Title: Feasibility Study of a Cognitive Behavioural Suicide Prevention Intervention for Male Prisoners
Funder: Department of Health (England)

Abstract: Background In 2007, there were 22,459 recorded incidents of suicidal behaviour in prisons in England and Wales, resulting in 92 suicidal deaths – a rate 5 times greater than for the general population. Coping with a prison environment that embodies fear, distrust, and a lack of control, can leave prisoners feeling overwhelmed and hopeless, leading some of them to choose suicide as a way to escape. We have developed and manualised a new talking therapy intervention for suicidal behaviour (Cognitive Behavioural Suicide Prevention, CBSP). Our individualised treatment offers a structured, theoretically-based, psychological intervention designed to address and amend the specific psychological architecture responsible for suicidal behaviour in prisoners, using established cognitive-behavioural techniques. Aims The aim of this study is to demonstrate the feasibility of delivering our existing CBSP intervention in a prison environment. We will also investigate how best to adapt the delivery of CBSP for prisoners. To address these aims, Work Package 1 will be a randomised controlled trial (RCT) with 30 prisoners at risk of suicidal behaviour receiving CBSP plus usual treatment. Another 30 prisoners, also at risk, will receive their usual treatment alone. The RCT will be nested within Work Package 2, which will inform and subsequently assess the delivery of CBSP to prisoners. Prisoner interviews and a staff focus group will examine views on how CBSP should be modified for the prison environment. Work Package 3 will be a 6-month follow-up study of the longer-term impact of the intervention.???? Plan of Investigation This study will take place in a male closed training prison in the northwest of England (HMP Wymott), that holds prisoners who have typically received a sentence of 2 or more years. Participants will be prisoners identified by staff as at risk of suicidal behaviour. Work Package 1: We will conduct an exploratory RCT of the CBSP intervention with a sample of 30 prisoners, compared to treatment as usual. Work Package 2: To address potential contextual issues, enhance and subsequently evaluate the delivery of CBSP, we will use qualitative methods to explore prisoners’ and staff’s experiences of the intervention. Work Package 3: To investigate the longer-term impact of the CBSP intervention, participants will be invited to assessment interviews as part of a 6-month follow up study. Potential Impact The costs of suicide to society are high, especially once indirect costs are included, e.g. lost productivity. Nevertheless, the economic costs can seem small in comparison to the ‘intangible costs’; the grief, anger and abandonment of family and friends, and the lost potential of lives cut short. Prisoners are from marginalised populations that have poor access to health care in the community. Therefore, periods of incarceration offer important opportunities for treatment interventions that stand to benefit not only the prisoners themselves, but also the larger public health with potential downstream savings in other publicly funded services. Furthermore, the improvement of prison healthcare, including prisoner mortality, has now become the responsibility of NHS services.


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