well being of prison staff
10.30 The link between violence and self harm
Karen Slade, Senior Lecturer in Psychology, Nottingham Trent University, spoke about the link between physical assault and self-harm in male prisoners.
She firstly outlined the key factors to identify future self-harm behaviour and suicide:
- Perceived stress, enhanced by vulnerabilities
- Perception of defeat, including loss of social ‘standing’
- Strong perception of Entrapment, both internal and external
- No escape or rescue. Including the perceived loss of family and peer connectedness
Dr Slade’s research shows:
- Those that self-harm tend to be more violent and vice versa.
- Those that commit violence have a stronger risk of self-harm than those that are victims of violence.
- Restrictive regimes exacerbate the risk of violence and self harm
Approaches to reducing risk
A local prison devised and implemented a new strategy to suicide prevention and experienced an exceptional sustained reduction in suicide.
Dr Slade outlined the measures they took as key recommendations:
- Safety was made the first priority
- Support staff supported innovative thinking
- Cross professional collaborative working – not seeing each other as aliens!
- Where necessary, specialists brought in to advise
- Developing a range of staff support measures so staff are not being frightened to make decisions.
11.00 Getting to the root causes
Governor Paul Holland and Rosie Rand, Equality, Rights and Decency Group in NOMS, in April this year set up a suicide and self-harm reduction project, to seek to reduce the levels of suicide and self-harm in prisons.
Ms Rand outlined NOMS’ initial findings:
- Prevention “we know we have a vulnerable cohort. Environment can make things better or worse”
- Intervention “we need to work out a more individualised approach – to what extent is that individual at risk and what can you do to support them?”
- Education “the same mistakes have occurred on numerous occasions, just in a different settings and at different times. How can we make sure we reduce that across the prison estate?
Mr Holland ended the morning saying, “this isn’t about stats, it’s about real people. Real people who have died in our care and the families that we devastate with a knock on the door… There’s no silver bullet. There’s a challenging agenda ahead.”
12.30 Panel discussing challenges and possibilities
The following experts discussed effective ways of combating mental health problems in prison: Mike Baines, North West Regional Safer Custody Lead, Lisa Davies, Managing Chaplain, HMP Styal, Linda Pyatt, Macclesfield Branch, Samaritans and Lorraine Atkinson, Senior Policy Officer, the Howard League for Penal Reform.
Lisa Davis runs a multi faith chaplaincy team at HMP Styal for people of all faiths and none.
- To help women’s self esteem they run a six week programme that draws out positive achievements of women – anything from giving birth to making a cake. Women list things they like about themselves and say positive reinforcements about others.
- “It’s important to show them affirmation.”
- Her team has seen an increase in participants: staff “just haven’t time any more for ‘proper’ conversations.”
- “Five minute interventions are important but they are not enough.”
Linda Pyatt has been involved in prisoner work for around 15 yrs.
- The prison population mirrors the demographic in society in general that is particularly at risk of suicide: aged 20 – 50, possibly single, with a criminal background, low education and poor socioeconomic backgrounds.
Prisoner listeners are selected and trained in same way Samaritans are trained.
- “It’s not about what has happened but how. We focus on listening to feelings and thoughts rather than on things. Human contact is very important.”
Lorraine Atkinson has been working on a joint project with the Centre for Mental Health.
- “Prisons are facing real challenges. Some of the issues concerned with suicide don’t lie in prisons themselves but outside too with courts and sentencing.”
- The number of staff has been falling – meaning prison staff are spending less time with prisoners, and prisons are losing experienced staff on the wings, who are replaced with younger, less experienced staff.
- Locked up prisoners for 23 hours impacts on mental health and wellbeing. “Coming out for 4 or 5 hours a day is not enough.”
“We need to recognise that staff shortages, policy changes and overcrowding are having an impact [on suicide and self harm rates].”
- It’s not just prison service bearing the costs of suicide – the authorities and taxpayers are too.
- She wants to bring about a cultural change in people’s attitudes to sentencing people in prison.
- Short sentences are expensive and ineffective, those on remand shouldn’t be in prison and those who have been recalled often don’t need to go back to prison either.
- She finished by urging: “We must reduce the number of people in prison”
Focusing on the early days
On the second discussion panel was: Bethany Schmidt, Univeristy of Cambridge, Bev Powis, Senior Quality Outcomes Specialist, Interventions services, NOMS, Laura Nettleingham, Senior Researcher in Commissioning strategies group, NOMS, Jane Moor, Head of Residence and Safety, HMP and YOI Foston Hall, Cathy Bennett, Safer Custody Team, HMP Altcourse and Sandra Bennett, Young Adult Support Team (YAST), HMP Altcourse.
Jane Moor has been working on early days and induction.
- “One third of deaths in custody happen within first month. We can’t undo what we get wrong in those days.”
Environment really matters – what works are photos of nice positive things, warm lighting, posters with motivational quotes.
- A female in the prison estate is going to think it is violent. They are asked if they are homophobic or racist – so will think there are lots of them.
- Moor runs a two week induction programme.
- In the first week the priority is safety, as well as things like helping to sort childcare, maintain family ties and meet healthcare needs.
- Also helping ladies understand what can do to help fill their time, to distract themselves from their “horrible” environment: rooms workouts, mindfulness, earning money and working.
- Week two is about prison regime and building relationships.
Cathy Bennett recruits, vets, trains and supports prison mentor groups.
- Prisoners are trained around suicide, self harm, confidentiality and being non-judgmental.
Carers focus on high risk areas, such as admissions.
- They also run a care suite – any prisoner at risk of suicide will go there and remain overnight, supported by a carer who stays awake.
Sandra Bennett helped set up Altcourse’s Young Adult Support Team (YAST).
- Robbie, one of the YAST carers explained: “It’s putting an arm round them and caring for then. But also showing them the rights and wrongs of the prison system. They will listen to us more.”
- They run awareness classes on NPS, violence, respect, positive thinking and short and long term goals.
- Danny mentors young boys and hopes to continue when he gets out. He mediates between people in gangs fighting within the prison. “We get them to shake hands and put it to bed. Where it could have been tit for tat stabbings and all sorts.”
- Praising those being productive and displaying good behaviour – who often get overlooked – is “motivation for kids who maybe aren’t doing so well,” Danny said.
14.00 Going through the gate
Nicky Padfield, Reader, University of Cambridge, and Andrew Connolly, Senior Probation office, National Probation Trust Manchester and Trafford, discussed suicide prevention after release.
Andrew Connolly presented research by psychologist Amy Beck.
- There has been a dramatic increase of self inflicted deaths in custody, he said.
- He highlighted that not all probation staff get suicide prevention training.
Nicky Padfield outlined research on deaths of people on probation supervision.
“We should be just as concerned by people who die from suicide when come out then when inside… But it remains astonishingly difficult to get data.”
- The failure to join up services over is “hugely problematic”.
- Coroners really want to talk to researchers and prison staff. “They are very troubled about people who come out of prison and die two days later of drug overdose.”
14.30 Leading safer prisons
Andy Sleight, deputy director, HMP Altcourse and Andy Foster, Functional Lead for Safety and Equality, HMP Berwyn, discussed how they’re working with staff.
Getting experienced prison officer to think back to what inspired them to join the job is a challenge.
My biggest challenge at the moment is staff. Not because they are challenge, but because if we don’t get staff culture, morale and wellbeing right, everything we talk about will be meaningless.
- Andy Foster said prisons should be about relationships. With each other and the men in our care.
- The experience of staff and prisoners is affected by whether the prison promotes ” thefeeling of distress or of wellbeing”.
Suggestions from the carers
- First night – prisoners are allowed a two minute phone call in front of prison officers. It should be longer and private.
First night very important – they do see the carers but sometimes understaffed and they slip away and then carers don’t see them.
- Yvonne, a safer custody officer at Altcourse, said large numbers of inmates may arrive at 1930. “There’s a big rush to get them settled.”
- “More courts close, people travel greater distances to prison, get there later on their first night. Some prisons take people after midnight on a regular basis. They arrive starving or cold.”
Lisa Davies, a Chaplain, said that women often arrive having not expected custodial sentence, with no one to pick up their kids from school.
The next Cambridge University roundtable discussion of suicide in prison is scheduled for 6 September.