Learning from ‘Near Misses’: Interviews with Women who Survived an Incident of Severe Self‐Harm in Prison

Abstract

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...

Researching Suicide, Attempted Suicide and Near-Lethal Self-Harm by Offenders in Community Settings: Challenges for Future Research

“…While this raises concerns about participants who are committed to carrying out a future suicide withholding information, evidence from prison studies suggests that in practice offenders welcomed the opportunity to disclose suicidal risk through the mediation of the interviewer, because they found it difficult to disclose directly to staff (Fazel, Hawton, Marzano & Rivlin, 2012). It is also helpful to provide the participant with the opportunity to choose if they would like anything to be passed onto a member of staff (Borrill et al, 2005). Developing trust and a non-judgmental approach are also both important issues when researching a sensitive subject such as suicide, particularly when using an offender population (Patenaude, 2004).…”

“…Despite this, past research has indicated that individuals who have experienced a near-lethal suicide incident and have taken part in research have not found it to be a negative experience, and in some cases found the experience to be beneficial (Fazel et al, 2012). Prison studies in which researchers interviewed inmates about suicide attempts found that listening was a key issue for staff-prisoner relationships, and that prisoners appreciated having someone to listen to them (Liebling & Price, 1999;Borrill et al, 2005).…”

Institutional Responses to Self-Injurious Behavior Among Inmates

“…Excluded from this definition are common expressive forms of body modification such as tattooing and piercing (Favazza, 1989). Attempted/completed suicides, although sometimes grouped with self-injury data in previous investigations, are viewed as distinct in etiology and motives and therefore deserving of separate investigation (Borrill et al, 2005; Canadian Centre on Substance Abuse, 2006).…”

Interviewing survivors of near-lethal self-harm: A novel approach for investigating suicide amongst prisoners

“…Replicating and expanding on earlier pilot work carried out by the Safer Custody Group, 36,37 this three-year project aims to explore some of the questions and risk factors that prison-based research has traditionally overlooked.…”

“…Although prisoner self-harm has been used as a proxy indicator for suicide, what may constitute a 'serious', 'severe' or 'near-lethal' incident has been variously and poorly defined, if at all. With a few notable exceptions, 36,37 it is questionable, and often difficult to establish, whether the prisoners involved in these studies may be considered to be ''virtual suicide victims". 38 Whilst it is important to avoid making artificial distinctions between different types and levels of self-harm, the study of such complex and dynamic behaviour(s) requires some clear and replicable criteria, which previous research has seldom included.…”