Preventing Self-Injury and Suicide in Women's Prisons

Citation

Logan, C. (2016), "Preventing Self-Injury and Suicide in Women's Prisons", Journal of Criminal Psychology, Vol. 6 No. 4, pp. 221-222. https://doi.org/10.1108/JCP-06-2016-0019

This is a very good book, which should be regarded as required reading for all practitioners working in correctional and forensic mental health services with women and adolescent girls. Why? Because the authors set down the facts of self-harm and suicide in this group, they highlight what makes women and girls vulnerable to and the establishments they reside in facilitative of this outcome, and they provide a manifesto for its management and ultimate prevention (all in 170 pages). And they manage this because they are experts in the field and they have a clarity of vision that enables them to get straight to the point.

What the authors recommend to manage this endemic problem is not rocket science: good assessment, especially at critical times (e.g. at reception into prison, or on transfer to another facility, or back to the community), formulation-based risk management, appropriate, responsive, proportionate, and coordinated interventions throughout custody and beyond, delivered by an informed, skilled, and caring staff group, and in a well-equipped and well-managed environment. So why is the problem of self-harm and suicide among women and adolescent girls in custody as endemic – and entrenched – as it is? Why are repeated calls to address this challenge seemingly unheard? Why has it proven so hard to implement what is so obvious by way of a response? Why does it need such a startlingly frank book such as this to try to create impetus in our correctional services? There are at least three reasons why the implementation of better systems to support and help vulnerable women and girls eludes us.

First, the challenge of self-harmful behaviour by vulnerable and at risk women and young girls in custody requires a coordinated response from beginning to end. Walker and Towl are most clear on this. A coordinated response would include competent staff selection, training, and support procedures. It would also mean the implementation of a range of the potentially effective interventions that have been piloted around the world, which are responsive to need both in terms of its nature and severity in the individual case, but also in terms of the needs of the environments that manage the prisoners at risk of acting harmfully towards themselves. In addition, a coordinated response requires good leadership, both overall and within individual establishments, to oversee a strategic approach to the problem. But because there is uncertainty in the research about what works with whom, and because prisons have so many competing priorities, staff are stretched across an increasingly wide range of tasks rather than able to focus on self-harm and suicide specifically. Their attention to this problem among so many others is just too limited to make a coordinated approach possible. Therefore, well-intentioned plans to prevent and manage risk of suicide and self-harm are rendered unsustainable or implemented in only a piecemeal way, which severely limits their effectiveness over time.

Second, a coordinated response to vulnerable women and young girls requires adequate funding – to enable staff to receive the training and support they need to understand what works for whom, and to implement interventions in a sensitive and compassionate way for the time it takes to manage and eventually reduce risk. However, funding is very limited and cuts in financial provision for correctional services are happening in many jurisdictions. Staff have multiple roles and too little time. Also, increasing numbers of women and young girls are being sent to prison with significant problems and vulnerabilities that pre-date their incarceration, meaning the demand for support and intervention is increasing just as the capacity of staff to respond declines. Therefore, there is not the financial or personnel resource to pay for what is required to manage this risk making the response to it merely reactive rather than anticipatory and planned – strategic.

Finally, this book commences with an excellent foreword by Lord Toby Harris. He makes a startling statement – startling, and depressing, because what he says is still true in the twenty-first century. He says this: “One cannot help but feel that [the failure of the State to prevent self-inflicted injuries and deaths among women and adolescent girls in custody] is because as a society we value the lives of those in custody less than those at liberty” (p. xii). This view may be disputed by some, but it is difficult to argue with the disparity between the investment in offending behaviour programmes in prison and probation services compared to the investment in effective mental health services and comprehensive self-harm prevention.

Walker and Towl have prepared a well-written, informative, and compelling text about an overlooked issue in a side-lined group. It is a hard read, because the solutions are in a sense obvious yet so hard to achieve in these turbulent times. But unless we do something and soon, the cost of reacting poorly to suicide and self-harm among women and young girls in custody will amount to more than it would take to implement an organised, informed, and coordinated system like Walker and Towl describe and recommend – and not just in terms of money spent but in lives disrupted and ultimately lost.