Title: Feasibility and Acceptability of Medical Skin Camouflage for Recovery of Women with Self-Harm Scarring in Prison
Funder: Department of Health and Social Care

Abstract: In prison, women prisoners comprise only 5% of the population yet are far more likely to commit suicide or self-harm than women in the community (3;4;5) or male prisoners (6). Health care services have significantly improved the management of acute SH crises within the community and the prison service (7) but there has been little focus on the recovery, psychosocial functioning and quality of life for living with self-harm scarring. Historically, medical skin camouflage clinics treat individuals suffering with disfiguring skin conditions such as burn scars. Evidence suggests that medical skin camouflage can play an important role in improving well being and recovery for these individuals (21;22; 23). However, all available data relates to non-SH scarring and there is little or no evidence about medical skin camouflage interventions with women prisoners in the UK. Primary Aim: To test feasibility and acceptability of medical skin camouflage for self-harm scarring in women prisoners. Research questions: Is it feasible to deliver medical skin camouflage in a prison environment? What are the potential barriers to recruitment, participation, retention? Is medical skin camouflage acceptable to women recipients and stakeholders in the prison setting? What women, service-centred and research-centred outcomes should be adopted in future RCT? Plan of Investigation: Randomised, wait-list control design in four phases: Phase 1: -Obtain ethics and National Offender Management Service (NOMS) approvals; establish Research Management and Research Steering Group. -Explore likely barriers to introduction of medical skin camouflage in prison with stakeholders to develop strategies to overcome these in Phase 4. -Develop women, service and research-centred outcomes. In order to achieve this, we shall conduct 2 focus groups with women prisoners (including current self-harmers) and prison staff (6-10 in each, potentially mixed constituency group; 12-20 in total). Phase 2: Utilizing the findings from Phase 1, we shall adapt the medical skin camouflage. In particular, we shall address practical aspects of where, when and how treatment will be delivered in the prison. Phase 3: Changing Faces will train six or more long-term women prisoners as medical skin camouflage practitioners. Phase 4: 20 participants will be randomised to receive 6 weeks medical skin camouflage from trained women practitioners; a further 20 women prisoners will be wait-list controls and receive the intervention after study completion. Data collection. Baseline: basic demographics, women, service and research-centred outcomes from Phase I; psychosocial well&shy;being; social functioning; HRQoL, everyday activities, self-harm and related life-events. Six weeks post-intervention: repeat baseline measures (apart from HRQoL); qualitative interviews to evaluate acceptability for participants and from camouflage practitioners on acceptability of training and delivering intervention to fellow prisoners. Three-months post-intervention pilot collection of resource use and HRQoL data, and participant follow-up data. Recruitment, participation, retention and causes of drop-out will also be collected. Prepare publications, conference abstracts, dissemination events and submit final report. Patient and NHS benefits Key potential patient-benefits include increased self-esteem, quality of life and recovery for women prisoners with self-harm scarring; improved recovery and decreased likelihood of self-harming behaviour. An intervention to improve self-harm recovery may produce significant efficiency savings for prisons and NHS as the cost of treatment for this group will be reduced both within the prison setting and upon release when they continue to be NHS service users. Prisoners may become empowered to participate in work and social activities. A recovery model for self-harming is likely to reduce direct costs by promoting positive attitudes about self-harm and its management amongst staff, reducing relapse rates and, longer-term, promoting better care pathways. Prisoners are entitled to equivalent healthcare to that offered in the NHS; on release, better outcomes may benefit the NHS by improving health of this vulnerable group.

Lay abstract: Women prisoners (WPs) comprise 5% of the prison population but are far more likely to commit suicide or Self Harm (SH) than women in the community or male prisoners. Healthcare services have significantly improved the management of acute SH crises in the community and prison service but there has been little focus on the recovery, psychosocial functioning and quality of life for those living with SH scarring. Medical skin camouflage (MSC) clinics treat individuals with disfiguring conditions like burn scars and show evidence of improved recovery and psychosocial wellbeing. There is little/no evidence about MSC interventions with SH scarring or prisoners in the UK. AIM: To test feasibility and acceptability to women prisoners with SH scarring of delivering MSC in a women s prison. METHODS: Phase 1. Stakeholder focus groups will (i) explore strategies to overcome barriers to prison-delivered medical skin camouflage for use in Phase 4; (ii) develop women, service, and research-centred outcomes. Phase 2. Will use Phase 1 findings to adapt prison-delivered medical skin camouflage focussing on practical aspects of where, when and how treatment is delivered. Phase 3. Changing Faces will train 6 or more long-term prisoners to deliver medical skin camouflage. Phase 4. Evaluates feasibility/acceptability of prison-delivered medical skin camouflage with 40 women prisoners: 20 will be randomised to the 6-week intervention; 20 women prisoners will be wait-list controls and receive the intervention after study completion. Pre and post-intervention, we shall pilot collection of (i) women, service and research-centred outcomes from Phase I; (ii) psychosocial well&shy;being; (iii) social functioning (iv) everyday activities and, during the intervention phase (v) recorded/ACCT data on self-harm and related life-events; (vii) pilot 3-month follow-up data collection. Data will be collected on recruitment, participation, retention and causes of drop-out. Collection of health-related quality of life and resouce use data will be pilotted.

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