Title: COVID-19 measures and prisoner self-harm: critical time trends analysis informing policy to improve individual and institutional resilience (COPE)
Funder: Department of Health and Social Care

Abstract: Research question What is the impact of the Covid-19 pandemic, and the resulting protection measures, on prisoner self-harm? Background Prisons have reacted to the Covid-19 pandemic by minimising person-to-person contact, meaning the cessation of social visits, education and training programmes, non-essential employment, gym access, and religious association. The social isolation associated with these measures has resulted in concerns about prisoner mental health and exacerbation of the already troubling prison self-harm rates. To mitigate these effects, prisons have adopted a range of measures, such as instigating video call visits or providing additional in-cell activities. Although there are cross-prison policies on the pandemic response, there are likely to be heterogeneous responses at an individual prison level and, thus, anticipated differences in the pandemic effects on self-harm rates. Knowing what factors affect prisoners self-harm, and which promote resilience, is vital if we are to learn from the pandemic and enact policies that help reduce prisoner self-harm now and in the future. Aims/objectives Understanding changing self-harm from prisoner/staff perspectives Quantifying changes in prisoner self-harm across the pandemic Identifying whether changes, enacted in response to the pandemic, have affected self-harm rates Identifying characteristics which make prisons resilient (or not) to the pandemic s effects Gaining greater understanding of self-harm in prisons from the natural experiment afforded by the pandemic Methods We propose to examine the pandemic s effects on self-harm among prisoners using three data collection phases. The first is a consultation with the Prisoner Policy Network (PPN), a large network consisting mostly of current prisoners. The PPN will be asked to reflect on how the pandemic, and prison measures, have affected their self-harm/mental health. This will help inform the second data collection phase: a bespoke survey of staff in all 117 prisons in England/Wales. Staff will be asked to reflect on their experiences of the pandemic and to answer a brief structured questionnaire to ascertain prison-level changes that may have influenced self-harm during the pandemic. Finally, we shall extract aggregated quantitative data from prison databases, for which we have permission and access. This will include monthly self-harm statistics, data on prison demographics and other prison attributes. The resulting data will be analysed using mixed-methods. As part of Framework Analysis, data from the PPN consultation and the short staff interviews will be thematically grouped, charted in the matrix and compared. Using the quantitative data, independent predictors of self-harm in prisons will be identified using Poisson models with random effects to account for the longitudinal nature of the data. Timeline Month Deliverable 1-3 PPN consultation 4 Pilot staff survey 5-6 Staff survey 1 Self-harm data collection 1 9-10 Staff survey 2 Self-harm data collection 2 10-12 Round table/final report Impact Collecting prisoner and staff views on the pandemic and self-harm Producing robust evidence of the determinants of prisoner self-harm over the course of the pandemic Understanding factors which help promote resilience to self-harm Informing policy responses to self-harm in prison (during infectious outbreaks and more widely) Engaging prisoners and the public in the issues around self-harm in prison

Lay abstract: Aims To understand how the COVID-19 pandemic, and measures to control it, have affected self-harm in prisons so we can learn lessons to manage self-harm and future pandemics in prisons better. Background On 20th October 2020, the Chief Inspector of Prisons called for more sophisticated analyses of self-harm in prisons... COVID-19 has changed how prisons work. Prisoners now spend much more time alone in their cells, sometimes up to 23 hours a day; and they cannot meet family or friends. It is important to understand how these, and other changes associated with preventing the spread of COVID-19, have affected prisoners self-harm and mental health. High-quality, reliable information about how self-harm has changed with COVID-19 measures, taking account of existing trends, is urgently needed. As the pandemic continues, decision-makers need this not only to manage self-harm in prisons now, but also to identify ways to improve self-harm rates and the way of life in prisons in the future. Design and methods The Prison Reform Trust will contact all prisoners across both the women s and men s estates in England and Wales to find out how COVID-19, and the changes made to reduce its spread, have affected their lives and their self-harm. We shall make use of existing nationally-gathered information to track how self-harm has changed across prisons before and during the pandemic. We shall link this to information about prisoners and individual prisons to understand what may account for any changes in self-harm. We shall examine how often prisoners harm themselves, exploring how this links with changes to the prison environment across the pandemic. We shall write a report for people who make decisions about how prisons should operate and produce materials for prisoners, so they know the results of this research. Patient and Public Involvement We are working in partnership with the Prison Reform Trust, an independent charity that works with current prisoners and people who have left prison. We also have two team members with personal experience of self-harm in prison. The Prison Reform Trust and our team members are involved in the research design, conduct and public engagement. Target audience and Dissemination We shall work with existing contacts in Her Majesty s Prison and Probation Safety Learning Group, to evidence immediate and future strategies for prison recovery from the pandemic. We already work closely with Ministry of Justice, Department of Health and Social Care and Public Health England and have active support for this work. Throughout the research, we shall provide them with ongoing reports. Results from the research will also be shared with current prisoners. We shall produce easy read articles for Inside Times/Converse, a Secret Life of Prisons Podcast and an animated film for Way-Out TV.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION;MENTAL HEALTH