Title: An Exploratory Study of Interventions for Self-Harm in Men's Prisons
Funder: Department of Health and Social Care

Abstract: Background There is a high prevalence of self-harm in men in prison in England and Wales. Rates are at a record high, with 47,136 incidents between March 2018 and 2019. Self-harm causes physical and emotional suffering, with significant prison and NHS costs. There is no evidence-based treatment for self-harm in this population of men. The prison environment, with stigma around self-harm, has made developing treatments challenging. The prison service and NHS have little awareness of which treatments are offered. Aims and Objectives Aim: To examine which self-harm interventions are being delivered to imprisoned men in England and Wales and understand the treatment experiences and preferences of stakeholders. Objectives: To describe ( map ) interventions for self-harm across a representative sample of men s prisons. To explore the experiences of self-harm for men and staff in prison. We will obtain their views on treatments they have experienced and new interventions. Methods 1. We will conduct structured telephone interviews with staff across a representative national sample of 22 men s prisons (20% of all men s prisons) to establish what treatments are being delivered. We will interview 22 prison and 22 mental health staff using a standardised checklist and obtain written materials. 2. We will hold 9-11 focus groups across a sample of men s prisons (one group per prison). Each group will include 5-8 health and custody staff with experience of working with men who self-harm. Their experience of self-harm and its treatment in prison, and views on the acceptability and feasibility of a range of treatments, will be explored. Questions will be informed by the mapping exercise and the current evidence base. 3. We will conduct 24-30 individual semi-structured interviews with a sample of remand and sentenced adult prisoners who have self-harmed in prison. They will discuss their self-harm, treatment experiences, and views on current and novel treatments. Analysis: Data on current interventions will be ordered to provide a descriptive map of self-harm provision. Transcripts from focus groups and interviews will be analysed using framework analysis. Timelines for delivery Months 1-4: HRA, NPC and R&D approvals; security clearance; preparation of materials Months 5-7: Mapping of current interventions Months 8-17: Focus groups and interviews; begin analysis Months 18-21: Completion of analysis, write-up and dissemination Anticipated Impact and Dissemination Mapping current treatments will influence policymakers in their support for research into evidence-based treatments. It will also provide evidence of treatment as usual for future trials. This work will identify promising interventions. Following this study, they can be used in feasibility and acceptability studies, succeeded by a full-scale clinical trial. Findings will be shared with policymakers in the prison service including the national prison Safer Custody group. This project is the first step in the development of cost-effective treatments for men who self-harm. It will ultimately benefit thousands of men, staff, their peers, and families, as well as reducing NHS and prison costs. We will disseminate findings through lay research summaries, prison dissemination events, papers, a conference presentation and social media.

Lay abstract: Background Self-harm is when someone deliberately hurts themselves. There are many reasons someone might self-harm. It is commoner in prison than in the general public. There were 47,136 self-harm incidents in men s prisons in the year to March 2019. This was 24% more than the previous year and the highest ever number. Men s self-harm is different to women s, but we know less about treating it in men. Self-harm causes physical harm and emotional upset. Men who self-harm are more likely to kill themselves. Self-harm causes anxiety to families, prison staff and other prisoners. It is expensive for the NHS and prison service to provide treatment and keep men safe. The costs of this are not known. There is no treatment that has been tested in a clinical trial. Charities, the NHS and prison service have asked for new treatments. Past research into treatments has not listened to the men themselves. Aims We need to choose the right treatments to test in future clinical trials to see if they reduce self-harm. We want to: Find out what treatments are being given in prisons. Understand men s and staff s past involvement with self-harm. Find out what they think of the treatments they have had, treatments that are given now, and possible new treatments. This will let us find treatments that are practical to use in prisons, that men would like, and which might work. After this research we will apply for funding for trials to test these treatments. Future benefits will include reduced self-harm with reduced distress, harm and cost. Design/Methods 1. We will interview staff from 22 prisons in England. We will find out which treatments for self-harm they offer men. 2. We will hold discussion groups with staff from up to 11 prisons. We will ask about working with men who self-harm, what might help them and how treatments could be given in prison. 3. We will interview up to 30 men in those prisons. We will ask about their self-harm and treatment they have had. We will ask about possible treatments. These will include education, activities, computer treatments, and talking therapies. Patient and Public Involvement A discussion group with 10 men with direct experience of self-harm in prison helped to design this project. One of our team has self-harmed in prison. He has worked on designing the project and will carry out some of the research. Prison staff support this research. They will give us advice and make sure that prisoners can take part. Dissemination We will share findings with prisoners and staff through prison newspapers and through presentations at prisons. We will also share findings with the NHS and prison service at conferences, meetings and in academic journals.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH