Intensive Cognitive Behaviour Suicide Prevention for Males in Custody: A Pilot Feasibility Case Series

ABSTRACT

Background

Retention of participants to programs of psychological therapy in a prison setting is problematic. Intensively delivered therapy has emerged in recent years, in contrast to the traditional format of weekly sessions of psychological therapy.

Method

This study aimed to evaluate the feasibility of an intensive program of cognitive behavior suicide prevention therapy within a male prison, for the first time. Thirteen participants consented to take part. Up to 10 h of therapy was offered, across five sessions, within a 3-week delivery window. Outcome measures were completed at baseline and follow-up.

Results

Program completion and client satisfaction with the intensive program were high. Outcomes related to suicidal distress were assessed, with effect sizes reported. Large and statistically significant effect sizes were found for suicidal ideation and emotional regulation when comparing baseline to follow-up. Small and non-significant effects were found for social support and problem solving when comparing the same.

Conclusion

The study holds promise for the feasibility and efficacy of delivering an intensive cognitive behavior suicide prevention therapy for people in prison. Further exploration on a larger scale is warranted [Clinical Trial ID: NCT03499548].

KEYWORDS:

• Suicide ideation
• cognitive strategies
• male criminal offenders
• prison

Acknowledgments

Minjae Kim who supported data entry. Assessment, Care in Custody and Teamwork (ACCT); Beck Scale for Suicide Ideation (BSS); Cannot attend (CNA); Care and Segregation Unit (CSU); Client Satisfaction Questionnaire-Revised (CSQ-8-R); Cognitive Behavioural Suicidal Prevention (CBSP); Cognitive Behavioural Therapy (CBT); Collaborative Assessment and Management of Suicidality (CAMS); Cry of Pain (CoP); Department of Health (DoH); Did not attend (DNA); Difficulties in Emotion Regulation Scale (DERS); Intensive Cognitive Behavioural Suicide Prevention (InSPire); Medical Research Council (MRC); Ministry of Justice (MoJ); Multidimensional Scale of Perceived Social Support (MSPSS); National Institute for Health and Care Excellence (NICE); National Obsessive Compulsive Disorder (OCD); Offender Management Service (NOMS); Office for National Statistics (ONS); Participant information Sheet (PIS); Patient and Public Involvement (PPI); Post-traumatic stress disorder (PTSD); Prevention of Suicide in Prisons (PROSPeR); Randomised control trial (RCT); Schematic Appraisal Model of Suicide (SAMS); Social Problem Solving Inventory-Revised (SPSI-R); World Health Organisation (WHO)

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ In 2005, the National Offender Management Service (NOMS), in partnership with the Department of Health (DoH), introduced the Assessment, Care in Custody and Teamwork (ACCT) system into prisons in England and Wales. The Ministry of Justice (MoJ; Ministry of Justice, 2013) stated that “any prisoner identified as being at risk of suicide or self-harm must be managed using the Assessment, Care in Custody and Teamwork (ACCT) procedures”. The system was developed to allow at risk individuals to be identified and appropriately supported by prison staff. Typical care involves active supervision and monitoring of risk; consideration of triggers (i.e. demographics, history, psychological and psychosocial factors); facilitation of peer support and listener schemes; regular multidisciplinary ACCT reviews and completion of individualized care plans (Ministry of Justice, 2013). The ACCT system is overseen by each prison’s Safer Custody Team (Ministry of Justice, 2013).

Additional information

Funding

The authors report no conflict of interest; this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.