This article describes qualitative research with women survivors of potentially lethal self-harm in prison. In-depth interviews were carried out during 2002/03 with 15 women, (adults and young offenders), from six establishments. The interviews focused on the women's own accounts of the 'near miss' incident, including intentions and motivations, factors leading up to the incident, experiences of care and support, current self-harm and suicidality, and suggestions for prevention. Recommendations include: improvements to the general prison regime; training and support for staff; specialist help for women with histories of abuse, mental illness, or borderline personality disorder; improved support following stressful life events.Most prisoners who kill themselves in custody are male, reflecting the larger male prison population. However, the last decade has seen a disproportionate rise in the number of female self-inflicted deaths (SIDs) in prison, from one death in 93/94 to ten in 2003/04, with 13 in 2002/03. The average female prison population increased by approximately 165% between 1993 and 2003, while the rate of female SIDs (per 100,000 of the average daily population, ADP) increased by almost 500% during that period. Calculating rates by ADP underestimates the number of women actually passing through the prison system, many of whom are on remand or serving short sentences, and thus inflates the 'true' rate. Nevertheless, the increase in numbers is a matter of considerable concern.Women in prison also have disproportionately high rates of self-harm. For example, in 2003, women constituted 6% of the prison population but were responsible for 46% of recorded self-harm incidents. Previous research has attempted to distinguish between prisoners who attempt suicide and those who harm themselves for other reasons. Coid et al. (1992) used cluster analysis of interviews to identify two groups of women who harmed themselves while on remand. The first and larger group selfharmed to relieve symptoms of anger, depression, and anxiety, linked to histories of childhood deprivation, abuse, and impulse disorders. They were frequently diagnosed with borderline personality disorder. The second group tended to self-harm in reaction to life-events or psychotic experiences and were more likely to engage in serious, potentially lethal, self-harm. Snow (2002) focused explicitly on prisoners' motives for selfharming behaviour, identifying gender and age differences. Participants who injured themselves without suicidal intent described precipitating factors related to negative emotions and the need to relieve anger and frustration, whereas those who had attempted suicide were more likely to report specific events or experiences which had acted as triggers.A small study analysing investigation reports in the self-inflicted deaths of 13 women in prison identified both individual 'vulnerability' factors known to increase suicide risk and the occurrence of specific precipitating events (Mackenzie, Oram and Borrill 2003). Vulnerability fac...

Because of the nature of prison, with its forcible suspension of everday life and its emphasis on time-discipline, prisoners are forced to confront the issue of passing time and personal identity. Suicidal prisoners experience time as an acute source of suffering and connected to the deterioration of their sense of self. The nature of their relationship with time can be profitably explored by qualitative research which focuses on prisoner accounts, since prisoners themselves are valuable sources of knowledge about the prison experience in general and suicide in prison in particular. The accounts of prisoners demonstrate patterned differences between suicidal and coping prisoners in their relationship with prison time. Suicide awareness and prevention policies will be enriched if they acknowledge the special pains of prison time and their connection with personal identity, and aim at addressing these in regimes and care.

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