Shifting the paradigm of prison suicide prevention through enhanced multi-agency integration and cultural change

Abstract

This study examines an unusually sustained reduction in suicide rates in a local London prison during the three year period 2008–2011. The likelihood of this reduction taking place by chance was <2:100,000, and its perceived success was such that the prison service recommended an evaluation of its characteristics. This study arose from that recommendation, and it used a retrospective case study multi-method approach (including factor identification, qualitative interviews and triangulation with official documentation) to identify factors which had been associated with the reduced suicide rates. The results endorsed a number of factors which have already been internationally identified as best practice, along with some local innovation factors. Two further pivotal factors emerged through analysis, and they are the key to service improvements. These factors – senior management support for cultural change and cross-professional collaborative working – indicate that positive leadership and multi-agency integration are vital ingredients.

Keywords:

• prison
• suicide
• prison culture
• multidisciplinary
• suicide prevention
• integrated service model

Acknowledgements

We thank the staff and Governors from HM Prison Service who participated in and provided assistance for the research, and Prof Thomas Baguley for support with analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. This compares with a general community suicide rate of 11.6/100,000 (Office of National Statistics, 2014).

2. The Assessment, Care in Custody and Teamwork (ACCT) system, which included a structured care-planning approach to self-harm and suicide prevention, was introduced in 2006. It replaced the F2052SH system, which had been introduced in 1999.

3. A local medium secure prison is one which serves local courts and receives all prisoners remanded or sentenced to prison, except those who are considered to present the highest risk to the public.

4. Her Majesty’s Inspectorate of Prisons (HMIP) is an independent body which is responsible for reporting directly to the UK Government on the treatment and conditions of prisoners in England and Wales.

5. Seventeen participants included prison governor grades, prison officers, nurses and psychologists (male 64%; age range 24–59).

6. Seven participants were two prison governors during 2008–2011, current suicide prevention co-ordinator, regional suicide prevention co-ordinator during 2008–2011, psychologist and two prison officers (male 57%; age range 24–55).

7. When a self-inflicted prison death takes place, HM Prison Service of England and Wales formally records ‘self-inflicted’ death. However, most of these cases have a verdict of suicide returned at subsequent inquest (Forrester, 2009). Due to extensive delays of up to five years between death and inquest, all figures provided here reflect the broader term ‘SID’, rather than the term ‘suicide’.

8. As was attendance at other multi-agency meetings, including Care Programme Approach meetings (before transfer to other prisons or release to the community) and Multi-Agency Protection Panel Arrangements meetings.