Staff-prisoner relationships are key to managing suicide risk in prison, say researchers

On 1 July 2015, the Government published the Labour peer Lord Toby Harris’ final report of the Independent Review into self-inflicted deaths in custody of 18-24 year olds, which was commissioned to make recommendations on actions that need to be taken to reduce the risk of future deaths in custody.

A team from Cambridge University’s Faculty of Law and Prison Research Centre (PRC), in partnership with RAND Europe, was commissioned by the Harris Review to undertake new research on the experience, knowledge and views of prison staff about the nature of suicide risk and its identification and management. Researchers conducted around 50 interviews and focus groups, and observed prisoner assessments across five prisons in England and Wales, including both private and public establishments.

The researchers found that many prison staff use ‘jailcraft’ — the knowledge and expertise gained through their own experience — to identify and manage at risk prisoners, but staff felt that their capacity to build and exercise this expertise has been adversely affected by a lack of time and budget, and a reliance on blanket risk management procedures.  

While some staff held fatalistic views of individual prisoners (‘those who really want to do it will do it anyway’), researchers say that staff who understood the impacts of prison environments, and attempted to proactively ameliorate those impacts upon prisoners, through their relationships with prisoners and practices, were more likely to be effective in preventing deaths.

Such staff placed individual prisoner care at their heart of their work. They used initiative by, for example, ‘creating’ jobs to occupy prisoners’ minds, such as additional cleaning or painting on the wing, or offering in cell ‘distraction packs’ that included Sudoku puzzles or crosswords.

“While some prison staff felt that suicide attempts could be described as acts of manipulation, many saw it as a cry of pain. The prison officers who recognised the complex interaction between prisoners’ imported vulnerabilities — such as addiction or illiteracy — and their environment and situations, felt more empowered to gauge the risks of self-harm or suicide and intervene to prevent situations from escalating,” said the PRC’s Dr Amy Ludlow, who led the research.

The team say their findings highlight the importance of “high-quality relationships between prisoners and staff for identifying and managing suicide risks in an increasingly austere prison environment”.

However, many of the staff interviewed for the research felt that budget-reduction policies, including ‘Benchmarking’ and ‘New Ways of Working’, had adversely affected their capacity and expertise to manage suicide risk proactively, rather than reactively. Many staff expressed frustration at having too little time for personalised, integrated care.

Many of the study’s interviewees described staff losses from early redundancy packages being compounded by high staff sickness — often, they reported, because of work-related stress. In some prisons, researchers observed senior managers undertaking prison officer work such as serving meals to make up for the short fall.

One prison manager told researchers: “Benchmarking has put us between the devil and the deep blue sea. We’ve had to implement it even though we know it’s damaging the prison”.

Staff reported that there were currently too few staff on prison wings, and those staff present were often less effective than they could be because of inconsistent staff deployment, the use of agency staff, low morale and infrequent or inadequate training.   

Many staff also reported that social and educational activities in prisons had been reduced as a result of budget cuts, with whole wings of prisoners routinely ‘banged up’ (confined to their cells) for almost all of the day.

“We know from this and other studies that there are a number of protective factors related to the prison environment that impact on the likelihood of suicide,’ said the PRC’s Professor Alison Liebling.

“Part of this story is how well a prison responds to prisoners’ needs during acute periods of distress. But it is also important that a prison provides an environment where prisoners have meaningful activities and human contact, both for prisoners who are and those who aren’t seen as at enhanced risk of self-harm,” she said.

Researchers found the Assessment, Care in Custody and Teamwork (ACCT) process that dominates the ways in which prisoners at risk are identified and managed — and was credited with contributing to the decline in suicide that began in the mid-2000s — was now often being approached as a ‘tick box’ exercise because staff felt that they ‘haven’t got time to deal with [risk] any other way’.

Staff described an over-reliance on ACCTs, with the result that support was not focused on prisoners most in need of it. Many cited a fear of blame for deaths in explaining their ‘defensive’ use of ACCT. Staff described feeling unfairly blamed when things go wrong, and unrecognised for their successes in preventing deaths by a system that does not understand the resource constraints within which prison work is carried out.

The research also found that adequate support for staff in preparing for inquests was important in securing positive oriented learning experiences from deaths in custody. While some staff reported evidence of positive change to practice following inquests, some staff, particularly managers, expressed frustration that some ‘pretty straightforward lessons’ were not learned by all staff from inquests.

Some staff and managers were equally of the view that ‘self-inflicted deaths (SID) could act as catalysts for reflection and changes to practice that make SID prevention more effective’, and staff reported looking for an achievable model of effective practice. One member of prison staff reported that “listening to colleague’s stories and experiences would help you grow. Retrospective learning from such incidents would be great. We do too little of it now — we’re always in defensive mode”.

The team’s findings have helped inform some of the Harris Review’s 108 recommendations about how more deaths in prisons can be prevented: through improved training for staff; recognition of the importance of — and investment in — caring, personalised and respectful staff-prisoner relationships; better information flows between relevant agencies; and a focus on lesson learning following all incidents of self-harm and suicide.

“The Harris Review has raised important questions that demand the attention of policymakers,” said Ludlow.

“My hope is that our study will be a catalyst for further dialogue about suicide prevention, which will complement the Review’s thorough work. There are some dedicated prison staff whose knowledge and experience should inform next steps, as should the insights of the many excellent volunteer prisoner Listeners who support fellow prisoners at times of crisis. That sustained reductions in the rate of suicides in prison were achieved post 2005 suggest that systematic efforts to prevent them can work, given the right organisational context,” she said.

Ludlow points out that the Harris Review states that, by and large, the policies that National Offender Management Services promulgates through Prison Service Instructions are sound and, if implemented, would deliver good practice.

“While suicide risk is intense, multifaceted and dynamic, the protective potential impact of staff-prisoner relationships and the prison environment should give us hope that more deaths can be prevented given adequate resource and leadership, and genuine political commitment to some of the welcome fundamental critiques raised by the Harris Review about the size of our prison population, and experiences of imprisonment that too frequently inadequately support prisoners in their journeys towards non-offending lives,” Ludlow said. 

The full findings of this study are now available online.

The research team will host a roundtable event to discuss this and related research at the University of Cambridge on 8 September 2015.