Improving Surveillance and Monitoring of Self-harm in Irish Prisons

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1 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: Imprving Surveillance and Mnitring f Self-harm in Irish Prisns Prject Scpe Dcument 8 th June Backgrund t Prject Page 2 2 Prject Aim and Purpse Page 5 3 Prject Deliverables Page 5 4 Benefits Identificatin Page 6 Prject Natinal Suicide Research Fundatin Dr Eve Griffin Manager, Natinal Self-Harm Registry Ireland Leader (NSRF) Prject Natinal Office fr Suicide Preventin Dr Gemma Cx Evaluatin Manager, Cnnecting fr Life Supprt (NOSP) Irish Prisn Service Sarah Hume Acting Senir Psychlgist (IPS) Deirdre, O Reilly Chief Pharmacist Enda Kelly Natinal Operatinal Nurse Manager Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 1 f 6

2 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: Backgrund t Prject The prisn ppulatin is an extremely vulnerable ne and is mre likely t exhibit characteristics assciated with self-harm than the general ppulatin. Self-harm in prisn is nt nly a risk factr fr prisn suicide, it can be a majr prblem fr the prisn and impact n (staff and inmate) mrale within the institutin. In additin, risk factrs fr self-harm amng thse in custdy will be different t thse f the general ppulatin. An essential cmpnent f suicide preventin in prisns is having a surveillance system in place t mnitr the incidence f self-harm and suicide attempts. Such a system will prvide rbust infrmatin relating t the incidence and prfile f self-harm within prisn settings, identify individual- and cntextspecific risk factrs relating t self-harm and examine patterns f repeat self-harm (bth nn-fatal and fatal). Such infrmatin can be used t infrm the identificatin and management f thse in custdy, engaging in and at-risk f self-harm and t develp effective preventin initiatives. As part f Cnnecting fr Life, Ireland s Natinal Strategy t Reduce Suicide, (CfL), the Irish Prisn Service (IPS) has cmmitted t, inter alia, reviewing, analysing and identifying learning fr each episde f self-harm within the prisn estate. The NSRF have expertise in the develpment and maintenance f self-harm surveillance systems. Since 2002, the NSRF has perated the Natinal Self-Harm Registry, a natinal system which recrds all presentatins as a result f self-harm t Irish hspital emergency departments. The NSRF is als a WHO cllabrating centre fr surveillance and research in suicide preventin. Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 2 f 6

3 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: T this end, since the IPS has undertaken a prgramme f wrk t ensure the availability f mre meaningful, rbust data n self-harm t help infrm plicy and practice. There were a number f stages t this wrk including: 1. Cnceptualising and defining self-harm The prisn envirnment is unique, and the reasns individuals in prisn self-harm are wide and varied. There is nt necessarily a relatinship between intent and the lethality f the methd used. Time was given t surfacing a shared understanding f self-harm within prisns, and an agreed upn definitin was surfaced. The IPS definitin is: Self-harm is (nn-accidental) self-pisning r self-injury, irrespective f the apparent purpse f the act. This definitin is in line with the NICE guidelines, and with the Natinal Self-Harm Registry Ireland. 2. Develpment f a Suicide/Self-Harm Matrix Tasked with develping a mre rbust prcess t review episdes f self-harm/suicide, a matrix was develped t enable easy analysis f the utcme f an incident. Using the matrix, all incidents f self-harm and suicide are graded accrding t the severity (rated alng the cntinuum f care frm the lwest level f care i.e. n treatment required t hspitalisatin and ultimately lss f life). The intent scale is based n the Beck Scale fr Suicidal Ideatin (ranging fr n/lw intent t high level f intent). In rder t gain an understanding f the pssible influencing/mtivating factrs f each incident, primary and secndary cntributing factrs are recrded under the fllwing dmains, envirnmental, relatinal, persnal and mental health/medical. Demgraphic infrmatin relating t the individual is als recrded (e.g. gender, accmmdatin, legal status, length f sentence), as well as details relating t the self-harm act (e.g. methd). Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 3 f 6

4 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: In line with best practice, the Suicide/Self-Harm Matrix is cmpleted by a cllabrative, multiagency and multidisciplinary team i.e. the Lcal Suicide & Self-Harm Preventin Grup in each institutin. These grups are chaired by the Gvernrs and include representatives frm the varius services, including prisn staff, psychlgy, primary health care, psychiatry and ther relevant service prviders invlved with the persn in custdy. 4. Testing the Matrix The Matrix evlved ver time as it was tested acrss different institutins and edited/amended accrdingly. 5. Reprting t the IPS Natinal Suicide and Harm Preventin Steering Grup. Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 4 f 6

5 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: Prject Aim and Purpse The aim f the prject is tw-fld: 1. Firstly t cllate, enter and analyse data frm the IPS s Self-Harm/Suicide Surveillance & Mnitring System. The NSRF will lead ut n this cmpnent f the prject. A phased apprach has been taken t the rll-ut f the mnitring system, acrss Irish prisns. As f January 2017 all prisn Suicide Preventin Grups are using the Matrix. Data fr the year (2017) will be the subject f the analysis. 2. Secndly, t undertake a case-study t understand and dcument the design and implementatin f the Self-Harm/Suicide Surveillance and Mnitring system. NOSP will lead ut n this cmpnent f the prject. 3 - Prject Deliverables Interim and summary reprts: Analysis f the Self-Harm/Suicide Surveillance & Mnitring System will be disseminated in tw frmats. Tw Interim reprts will be prduced, in September 2017 and March Finalised data fr 2017 will be published in a summary reprt (June 2018). In-depth Analysis: The summary reprt will include the fllwing themes: Analysis f self-harm acts by prisn Prfile f thse persns in custdy wh engage in self-harm Identificatin f risk factrs assciated with self-harm in prisns Identify shrt-term trends Recmmendatins re: strengthening the data cllectin system. A case study analysis f the design and implementatin f the surveillance & mnitring system (fr inclusin in Cnnecting fr Life s mid-term Evaluatin Reprt June 2018). In additin publicatin f findings via a peer-reviewed article will be explred. Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 5 f 6

6 HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: Benefits Identificatin Fr the mst part, IPS has had t rely n (ften cntradictry) UK and US research as an empirical base frm which t develp plicies and practices regarding the management f self-harm in prisn. The cultural differences between hw peple wrk, perate and live in prisns are enrmus. This prject will prvide usable actinable data fr the IPS and individual prisns t infrm and drive change in practice. It will facilitate cmparisns acrss prisns; highlighting where there may be prblems, and/r prviding evidence f where there are n prblems. The prject will help ensure that all key stakehlders are aware f hw the IPS are reprting and managing self-harm and suicide preventin within prisns; and hw they are using evidence t drive plicy and practice. The prject will strengthen and supprt a culture f cllabrative wrking within and acrss the prisn system. A thrugh analysis will shw that data are cllected fr a purpse, and will help all relevant stakehlders understand the benefits f and need t share relevant (health) infrmatin, in the best interest f the individual. The prject will help build the evaluatin capacity f the IPS and help facilitate data drive decisin-making. The prject will als build supprt fr research within the prisn system. The prject will enable NOSP t mnitr and publish trends in suicide and self-harm rates amngst prisners in Ireland, wh are listed as a pririty grup within CfL. Natinal Office fr Suicide Preventin І 8 th June 2017 І Page 6 f 6

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