AS MANY as one in four women prisoners in England and Wales self-harm every year, and female prisoners are four times more likely to self-harm than male inmates, according to the largest ever study of self-harm in prisons, published in The Lancet.
Led by Dr Seena Fazel and Professor Keith Hawton from the University of Oxford in the UK, the study examined the prevalence of self-harm in all prisoners in England and Wales between 2004 and 2009 – a total of 139,195 incidents of self-harm, involving 26,510 inmates.
Risk factors for self-harm were assessed and compared with those of the general prison population, and associations with suicide examined.
Despite reductions in suicide rates over the six-year study period, incidents of self-harm in custody did not decrease, and ranged from about 20,000 to 25,000 per year, with women accounting for roughly half of these incidents.
Incidents of self-harm were 10 times higher in female than in male prisoners – with 20-24 per cent of female prisoners and 5-6 per cent of male inmates self-harming every year – and around 30 times that of the general population of the UK (0.6 per cent).
‘Repetition rates were striking – if a female prisoner self-harmed, she would self-harm eight times per year, and there were 102 women (and two male) inmates who self-harmed more than 100 times per year’, explains Dr Fazel, a Wellcome Trust Senior Research Fellow.
The researchers found that several factors increased the risk of self-harm in both sexes, including: younger age (around 20 years), being white, and being unsentenced or having a life sentence.
Among female prisoners, having committed a violent offence was also a factor.
Cutting and scratching were the most common methods of self-harm in both sexes, followed by poisoning, overdose, or swallowing objects not intended for ingestion among men and teenage boys (nine per cent), and self-strangulation in women and adolescent girls (31 per cent).
Importantly, self-harm in prison was also found to be a strong risk factor for suicide in prison, particularly among male inmates – with an annual suicide rate among male prisoners who self-harm (334 per 100,000) around four times that of the general male prison population (79 per 100,000).
According to Dr Fazel: ‘While self-harm is a substantial problem across the board, it is a particularly serious issue for women in prison who make up only five per cent of the prison population but account for half of all self-harm incidents.
‘Moreover, now we know the extent to which the risk of subsequent suicide in prisoners who self-harm is greater than the general prison population, suicide prevention initiatives should be changed to include a focus on prisoners who are self-harming, especially repeatedly.’
Writing in a linked comment, Dr Andrew Forrester from Kings College London, and Dr Karen Slade from Nottingham Trent University, call for more research to address the questions of ‘why’ and ‘what works’ to reduce the stagnating self-harm rate in prisons.
They write that: ‘Despite clear gains in the care of prisoners and prevention of self-harm and suicide in prisons in England and Wales, much work remains to be done…(the) available evidence indicates a key role for multi-agency collaboration, in which “suicide is everyone’s concern”, rather than being the sole preserve of health-care staff…
‘We need to invest in the wide inclusion of all people who, on the ground, can listen to prisoners who are experiencing distress, mobilise concern, and help to deliver joined-up care.’
• Responding to the National Audit Office’s report, Managing the prison estate, published on Thursday, Andrew Neilson, Director of Campaigns at the Howard League for Penal Reform, said:
‘National Audit Office experts are right that the government should cut the number of people being held behind bars at the cost of millions to the taxpayer, reducing demand on a system that is struggling to offer purposeful activity such as work, training and rehabilitation.
‘The current strategy of building larger and larger prisons may save costs but it is a false economy, as these prisons perform less well than their smaller counterparts.
‘The NAO also find that decision-making has sometimes traded good quality and performance for greater savings.
‘If ministers refuse to look at reducing prison numbers, then custodial regimes will continue to suffer and the result will be more crime and more victims of crime in the long run.’
The National Audit Office press statement said: ‘The new prison capacity built by the National Offender Management Service (the Agency) provides good, modern accommodation, with safety features that reduce the risk of self-harm and suicide.
‘The Ministry also builds flexibly, so it can easily convert prisons to a higher security status.
‘However, some prisoners still routinely share cells, some of them in overcrowded conditions.
‘The strategy understandably focuses on cost reduction and, by 2015-16, it will have resulted in total savings of £211 million, with further savings accruing at a rate of £70 million a year thereafter.
‘However, decision-making has sometimes traded good quality and performance for greater savings.
‘Some highly-performing prisons were closed before the new prisons Oakwood and Thameside began performing well.
‘The Ministry of Justice and the Agency use good forecasts of prisoner numbers and have good contingency plans to help them implement changes to the estate, for example responding effectively to an unexpected spike in prisoner numbers after the riots in 2011.’
However, the NAO stressed: ‘Reducing prisoner numbers, where possible, still represents the best way of saving money in the medium and long term.
‘Even with cheaper new capacity, every 1,000 places in the prison system costs on average £28 million a year.
‘Today’s report suggests that the Agency could free up more spare capacity if prisoners serving indeterminate sentences had more access to accredited courses, the completion of which might reduce their risk of causing harm sufficiently to allow the Parole Board to release them.
‘The report also points out that the Home Office removes over 1,000 foreign national offenders from
the UK every quarter but, for a number of reasons, is currently removing fewer than in 2009.’
