Cutting the pain away

Cutting the pain away


Marc Leverton reports on moves to prevent prisoners self-harming or committing suicide

Tuesday July 17, 2007
SocietyGuardian.co.uk


"We have seen scratching, head banging, people setting fire to themselves, severe lacerations, pulling out of tendons, people sewing their own lips up, even cutting parts of their bodies off," says Jez Spencer, describing a less typical day in his role managing the safer custody team in 14 regional prisons.

"Prisoners are regularly saved by prison staff who cut them down in the nick of time. In the women's prison, cutting prisoners down happens on a daily basis," he says.

The team is responsible for trying to reduce the number of prisoners self-harming or attempting suicide across the 14 prisons in south-west England and Wales. "The majority of cases are cutting, though," Mr Spencer says, matter of factly.

After a review of the unacceptable numbers of high prison deaths at the turn of the decade, the safer custody team was set up to help 'at risk' prisoners.

Mr Spencer co-ordinates the staff, prison officers, mental health workers and the voluntary groups that work alongside prisoners, "Prevention only works if there is a team effort to spot danger signs," he says.

Once a prisoner is earmarked as being in danger, they are put on an ACCT Plan (Assessment, Care in Custody and Teamwork), enabling them to access specialist help.

The reasons leading to the drastic behaviour Mr Spencer describes are varied. "A lot of prisoners had problems as children; self-harm is often a way of coping with physical, mental or sexual abuse," he says. "It is a release: blood-letting is a way of releasing tension or it can be a way to feel alive as prisoners can feel so dead inside."

Other prisoners may have mental health needs. "They often don't know how to ask for help and self-harming gets them the attention that they crave," he says.

The average population in the 14 prisons is close to 6,000. Highest levels of harm are seen at the local prisons, Bristol, Exeter and Cardiff, and the young offenders' institute, HMYOI Portland. Their combined population is near to 2,700 and about 110 prisoners (4%) are subject to ACCT procedures at any one time.

But the greatest problems involve female prisoners. Mr Spencer's team had 24,000 recorded incidents last year and 49% involved women - even though they only comprise 400 (6.6%) of the 6,000 inmates, making them by far the more prolific self-harmers.

"Women are more likely to have been a victim of abuse," he says. "A significant number come from the sex industry and many are using drugs. They may also have had their children taken away from them. There is the emotional pressure that comes from that, and the society pressure to be the carer. Put all that into a prison setting and it is a potent mix."

He cites the case of a young woman sentenced for drug-related offences. She had a long history of abuse and had worked in the sex industry. When she came to prison she started to self-harm, making lacerations to her arms and legs. She made several trips to A&E for stitches and, on several occasions, she lost large amounts of blood and lost consciousness.

"Quick staff intervention saved her life on these occasions," Mr Spencer says. "Her ACCT care plan involved art therapy, use of a relaxation room and employment within the prison. Alongside one-to-one counselling sessions, she was able to reduce her self-harm and eventually stop." She left prison last year and at that time was not self-harming.

Listening to prisoners is often the most effective way of helping them through their sentence. "Our work is a lot to do with things like building self-esteem," he says. "Instead of self-harming or bullying others, we help prisoners to talk about their problems. They are not used to that. Quite often we ask 'how are you feeling?' and it will be the first time they will have ever been asked that question. Basically we are helping them to manage their feelings."

Research shows that prisoners are most susceptible to self-harming and suicide in the early stage of a sentence. The risk rises again if it is a first offence or if the prisoner has committed a crime against a member of their own family. Another key factor is if the prisoner has been using drugs on the outside and is going through detox.

A key part of the project is a prisoner mentoring scheme. Mr Spencer says: "We have 'listeners' who are prisoners trained by the Samaritans. They are there to give new inmates advice, like when they will get canteen [weekly supplies] or phone calls and basically show them the ropes. Prisoners sometimes prefer to talk to other prisoners rather than uniformed staff and it helps them to integrate."