Di Bailey

A participatory action research methodology in the management of self-harm in prison

Background Self-harm in custody is a well-researched phenomenon. This is particularly true for women in prison who demonstrate disproportionately high rates of self-harm. Despite the growing body of prison research, there has been a lack of service user involvement (SUI). Aims To outline the first use of SUI in a custodial setting in developing care pathways for self-harm. Methodology A participatory action research approach was used to engage women prisoners and staff. Results Participants were able to identify strengths and weaknesses of current care pathways and offer suggestions for service development based upon their experience of receiving and delivering care. Conclusion The authors conclude that despite participatory approaches being in their infancy in prisons the engagement of service users when aimed at effecting positive change can be successful.

Can Health Trainers Make a Difference With Difficult-to-Engage Clients? A Multisite Case Study

A political attempt in the United Kingdom to address health inequalities in the past decade has been the government’s initiative to employ local health trainers (HTs) or health trainer champions (HTCs) to support disadvantaged individuals with aspects of their health-related behaviors. HT/HTCs provide health-related information and support to individuals with healthy eating, physical activity, and smoking cessation. They undertake community engagement and direct individuals to relevant health services. They differ in that HTs are trained to provide health interventions to individuals or groups and to make referrals to specialist health care services when necessary. This article provides an evaluation of HT/HTCs interventions across three sites, including one prison, one probation service (three teams), and one mental health center. An evaluation framework combining process and outcome measures was employed that used mixed methods to capture data relating to the implementation of the service, including the context of the HT/HTCs interventions, the reactions of their clients, and the outcomes reported. It was found that HT/HTCs interventions were more effective in the prison and mental health center compared with the probation site largely as a result of contextual factors.

Service user involvement in the evaluation of psycho-social intervention for self-harm: a systematic literature review

Background The efficacy of interventions and treatments for self-harm is well researched. Previous reviews of the literature have highlighted the lack of definitively effective interventions for self-harm and have highlighted the need for future research. These recommendations are also reflected in clinical guidelines published by the National Institute for Health and Clinical Excellence (NICE, 2004) which also call for service user involvement in studies of treatment efficacy. Aims A systematic review was undertaken to determine: a) what contributions service users have made to the evaluation of psycho-social interventions; b) by what methods have service users been involved; c) in what ways could service user involvement supplement empirical evidence for interventions. Methodology Electronic searches were completed on the 28th January 2011 of the Medline (1950–present), Web of Science (1898–Present), Web of Science (including Science Citation Index and the Social Science Citation Index), the Cochrane database of systematic reviews, and Psychinfo (1979–present) databases using a combination of 13 search terms. References were independently sifted according to set criteria by two of the authors to ensure inter-rater reliability. Results Sixty-five references were included in the review. Of these, 59% of studies were empirically based, and 26% used qualitative data collection methods to gather service user narratives. Only 8% of studies used a mixed-methodology to combined qualitative and quantitative data collection. No studies featured service user involvement. Conclusion Service user involvement is a rarity in the evaluation of psycho-social interventions, despite its use being mandated by the National Institute for Health and Clinical Excellence and evidenced as effective in other areas of mental health (Leader, 1998). The authors make a number of recommendations for future involvement in future self-harm research.

At arms length: the development of a self‐injury training package for prison staff through service user involvement

Purpose – People who self‐injure present a serious concern for many healthcare providers and no more so than for those working in the female prison estate. Despite the prevalence of self‐injury and recent policy highlighting the need for staff training, misunderstanding and misinterpretation of self‐injury is rife within the healthcare professions often demonstrated by poor levels of service and care. This paper seeks to describe the development of a self‐injury training package for prison staff, through service user involvement, in order to address such deficits in care.Design/methodology/approach – A participatory mixed methodological design engaged both staff and women in prison. Women offenders were involved in the development of training drawing upon their unique experiential expertise.Findings – In total, 43 per cent of staff working directly with women recognised the need to develop their understanding of, and skills to manage, self‐injury. Key messages women wanted to convey to staff included how ...

Consent, confidentiality and the ethics of PAR in the context of prison research

Purpose – To consider the unique ethical dilemmas, such as limitations in confidentiality, that research in prison settings is required to address. Methodology/approach – The ethics of prison-based research are explored within the context of a three-year Participatory Action Research (PAR) project which aimed to involve staff and women in prison in the development of care pathways for self-harm. Findings – The ethics of prison research are complex and require the balancing of individual rights with prison security requirements. In keeping with the PAR approach the experience for two of the women of being involved in the research and action for change is discussed through their own accounts. Originality/value of paper – PAR has not been previously used in an English prison; this article provides an account of the ethical considerations of empowering methodologies with people who by their very status as prisoners are disempowered. Research implications – Although this is just one example within a womens prison the authors assert that PAR as a methodology within a prison environment is not only feasible but also desirable for engaging offenders in the development of services. Practical implications – The engagement of this traditionally ‘hard to reach’ groups of people can ensure the development of meaningful and effective services based upon service users experiential expertise (Beresford, 2000). Social implications – PAR offers those in prison a stake in the development and design of services. This not only has personal benefits for the individual but also is likely to increase service uptake and relevance (Foster, J., Tyrell, K., Cropper, V., & Hunt, N. (2005). Welcome to the team – Service users in staff recruitment. Drink and Drugs News, 21).

What is the impact of health trainer interventions within a mental health setting

This paper relates to a single case study that was part of a larger project using a tried and tested evaluation methodology to evaluate the role of health trainers (HTs) working with groups who are considered ‘difficult’ to engage in health care. In this example, the HTs were based in a mental health centre run by a charity. The service was commissioned by a Primary Care Trust (PCT) located in the North East of England. Data collected between April 2010 and July 2011 included quantitative data from 72 service users from the National Data Collection and Reporting System. Additional quantitative data were obtained from the HTs relating to the usage of group activities and a satisfaction questionnaire completed by service users. Qualitative data included interviews with four key stakeholders, a focus group with service users, case studies and progress reports provided as part of the Centres annual reporting requirements for the PCT. Findings reveal that more service users aged 26–44 used the service compared with national figures. Partnership working was essential to embed the initiative into the Centre. HT interventions that were flexible, and gave service users options, encouraged mental health promotion. The success of the intervention depended less on what the HT did and more importantly on how they did it.

What is the pattern of self-harm and prison rule-breaking behaviour in personality disordered offenders in a high secure prison?

Purpose The purpose of this paper is to describe the pattern of self-harm (SH) and proven prison rule-breaking (PRB) behaviour in prisoners receiving treatment for personality disorders (PDs) within a high security prison. Design/methodology/approach A comparative quantitative case study design supported the understanding of the frequency and pattern of SH and PRB behaviour across two stages of a PD treatment programme for 74 male prisoners. Data obtained from the prison’s records were analysed using dependent t-tests, χ2 test of independence and time-frequency analyses. Findings Inferential statistics showed that the frequency of SH and PRB behaviour statistically increased across two phases of the PD treatment programme; however, the method of SH or type of PRB behaviour engaged in did not change. Mapping the frequencies of incidents using a time-frequency analysis shows the patterns of both behaviours to be erratic, peaking in the latter phase of treatment, yet the frequency of incidents tended to decline over time. Originality/value This is the first study to explore SH and PRB behaviours in men across two phases of a PD treatment programme. This study highlights the need for continued psychological support alongside the PD treatment programme with a focus on supporting men in treatment to effectively manage their SH and PRB behaviour.

Self-harm in young people: a challenge for general practice

Self-harm is increasingly common in adolescence, with reported prevalence rates in the UK varying from 68%1 to 10%.2 Though frequently low risk and transient, in some young people the behaviour can persist into adulthood and/or become life threatening. Although GPs regard the identification and support of young people who self-harm as part of their role,3 there are particular challenges with this as self-harm is one of the most complex mental health issues with which young people present. These challenges broadly relate to understanding young people’s self-harm and talking about it with them in short, time-limited consultations. Additional dilemmas surround recording self-harm and how to intervene in ways that help. Self-harm encompasses behaviours that young people do to hurt themselves, such as self-cutting, self-burning, and ingesting toxic substances or objects. Young people who present with self-harm to primary care are a heterogeneous population, which includes a minority who are intent on ending their own life4 but who are not easily distinguishable in their help-seeking behaviour from the majority whose self-harm is reported as an attempt at self-help, a coping strategy ‘that they wished they did not need and might someday be able to quit’ .5 The relationship between stressful life events and common mental health problems such as depression and anxiety for those of any age is well documented, and for young people such stressful life events need to be understood in the context of the inevitable developmental milestones of growing up. Young people often report that their self-harm helps them to cope with overwhelming distress …

How Far Can a Short Leadership and Management Programme Address the Challenges for First Line Social Work Managers? An Evaluation of One of the Skills for Care Leadership and Management Demonstration Sites

This article describes the evaluation of a leadership and management training programme for first-line social work managers, focussing on safeguarding. The programme was developed collaboratively with local authority partners, including both children’s and adult services’ managers. The evaluation, funded initially by Skills for Care, used a multi-level evaluation framework, tried and tested previously by one of the authors. The evaluation testified to the value of the training to participants who reported enhanced learning and changes in their behaviour. These reported changes included improved leadership and management skills, underpinned by greater reflection which was reportedly transferred to managers’ decision-making and confidence in safeguarding. In two cases, these changes in participants’ reported behaviour were also observed by their managers. Participants particularly appreciated the opportunity the training afforded them to reflect on practice and spend time exploring issues around safeguarding and risk. Feedback from the two participants’ line managers confirmed the benefits of the course to staff and offered a model for evidencing the transfer of learning into practice.

Mental Health and Social Work

This article is about social work relating to people with mental health problems. It explores historically how the care and treatment of service users with mental health issues have developed. This exploration is informed by four key themes: the advances in psychiatric treatments, the ways in which mental health and recovery are understood, a changing landscape of policy and legislation, and the influence of those with lived experience of mental distress and those who care for them on the reform of the service delivery agenda. The article offers international examples to illustrate the above and considers the role of mental health social workers in respect of the dilemmas, challenges, and opportunities that arise from the work they do.