Title: Women Offenders Repeat Self-Harm Intervention Pilot II (WORSHIP II)
Funder: Department of Health (England)

Abstract: Background Only 5% of the prison population is women, but they account for almost half of self-harm (SH) incidents in prison. This is a rate of 333 per 100,000 compared with a rate of 62 per 100,000 for men.The extent and seriousness of SH in women’s prisons is increasing and is a serious health concern. Rates of suicide are also far greater in women in prison. Services are required to develop close partnerships so prisoners have access to healthcare as the general population. A recent review in 2010 highlighted a need for development of evidence based SH prevention strategies for female prisoners; currently few exist, none are women-centred and none has been evaluated.There is an urgent need to develop targeted interventions to enable shared understanding and approaches to SH in female prisoners. Aims Examine efficacy of Psychodynamic-Interpersonal Therapy (PIT) versus an Active Control (AC) for repeat self-harm (SH), measured by suicidal ideation, thoughts of SH, repetition & severity of SH in women prisoners. Objectives. Immediately post therapy & 6 months post randomisation measure: 1) suicidal ideation & thoughts of SH 2) number of SH events, time to next event, severity of event (fatal, near fatal or not) and method 3) undertake process evaluation to assess factors associated with adherence and acceptability of the intervention (participant perception of usefulness, on-going skill usage & satisfaction) 4) assess feasibility of following women prisoners 6 months following randomisation 5) pilot methods for collection of prison resource allocation data incurred as a result of SH. Plan of Investigation In months: 0-3: Form Trial Management Group (TMG) & Trial Steering Group (TSG); recruit research assistant; update literature review; ethical, managerial and governance approvals; coordinate and publicise project in the two prisons; PIT training of TW and Therapists. 3-26: Recruitment amd randomisation of 120 particpants; deliver interventions; develop follow up methodology to access women at 6 months; blinded assessments completed before and post therapy and at 6 months follow-up; co-ordination of TMG and TSG meetings; continued contact with prisons; develop process evaluation interview and interview 20 prisoners and 20 prison staff. 26-32: Transcription of qualitative data and thematic analysis of interviews; quantitative data analysis. 32-36: Write, submit, disseminate report. Potential Impact Recent government policy highlights the need for evidence based SH prevention strategies for women in prisons. Engagement of women offenders in a targeted, women-centred, short-term intervention for SH, we anticipate a reduction in the level of thoughts of SH, in repetition and severity of SH, and in the risk and therfore rates of suicide in this high risk group. Relationships between prison staff and women may also improve and rehabilitative work within prisons is also likely to benefit from reduced intent to SH and reductions in SH behaviour by female prisoners. Prison resources are diverted at great cost to staff and women in order to manage repeat SH.These will be able to be employed again more appropriately in rehabilitative work.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH