A systematic review and mixed-methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm

Abstract

Background Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety. Aims To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm. Method Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity. Results Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is ‘manipulative’ or ‘attention-seeking’ were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff–prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care. Conclusions There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

Probing dual harm and non‐violent misconduct among imprisoned adult men in Northern Ireland

“…After conducting a meta‐analysis of the risk factors for self‐harm in prison, Favril et al (2020: 688–689) conclude both individual and environmental factors influence this behaviour, such that “prisoners might import a vulnerability for self‐harm into prison […] that might interact with custody‐specific stressors […] and thereby increase the likelihood of self‐harming”. Indeed, studies indicate that staff‐prisoner relationships, staff perceptions, attitudes and knowledge about self‐harm, as well as the availability of services and training can influence the quality of care received and amount of distressed experienced (Ekanem & Woods, 2022; Hewson et al, 2022). Consequently, while people may import risk factors for self‐harm into prison, the nature of imprisonment and limitations in the ability of prisons to cope with this behaviour may significantly worsen this behaviour and the psychological distress experienced.…”

Environmental risk factors for self-harm during imprisonment: a prospective cohort study

“…Recent work reviewing the available evidence has suggested that prison regime characteristics, namely time out of cell and time in purposeful activity, may influence self-harm and suicide risk in prisons 7 . In addition, qualitative and cross-sectional research implicates a broader range of prison environmental factors potentially implicated in self-harm such as staffing levels, relationships between prisoners and staff, staff turnover, prisoner turnover and overcrowding [8][9][10][11][12] .…”

Profiles of vulnerability for suicide and self-harm in UK prisoners: Neurodisability, mood disturbance, substance use, and bullying

“…Half of prisoners who die by suicide in prison have a history of self-harm, which is associated with between six- and eleven-times increased odds of suicide [ 11 ]. A recent systematic review and mixed-methods synthesis found that prison officers often underestimate the association between self-harm and suicide [ 12 ], even though prior self-harm consistently predicts subsequent suicide in prison or after release [ 13 ]. Prison staff have been found instead to characterise self-harm as being manipulative or attention seeking, and to perceive institutional guidance on the appropriate responses to self-harm as being ambiguous [ 14 ].…”