Title: Managing the Risk of Self-Inflicted Death to Support a Psychologically Safe and Rehabilitative Criminal Justice Pathway
Funder: Department of Health and Social Care

Abstract: Background Rates of self-inflicted deaths in the CJS are much higher than in the general population. The prison suicide rate in England and Wales has, after promising reductions for over a decade, started rising again about five years ago. It is unclear why this occurred but essential that possible individual and service level risk factors are examined and addressed to ensure the future safety of vulnerable people. Similarly, suicide rates are high in released prisoners and in those in contact with other parts of the Criminal justice (CJ) system, thus we need to understand and address risk factors across the whole CJ pathway. Aims To develop a protocol describing the data linkage processes involved in extrapolating evidence from existing CJ and NHS healthcare data sets; To development a framework of evidence model to inform best practice in suicide assessment and management; To describe ‘what works’ in suicide risk management, prevention and response across the CJS; and To develop practical proposals designed to improve safety, aimed at individual staff & institutional levels, including the development of skills & safer environments across the CJS. Research plan We will conduct three separate, but inter-connected, strands of inquiry to address the research question. We will conduct our inquiries, and make recommendations for change, within the context of the CJS as a whole, from first contact with police through to release from prison and community supervision. In Work Package one, we will interrogate existing sources of data to provide a consolidated resource about suicide in the CJS, including reliable epidemiological data and thematically analysed learning from a range of academic, policy, service and clinical resources. In Work Package two, we will conduct case study research, using National Confidential Inquiry into Suicide and Homicide by People with Mental Illness methodologies. In Work Package three, we will conduct wide-ranging new research into suicide across the CJS pathway through engagement with a range of experts by experience and professional individuals and groups, triangulating data from the earlier work packages with the realities of managing risk and delivering high standards of care across the CJS. Our primary outcome will be the development of a set of recommendations, service models and key deliverables designed to support the development of skills, competencies and environments, at both individual staff and institutional levels, across the prison estate and with related recommendations and implications for all CJS agencies across the pathway. Research team We are a multidisciplinary team of academics, clinicians and experts by experience with proven experience in suicide and prison healthcare research and innovative service delivery. Our research expertise includes quantitative and qualitative methods; largescale epidemiological studies; systematic reviews; and innovative peer led research. We have completed multiple largescale projects in the CJS to time and within budget. Our previous research has influenced national policy and practice relating to suicide, self-harm and prison health. Potential impact/influence on relevant policy, users and wider stakeholders The outputs from this project will include the development of methodologies to utilise epidemiological data to monitor trends in self-inflicted deaths across the CJS. This will allow the impact of any new interventions to be properly measured. We will establish, using a comprehensive multi-methods approach, ‘what works’ in suicide risk management to inform policy makers. We will also make practical recommendations and proposals to improve current service models; to develop skills and competencies in the work force; and to improve environments, enabling effective suicide prevention. This will ultimately have an impact on the clinical care and rehabilitation of service users throughout the CJ pathway.

Lay abstract: After over a decade of reducing, the number of people taking their own lives in prison started rising again around five years ago. People in prison have always been at much greater risk of suicide than the general population. This is unacceptable and it is important that staff and others are supported in doing everything they can to stop vulnerable people dying. As well as making prisons as safe as possible, it is equally important to make other parts of the criminal justice system, for example police cells, release from prison and/or community sentences safe. By the end of this research, we will have identified the most effective ways of preventing deaths by suicide and will have developed new service models to allow all parts of the justice system to work better at protecting people. We will identify whether some individuals, for example women, older people or those from black and ethnic backgrounds, are at a higher risk of suicide and how those extra risks can be tackled. We will do a number of things. Firstly, we will bring together knowledge which already exists about how to reduce self-inflicted deaths within criminal justice services. We will look at what information is routinely collected by police, prisons and probation and develop better ways of using this to learn more about the common risks and issues which could be changed to make people safer and more supported. Secondly, we will collect very detailed information about all suicides in the criminal justice system over a three year period, to further understand what drives people to suicide. This will include looking at individual factors, such as whether they had mental health problems or family issues, but also looking at wider issues which we know can badly affect people who commit crime, for example substance misuse and mental health issues, unemployment, family problems and bullying and overcrowding in prison. Thirdly, we will join all this knowledge up and talk to staff, current and ex-offenders and their families to create better models of care and support based, ready to be rolled-out across the criminal justice system.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH