Greg E. Dear

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons.

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

Self-harm in prison : manipulators can also be suicide attempters

This study sought to determine whether self-harm incidents classified as manipulative would also be classified as low suicidal intent and low risk to life. Seventy-four prisoners who had self-harmed were interviewed within 3 days of the incident. Measures were obtained of the degree of suicidal intent (Suicide Intent Scale), the degree to which the incident posed a risk to life (assessed by medical staff), and the principal motive for self-harming (open-ended question). The data did not support the notion that manipulators and suicide attempters are mutually exclusive groups. Only 6 of the 18 participants who reported manipulative motives displayed low suicidal intent, and 3 of the 18 enacted self-harm that posed at least a moderate risk to life. Prison staff cannot assume that prisoners who appear manipulative or report manipulative motives were not suicidal at the time of self-harming.

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities.

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

The relationships between codependency and femininity and masculinity

Feminist writers critical of the codependency model have argued that codependency refers to an overly strong conformity to the traditional feminine role. Canonical correlation analysis using data from 192 first-year university students found a moderate association between codependency and gender-role identification. The specific nature of this association varied with different aspects of codependency. External focus (approval seeking) was associated with high scores on the negative aspects of femininity and low scores on positive aspects of masculinity. Self-sacrificing was associated with high positive femininity and low negative masculinity. Women scored higher than men on one aspect of codependency: external focus. Although the data are broadly consistent with a feminist critique of codependency, the relationship between codependency and gender-role identification appears to be more complex than previously suggested.

Self-Inflicted Injury and Coping Behaviours in Prison

Previous research (Bonner & Rich, 1990; Liebling, 1992; Liebling & Krarup, 1993) has suggested that self-harming prisoners are “poor copers,” but has not provided detail as to how they differ from other prisoners in terms of their actual coping behaviour. Liebling (1992) found that self-harmers were more likely to have serious difficulties with other prisoners, less likely to have outside supports (either family or probation), spent more time in their cell (partly through being on restrictive regime and partly because they were hiding from teasing and intimidation), and were less able to articulate constructive ways of filling their time. Liebling concluded that “inmates with the fewest opportunities to occupy themselves (for whatever reason, some self-induced) were those who were least able to cope with the isolation and boredom of confinement to a cell for long periods of time” (p. 144). Essentially, however, poor coping ability was inferred from the greater levels of distress and disorder reported and there was no direct assessment of coping behaviour. It is yet to be determined whether prisoners who self-harm differ from other prisoners in terms of their coping behaviour. A more specific test of Liebling’s assertion would be to examine whether prisoners who self-harm are less likely to employ effective coping strategies or are more likely to employ ineffective or counter-productive strategies. It is not clear, however, what constitutes an effective coping strategy. Aldwin and Revenson (1987) remarked that “we are far from describing a “magic bullet” coping strategy that can instantly solve problems and restore emotional equilibrium” (p. 338). Nearly a decade later, Steed (1995) undertook an extensive review of the coping literature and concluded that “there are no strategies which can generally be regarded as more effective than others, rather, it depends on the nature of the stressor, particularly its controllability” (p. 100). On a more general level, however, studies have consistently found that problem-

The Holyoake Codependency Index: Investigation of the Factor Structure and Psychometric Properties

The Holyoake Codependency Index is being developed to measure the extent to which a person endorses codependent beliefs and attributions. A 28-item pilot version was administered to 39 male and 268 female clients of a family counseling agency. Factor analysis, used to identify the shortest version with acceptable reliability, yielded a 13-item final version comprising three subscales (external focus, self-sacrifice, and reactivity). The subscales correspond to key themes within the literature on codependency. Scores on each subscale correlated significantly in the predicted direction with relevant measures of psychological functioning, providing initial evidence of construct validity. The 13-item scale was administered to a general community sample of 303 women and the factor structure was fully replicated. Internal consistency of the subscales ranged from .74 to .84 with the family counseling sample and from .73 to .83 with the general community sample.

The Holyoake Codependency Index: further evidence of factorial validity

The Holyoake Codependency Index (HCI) is a 13-item self-report scale that measures codependent traits. The HCI contains three subscales that correspond to key themes within the codependency literature and that were derived from factor analysis using a clinical sample of mainly females. The factor structure was subsequently replicated with an all-female general community sample. In this study the factor structure was replicated using a mixed-sex sample of 107 undergraduate university students and 378 other people who were snowball sampled from the student sample, and was found to hold for both male and female participants.

Factor structure of the Spielberger Anger Expression scales when used with Australian prisoners.

The State-Trait Anger Expression Inventory administered to prison inmates has supported the factor structure of the three anger expression scales although this structure has not been verified with Australian participants. Data collected from 397 Western Australian male prisoners produced a factor structure consistent with the scale structure outlined in the 1991 manual. Scale means and standard deviations were similar to those reported for U.S. and Canadian prisoners. It is therefore appropriate to use the standard scoring procedures with Australian male prisoners.

Test-Retest Reliability of the Holyoake Codependency Index with Australian Students

The Holyoake Codependency Index is a 13-item self-report measure of three aspects of codependency: External Focus, Self-sacrifice, and a sense of being overwhelmed by another persons problematic behavior (termed Reactivity). Previous studies have supported internal validity and the internal consistency and construct validity of the subscales. The present scores for 59 students indicate full scale test-retest reliability of .88 and for subscales (.76 to .82) over a 3-wk. interval.

The stigmatisation of the provision of services for alcohol and other drug users: A systematic literature review

Abstract Alcohol and other drug (AOD) workers are often stigmatised. This article describes a systematic review of the existing literature that addresses three aims: (1) identify how stigma occurs for people working in the AOD field, (2) identify what the impacts of stigma are on AOD workers and AOD service provision more broadly and (3) identify what extent stigma occurs for AOD workers. The review involved a multi-phase database, journal and website search, with additional hand searching of relevant referenced articles. Seven studies were found, pertaining to stigma and working in the AOD sector. Findings indicate that AOD workers experience stigma and this impedes occupational functioning. Stigma is not clearly conceptualised in these studies. It is unclear if researchers used the same construct of stigma as in the broader psychological research on stigma. It is also unclear as to what conceptualisation of stigma research participants in these studies held (e.g. stigma of self, workplace, client or job role). This has important implications for determining the degree to which the worker personally experiences and is impacted by stigma. Research is needed to clarify the origins, manifestations and impacts of stigma in relation to working in the AOD field.