Acceptability and feasibility pilot randomised controlled trial of medical skin camouflage for recovery of women prisoners with self-harm scarring (COVER): the study protocol

Abstract

IntroductionSelf-harm in prison is a major public health concern. Less than 5% of UK prisoners are women, but they carry out more than a fifth of prison self-harm. Scars resulting from self-harm can be traumatising and stigmatising, yet there has been little focus on recovery of women prisoners with self-harm scarring. Medical skin camouflage (MSC) clinics treat individuals with disfiguring skin conditions, with evidence of improved well-being, self-esteem and social interactions. Only one community study has piloted the use of MSC for self-harm scarring.Methods and analysisWe describe an acceptability and feasibility pilot randomised controlled trial; the first to examine MSC for women prisoners who self-harm. We aim to randomise 20–25 women prisoners to a 6-week MSC intervention and 20–25 to a waitlist control (to receive the MSC after the study period). We aim to train at least 6–10 long-term prisoners with personal experience of self-harm to deliver the intervention. Before and after intervention, we will pilot collection of women-centred outcomes, including quality of life, well-being and self-esteem. We will pilot collection of self-harm incidents during the intervention, resources used to manage/treat self-harm and follow-up of women at 12 weeks from baseline. Data on recruitment, retention and dropout will be recorded. We aim for the acceptability of the intervention to prison staff and women prisoners to be explored in qualitative interviews and focus groups.Ethics and disseminationEthical approval for COVER has been granted by the North East–York Research Ethics Committee (REC) for phases 1 and 2 (reference: 16/NE/0030) and West of Scotland REC 3 for phases 3 and 4 (reference: 16/WS/0155). Informed consent will be the primary consideration; it will be made clear that participation will have no effect on life in prison or eligibility for parole. Due to the nature of the study, disclosures of serious self-harm may need to be reported to prison officials. We aim for findings to be disseminated via events at the study prison, presentations at national/international conferences, journal publications, prison governor meetings and university/National Health Service trust communications.Trial registration number NCT02638974; Pre-results.

Lived experience codesign of self-harm interventions: a scoping review

“…Four interventions were for non-suicidal self-harm,40 47 54 61 while eight interventions did not discriminate based on suicidal intent 43–46 48 50 51 60. The remaining sources did not define self-harm or the definition did not reference intent.…”

“…Adults also codesigned materials to aid professionals and caregivers, including a handbook for mental health trusts61 and self-harm awareness training delivered by experts by experience 57. Women’s prisons were the focus of three interventions 58–60. Finally, adults codesigned an activity workbook for self-harm recovery 56…”

“…In one study, people with lived experience identified the need for a co-run self-injury group within their American college campus 47. Service-users were also involved in the grant phase and protocol development,52 and informed study outcomes 60…”

A Scarless Healing Tale: Comparing Homeostasis and Wound Healing of Oral Mucosa With Skin and Oesophagus

“…Besides minor traumatic wounds and acne, other cases can arise from clinical surgeries, chemical and thermal burns or in consequence of allergic reactions. Self-harm scarring and combat wounds also a matter of concern ( Mitchell et al, 2019 ; Johnson et al, 2020 ). The traumatic wounds in the hostility of war context come with exposure of bone, ligaments and tendons, as well as contamination, and the limited available resources in conflict zones’ hospitals impede the treatment of these wounds ( Johnson et al, 2020 ).…”

“…This behaviour will interfere with future work life and relationships. In some contexts, scars result from traumatising events and bury a psychological meaning ( Brown et al, 2008 ; Gibson et al, 2018 ; Mitchell et al, 2019 ). On the other hand, while visible skin scarring implies a social burden, oral and oesophagus scarring result in difficulties swallowing food and weight loss ( Campos et al, 2020 ).…”