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...

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This paper reports findings from a study of the social, situational and environmental factors that contribute to suicide and selfinjury in prison, focusing here on prisoners' motivations for their actions. In-depth interviews were conducted with 143 prisoners in ten prisons in England and Wales who had engaged in an act of self-injury or an attempt at suicide. The majority of participants described a number of precipitating or motivational factors related to concrete events, feelings/emotions (or both), operating within five different dimensions: offencerelated, interpersonal, symptom relief, instrumental and situational. In very few cases were there single reported causes. Motivational factors more prevalent among participants who attempted suicide included relationship problems, concerns about forthcoming court appearances and factors relating to drug withdrawal. Those who attempted suicide were more likely to describe concrete events or experiences as motivational factors. Those who injured themselves without suicidal intent were much more likely to describe negative feelings or emotions as precipitating factors. The results highlight the complex and multifactoral nature of suicidal and self-injurious behaviours. At the very least they lend support to the suggestion that different strategies should be developed for those who attempt suicide and those who injure themselves for other reasons. This paper begins by briefly defining the behaviours currently examined before providing an overview of the main prison-based Prisoners' motives for selfinjury and attempted suicide

examine the number and rate of self-inflicted deaths and make comparisons with previous years • compare the characteristics of those who died during 2001 with previous years and identify any emerging differences • set the recent deaths in context with prison and communitybased studies• identify lessons for policy and practice. DefinitionsThe Prison Service uses the term 'self-inflicted death' to refer to all apparent suicides in custody. The term was adopted in 1991 as an allembracing description of deaths arising from non-natural causes that appeared to be directly caused by the actions of the individual concerned (McHugh & Towl, 1997).A coroner holds an inquest into all deaths in custody, as well as unexpected deaths that occur in the community. A suicide verdict is returned only if there is clear evidence that the individual intended to end their life. If there is any doubt that the person meant to die, an alternative verdict is returned such as 'open', 'accidental' or 'misadventure'.To fulfil its commitment to openness and to ensure that lessons are learned from such tragedies, the Prison Service classifies deaths as self-inflicted for all coroners' verdicts of suicide, death by misadventure, open verdicts and accidental death (Snow & McHugh, 2000). Between 1988 and 1994 the percentage of self-inflicted deaths that received a verdict of suicide ranged between 58% and 84%, with the remainder classed as misadventure, accidental, open or Self-inflicted deaths during 2001: an analysis of trends ABSTRACT This paper summarises the findings of an unpublished Prison Service report into selfinflicted deaths in prisons in England and Wales over the period 1990-2001.The key findings are that the number and rate of deaths in prisons has increased during the period examined. The majority of deaths are among men, although there has been a recent increase in the number of women who have died over and above any increase in their proportion in the prison population. Women are likely to be younger than men when they die. There is a statistically significant association between increased rates of throughput in local prisons and an increase in the rate of self-inflicted deaths. Deaths are most likely to occur soon after prisoners have been received into custody. Few prisoners who die have been identified as at increased risk of suicide. There is some evidence that the period immediately following closure of an F2052SH is a high-risk period. Most prisoners who die are in single cells. Those who die in shared cells are usually alone at the time of death. The findings support the direction of the current Safer Custody strategy: in particular the focus on local prisons, on improved vigilance and care in the early days of custody and on providing improved facilities and care in health care centres and segregation units.

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