The RUSH program — real understanding of self-help: a suicide and self-harm prevention initiative within a prison setting

Abstract

s a consequence of adverse childhood experiences, offenders can develop mental health problems consistent with a diagnosis of borderline personality disorder (BPD). This is characterised by difficulties with distress tolerance, emotional and behavioural regulation, and interpersonal skills, that often manifests as recurrent suicidal ideation and self-harm. The dynamic interaction between the prison environment, offender psychopathology and individual coping styles further elevates this risk for suicide and self-harm. There are few treatment programs with proven efficacy in managing borderline characteristics with the exception of dialectical behaviour therapy (DBT) developed by Marsha Linehan (1993a) for clinical populations. However, the development, implementation and evaluation of forensic-based DBT programs is in its infancy. The RUSH (Real Understanding of Self-Help) Program is a recent Australian DBT adaptation targeting vulnerable offenders exhibiting borderline characteristics. This paper provides an in-depth exploration of RUSH, highlighting the modifications made to the original DBT framework. Therapeutic obstacles associated with implementing RUSH in a correctional environment are discussed, together with successful strategies to overcome these difficulties. Finally, examination of quantitative and qualitative outcomes suggests that RUSH is a promising, holistic offender rehabilitation program targeting BPD characteristics and related problem areas.

Treatment of impulsive aggression in correctional settings

“…Maintenance of DBT-CM skills, like any program taught skills for individuals with limited cognitive functioning or impairments, will need reinforcement. The literature supports maintenance of reduced aggressive or selfharmful behaviors as targeted by the intervention while incarcerated (Eccleston & Sorbello, 2002;Robins & Chapman, 2004); however, longitudinal studies on the effects of DBT from the prison environment to the community are limited (Nee & Farman, 2007). Given the known rates of reincarceration, although the causes of reincarceration are complex, it would support common sense that these skills would need ongoing supportive programming.…”

Non-Suicidal Self-Injury Within Offender Populations: A Systematic Review

“…This difference in effect sizes may point to the intractable nature of NSSI. The DBTbased abbreviated Real Understanding of Self-Help program was developed for use among forensic samples in Australia, although there is not yet an empirical basis for this program or its efficacy in addressing NSSI (Eccleston & Sorbello, 2002).…”

The Role of Loneliness in Prison Suicide Prevention and Management

“…The prevention of suicide and self-harm in prison is an important part of the work of correctional organisations, and while most jurisdictions implement some interventions to manage risk (Eccleston & Sorbello, 2002;Eyland, Corben, & Barton, 1997;WHO, 2000), there is a need for more basic research exploring individual difference factors in prison suicide. Consistent with Howells, Hall & Day's (2003) recommendations for good practice in the management and prevention of suicide and self-harm in prisons, the results of this study suggest that best practice for preventing suicide in a prison setting includes having an identification system that incorporates the prisoners response to ongoing stressors arising in the prison environment (''state'' factors) as well as long-term vulnerability (''trait'' factors).…”