Lisa Marzano

Psychosocial influences on prisoner suicide: A case-control study of near-lethal self-harm in women prisoners

We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in womens prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations.

Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case–control study

BACKGROUND Although male prisoners are five times more likely to die by suicide than men of a similar age in the general population, the contribution of psychiatric disorders is not known. AIMS To investigate the association of psychiatric disorders with near-lethal suicide attempts in male prisoners. METHOD A matched case-control study of 60 male prisoners who made near-lethal suicide attempts (cases) and 60 prisoners who had never carried out near-lethal suicide attempts in prison (controls) was conducted. Psychiatric disorders were identified with the Mini International Neuropsychiatric Interview (MINI), and information on sociodemographic characteristics and criminal history was gathered using a semi-structured interview. RESULTS Psychiatric disorders were present in all cases and 62% of controls. Most current psychiatric disorders were associated with near-lethal suicide attempts, including major depression (odds ratio (OR) = 42.0, 95% CI 5.8-305), psychosis (OR = 15.0, 95% CI 2.0-113), anxiety disorders (OR = 6.0, 95% CI 2.3-15.5) and drug misuse (OR = 2.9, 95% CI 1.3-6.4). Lifetime psychiatric disorders associated with near-lethal attempts included recurrent depression and psychoses. Although cases were more likely than controls to meet criteria for antisocial personality disorder, the difference was not statistically significant. Comorbidity was also significantly more common among cases than controls for both current and lifetime disorders. CONCLUSIONS In male prisoners, psychiatric disorders, especially depression, psychosis, anxiety and drug misuse, are associated with near-lethal suicide attempts, and hence probably with suicide.

Psychosocial Characteristics and Social Networks of Suicidal Prisoners: Towards a Model of Suicidal Behaviour in Detention

Prisoners are at increased risk of suicide. Investigation of both individual and environmental risk factors may assist in developing suicide prevention policies for prisoners and other high-risk populations. We conducted a matched case-control interview study with 60 male prisoners who had made near-lethal suicide attempts in prison (cases) and 60 male prisoners who had not (controls). We compared levels of depression, hopelessness, self-esteem, impulsivity, aggression, hostility, childhood abuse, life events (including events occurring in prison), social support, and social networks in univariate and multivariate models. A range of psychosocial factors was associated with near-lethal self-harm in prisoners. Compared with controls, cases reported higher levels of depression, hopelessness, impulsivity, and aggression, and lower levels of self-esteem and social support (all p values <0.001). Adverse life events and criminal history factors were also associated with near-lethal self-harm, especially having a prior prison spell and having been bullied in prison, both of which remained significant in multivariate analyses. The findings support a model of suicidal behaviour in prisoners that incorporates imported vulnerability factors, clinical factors, and prison experiences, and underscores their interaction. Strategies to reduce self-harm and suicide in prisoners should include attention to such factors.

The application of mHealth to mental health: opportunities and challenges

Advances in smartphones and wearable biosensors enable real-time psychological, behavioural, and physiological data to be gathered in increasingly precise and unobtrusive ways. Thus, moment-to-moment information about an individuals moods, cognitions, and activities can be collected, in addition to automated data about their whereabouts, behaviour, and physiological states. In this report, we discuss the potential of these new mobile digital technologies to transform mental health research and clinical practice. By drawing on results from the INSIGHT research project, we show how traditional boundaries between research and clinical practice are becoming increasingly blurred and how, in turn, this is leading to exciting new developments in the assessment and management of common mental disorders. Furthermore, we discuss the potential risks and key challenges associated with applying mobile technology to mental health.

The impact of prison staff responses on self‐harming behaviours: Prisoners’ perspectives

OBJECTIVES To further understanding of how health and correctional staff responses to self-harming behaviours influence prisoners and their subsequent actions. DESIGN Participant-centred, qualitative methods were used to explore the complex and under-researched perspectives of self-harming male prisoners. METHOD Semi-structured interviews were conducted with 20 adult male prisoners who had engaged in repetitive, non-suicidal self-harm during their current prison sentence, or considered doing so. The interviews were analyzed drawing on principles of thematic analysis and discourse analysis. RESULTS With some exceptions, prison officers, nurses, and doctors are portrayed by prisoners as being ill-prepared to deal with repetitive self-harm, often displaying actively hostile attitudes and behaviours. CONCLUSIONS These findings underscore the need for appropriate training, support and supervision for staff working with self-harming prisoners.

Interviewing survivors of near-lethal self-harm: a novel approach for investigating suicide amongst prisoners.

In most countries, rates of suicide in prison are higher than those reported in the general population, and seemingly on the increase. Previous studies of factors contributing to suicide in prisons have largely been limited to analyses of the clinical and prison records of prisoners who have died by suicide. In this paper we reflect on the limitations of this approach. Drawing on illustrative case vignettes from ongoing research, we argue that interviewing survivors of near-fatal incidents of self-harm offers a potentially fruitful method to further our theoretical understanding of this growing problem, and inform relevant policy.

The suicidal process in male prisoners making near-lethal suicide attempts

Abstract Most investigations of factors contributing to prisoner suicide have focused on suicidal behaviour as a discrete event and used official records or ‘psychological autopsy’ methodology. A potentially more informative approach is to study survivors of near-lethal suicide attempts about their suicidal process. We have investigated the suicidal process in male prisoners through semi-structured interviews with 60 prisoners who made near-lethal suicide attempts. The suicide attempts often followed adverse life events (especially broken relationships or bereavement), criminal justice/prison-related factors (e.g. concerns about sentencing) and psychiatric or psychological factors (e.g. drug/alcohol withdrawal, depression/anxiety and hearing voices). The majority of prisoners said they intended to die (73%), although many acts had been impulsive (40%). Most described visual images about their suicidal acts (82%). Limited access to methods of suicide had clearly influenced method choice (most commonly hanging/ligaturing 67%), along with expectations about the anticipated speed, painfulness and lethality. Half the prisoners believed their acts could have been prevented, often with relatively simple solutions. The suicidal process in prisoners is a complex interplay of background factors, adverse life events, mental health and psychological problems and cognitive processes. Understanding and recognising these various aspects of the process is likely to improve suicide prevention in prisons.

Impact on prisoners of participating in research interviews related to near-lethal suicide attempts.

BACKGROUND Prisoners have a high risk of suicide. Research studies have investigated factors contributing to this, some through interviews with survivors of suicide attempts, others with informants such as family and friends of suicide victims. However, there is little information regarding the effects of participating in such interviews. AIMS To investigate the effects on participants of taking part in detailed interviews about suicidal behaviour and contributory factors. METHOD Case-control studies of 120 prisoners who made near-lethal suicide attempts (cases) and 120 prisoners who had never carried out near-lethal suicide attempts in prison (controls) were conducted. Information regarding effects on prisoners of participating in the interviews was collected using quantitative and qualitative methods. RESULTS For both male cases and controls, and female controls, self-reported mood levels improved significantly by the end of the interviews. For female cases, the interviews had no negative effect on their self-reported mood. Whilst some prisoners found the interviews upsetting, nearly all said they were pleased to have participated. LIMITATIONS The same researchers carried out the interviews and collected data on the effects of participation. Also, several potential participants were excluded from the study and the likely effect of the interview on them is unknown. CONCLUSIONS We found little evidence that participation of prisoners in interview-based research on suicidal behaviour has negative effects on them; indeed, it can be beneficial. Inclusion of similar instruments to measure the effects of research participation in future investigations could provide valuable feedback to researchers and ethics committees.

Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons

Suicides in prisons are common. There is a pressing need to understand more about the causes and prevention of prisoner suicides. A particularly informative approach is through studying survivors of near-lethal suicide attempts. However, the extent to which this approach is a good proxy for completed suicide requires verification. In this article we aimed to assess (1) the extent to which male and female prisoners who made near-lethal suicide attempts in prison are similar to prisoners who die by suicide; (2) the suicidal intent of those making near-lethal suicide attempts; and (3) the applicability of the Suicide Intent Scale in prisons. Survivors of near-lethal suicide attempts and prisoners who died by suicide were compared on sociodemographic and criminological characteristics. The suicidal intent of prisoners engaging in near-lethal self-harm was assessed using Becks Suicide Intent Scale. There were no significant differences when the sociodemographic and criminological profiles of prisoners who made near-lethal suicide attempts and those who died by suicide were compared, except that male prisoners who made near-lethal suicide attempts were somewhat younger. Most prisoners carrying out near-lethal acts had high suicidal intent. However, some questions in the Suicide Intent Scale were inappropriate for assessing intent in prisoners. Prisoners who survive near-lethal self-harm would appear to be a valid proxy for those who die by suicide in prison. The Suicide Intent Scale requires some modifications for use in prisons.

Comfort and challenge: a thematic analysis of female clinicians’ experiences of supervision

OBJECTIVE The supervision of counsellors, counselling psychologists, and psychotherapists is generally perceived to be an invaluable component of training and practice. The present study analysed this process to explore the meanings of supervision and to consider implications for clinical practice and training. DESIGN This study presents the accounts of 19 psychological therapists who experienced supervision while working at a London-based womens therapy centre. METHOD Demographic information was collected by questionnaire, and semi-structured interviews were conducted to explore aspects of the supervisory experience. The qualitative data were thematically analysed. RESULTS Supervision has complex and paradoxical meanings, and it impacts on clinical counselling practice in multifarious ways. Dominant themes highlighted were the usefulness of supervision, specifically support, empowerment, and joining; fear of exposure in supervision versus gaining new information; the comfort versus the challenge of supervision; and supervision as a containing space. CONCLUSIONS An experiential model of supervision was developed from the data. This model complements existing models in the field. It could be evaluated and used alongside existing models in various training and supervision contexts. Findings are discussed in relation to the literature on clinical supervision.