Wales are not unique in this respectand epidemiological studies show that suicide rates in the prison population are greater than that of the general population . In European countries, the prison suicide rate is approximately 7 times higher than in the community. (World Health Organisation, 2014). Prison suicide rates in North America are also increasing. Government data shows that selfinflicted deaths increased 9% between 2012 and 2013 and account for over a third of deaths in correctional institutes (Noonan & Ginder, 2013). Although self-inflicted deaths in Australian prisons have decreased in recent years, they are still higher than those at liberty (Willis et al. 2016) as are suicides inCanadian institutes (Sapers, 2011).Self-harming, or self-injurious behaviours (SIB) also present a challenge for prisons. Case-control data demonstrate the self-harm rate in English and Welsh prisoners are 5-6% in males and 20-24% of females respectively (Hawton et al., 2014). These behaviours can occur for a number of reasons including; as an attempt to influence the environment, emotional regulation, or as a response to the symptoms of mental illness (Jeglic, Vanderhoff & Donovick, 2005). . They have however been identified as a risk factor for suicide in prison; albeit with a comparatively low absolute risk (Hawton et al, 2014). Whilst suicide risk is regarded as generally heightened during the early stages of custody (Crighton, 2006; Dahle, Lohner & Norbert, 2005) previous self-harm canbe predictive of suicidal ideation for new prisoners (Slade & Edelmann, 2014) In England and Wales, recent priorities outlined in agreements made between the National Offender Management Service (NOMS), Public Health England, and NHS England (2015) indicate a commitment to further improving the approach to managing prisoners at risk of both self-harm and suicide 1 In this paper the term 'prison estate' refers to all institutes used to incarcerate both remand and sentenced offenders.2 ), Given that early identification of suicidal prisoners is considered important to reduce deaths (Blaauw et al, 2001) the use of risk screening tools seems an obvious consideration. However, to date, this approach has proved controversial and met with, at best, limited success (Perry & Olason, 2009 to the attention of mental health professionals after an overt gesture has been made to self-injure (Blasko, Jeglic & Malkin, 2008). Suicide screening tools may be inappropriate for use in settings other than those which they were designed for but have nonetheless been implemented prior to any additional validation (Boudreaux & Horowitz, 2014;Perry et al, 2010). Likewise, In England and Wales a healthcare reception screening tool for use in primary care in both male and female prisons was developed, yet figures for 3 sensitivity and specificity rates pertaining to suicide risk were unavailable (Grubin, Carson & Parsons, 2002). An evaluation study found many institutions to be using an untested but modified version of the tool (Shaw et al, 2008 Suicide Te...

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Background. Self-harm is common in prisoners. There is an association between self-harm in prisoners and subsequent suicide, both within prison and on release. The aim of this study is to develop and evaluate a prediction model to identify male prisoners at high risk of self-harm. Methods. We developed an 11-item screening model, based on risk factors identified from the literature. This screen was administered to 542 prisoners within 7 days of arrival in two male prisons in England. Participants were followed up for 6 months to identify those who subsequently self-harmed in prison. Analysis was conducted using Cox proportional hazard regression. Discrimination and calibration were determined for the model. The model was subsequently optimized using multivariable analysis, weighting variables, and dropping poorly performing items. Results. Seventeen (3.1%) of the participants self-harmed during follow up (median 53 days). The strongest risk factors were previous self-harm in prison (adjusted hazard ratio [aHR] = 9.3 [95% CI: 3.3–16.6]) and current suicidal ideation (aHR = 7.6 [2.1–27.4]). As a continuous score, a one-point increase in the suicide screen was significantly associated with self-harm (HR = 1.4, 1.1–1.7). At the prespecified cut off score of 5, the screening model was associated with an area under the curve (AUC) of 0.66 (0.53–0.79), with poor calibration. The optimized model saw two items dropped from the original screening tool, weighting of risk factors based on a multivariable model, and an AUC of 0.84 (0.76–0.92). Conclusions. Further work is necessary to clarify the association between risk factors and self-harm in prison. Despite good face validity, current screening tools for self-harm need validation in new prison samples.

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health9, 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families’ desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care.

Aim: To explore the feasibility of holding critical incident reviews (CIRs) after patient suicides in general practice and their ability to change practice. Methods: Thirteen practices were invited to conduct a facilitated CIR on 18 current patient suicides. Next of kin views were sought. All staff attending a CIR were interviewed after the review. Results: Ten practices reviewed 12 deaths. Twenty six staff attended reviews; all were interviewed. Next of kin contributed to six reviews; only one criticised care. Changes following the reviews included steps to improve internal communication and bereavement support to set up internal CIRs and review prescribing policies. Communications between practices and other agencies were clarified. Conclusion: Practices were willing to hold CIRs and appreciated the potential positive value but need reassurance that they will not be blamed for suicides, and that the cost in time and resources will be recognised.