Laurent AUZOULT & Sid ABDELLAOUI. In Crisis : The Journal of Crisis Intervention and Suicide Prevention

Transcription

1 Perceptions of a Peer Suicide Prevention Program by Inmates and Professionals Working in Prisons Underestimation of Risk, the Modification of the Field, and the Role of Self-Consciousness Laurent AUZOULT & Sid ABDELLAOUI In Crisis : The Journal of Crisis Intervention and Suicide Prevention Abstract. Background: Suicide prevention in prisons is a major challenge for penal institutions in many countries. L approche traditionnelle qui s appuie sur l expertise des professionnels de santé peut être complétée par l intervention d autres acteurs de l incarcération. As a result, new methods of suicide prevention based on peer support have been developed in recent years. Peer prevention programs rely on the ability of inmates to identify suicide risk. Aims: The purpose of this study was to examine perceived suicide risk among inmates and to explore possible explanations. Methods: 54 inmates and 17 professionals working in prisons participated in the study. Results: The peer prevention program was found to change inmates expectations of support in the event of a suicide crisis. The study also found that the inmates involved in the program tended to underestimate the risk of suicide. The perception of the prevention program and the level of self-consciousness were found to account for the underestimation of suicide risk. Conclusions: Support for inmates involved in suicide prevention programs must take into account their isolation in prison. The training provided to inmates must also consider the biases affecting the assessment of risk. Keywords: Suicide prevention, self-consciousness, prisons, peers, risk perception. Corresponding Author: Laurent Auzoult Institut Universitaire de Technologie de Besançon-Vesoul Avenue des Rives du Lac - BP Vesoul cedex, FRANCE auzoult@voila.fr Mobile: + 33 (0) Laurent Auzoult, PhD, is associate professor at the University of Franche-Comté (France). His research focuses on self and social regulation in difficult situations. Dr Auzoult has participated in a number of research programs in prisons, and in particular in programs aimed at examining the perception of risk and power. Sid Abdellaoui, PhD, is associate professor at the University of Rouen (France). His main interest is in the kinds of strategies used by individuals in situations of personal or collective danger. 1

2 Introduction In recent years, a number of Western countries have developed a range of prevention programs and initiatives aimed at reducing suicide risk in prison based on the active involvement of inmates (Daigle, Daniel, Dear, Frottier, Hayes, Kerkhof, 2007). The assumption is that inmates can play a key role in identifying suicide risk, in alerting the prison authorities and in providing support in the event of a suicide crisis, particularly in view of their physical and psychosocial proximity to vulnerable inmates (Hayes, 1995). However, peer prevention programs have been severely criticized in most countries, with the majority of critics insisting that the health of inmates is generally the responsibility of the public authorities. It remains that the quality of the relationships between inmates is a key factor in dealing with the shock of imprisonment (Snow and Biggar, 2006). An evaluation of the effectiveness of peer prevention programs is therefore vital to ensure their sustainability and dissemination. Hall and Gabor (2004) assessed a peer prevention program implemented in Canada over three consecutive years the SAMS program (Samaritans of Southern Alberta). The role of SAMS inmates is to identify vulnerable inmates at risk of suicide. The authors found that participating inmates were often solicited and appreciated by their peers, although their impact on the number of suicides cannot be statistically determined. However, the reports of prison visits also show that SAMS inmates believe that limited contact with suffering inmates involved a real risk of suicide (over a three-year period, 23.5% of contacts on average involved a risk of suicide, while 1.16% of contacts involved a significant suicide risk). Hall and Gabor also indicated that [SAMS inmates] had confidence in their skills to identify suicide risk (p.22). This finding is not consistent with the significant number of suicide attempts and suicides in prison, but is consistent with the available knowledge on risk perception. Depending on whether it refers to an adaptation to risk or actual experience and to exposure to a risk, personal experience can modify or even distort the perception of a risk. Studies show that the acquisition of know-how (or more simply knowledge relating to a risk) results in an underestimation of risk, while exposure to a risk tends to result in an overestimation of risk (Kouabenan, Dubois, De Gaudemaris, Scarnato & Mallaret, 2007). Cette étude s intéresse au fonctionnement d un programme français de prévention par les pairs (codétenus de soutien: CDS1). Ce dispositif consiste à sélectionner, former et accompagner des détenus ayant pour mission l identification et le soutien des détenus présentant un risque suicidaire. Ces détenus sont recrutés sur le base de critères précis (être motivé pour la fonction, faire preuve de solidité psychique, ne pas être intimidable) et selon une procédure impliquant plusieurs services (Direction des établissements pénitentiaires, Service de santé, etc.). Ils reçoivent une formation aux premiers gestes de secours, au repérage des crises suicidaires et à l écoute. Une fois en activité, les CDS sont suivis par des bénévoles d une association extérieure à la détention. The more specific objectives are to assess perceived suicide risk among professionals and inmates based on the different roles they perform in the program, to assess the impact of the program on inmates expectations of their social environment, to assess the perception of the program among inmates, and to account for the perception of risk among inmates. The study assessed perceived suicide risk among inmates performing a support role, but also 1 Peer support program. 2

3 among ordinary inmates and health professionals. Risk assessment was based on the framework provided by psychometric risk theory (Slovic, 1987; Mullet, Duquesnoy, Raiff, Fahrasmane & Namur, 1993), while the explanatory framework of risk perception is based on the notion of self-regulation, in reference to the self-awareness model proposed by Hull and Levy (1979). According to Hull and Levy (1979), self-awareness involves selective information processing when the information is personally relevant, i.e. when it provides information about the current activities or projects of the individual. The processing of personally relevant information results in a change in self-image, accompanied by an activation of the processes governing behavior. Method Participants and procedure 54 inmates (mean age: 37 years) and 17 professionals (mean age: 42 years) working in the healthcare sector (psychologists, psychiatrists, and nurses) participated in the study. Some of the participants were CDS inmates (N = 20, 53% de condamnés et 47 % de prévenus) or ordinary inmates in prisons where the prevention program had been implemented (N = 18, 63% de condamnés et 37 % de prévenus), while other inmates were held in prisons where the program had not been implemented (N = 16, 50% de condamnés et 50 % de prévenus). Le dispositif expérimental était mis en place pendant une année dans quatre établissements (3 en province et 1 en métropole) destinés à des hommes. Les détenus participant à l étude étaient incarcérés pour des motifs de mœurs, de trafic de stupéfiants, de vols et d escroquerie. Les détenus et les professionnels étaient sollicités à mi parcourt du projet pour répondre à un questionnaire. Les détenus répondaient à l ensemble des questions alors que les professionnels ne répondaient qu à celles liées à la perception du risque suicidaire. Le taux de retour étaient de 98 % pour les détenus et de? pour les professionnels. Pendant l année d expérimentation du dispositif deux détenus non suivis par les CDS se sont suicidés dans les prisons où le dispositif était en place. Measures Inmates expectations: The inmates involved in the study indicated whether they expected to receive support from other inmates, from family or friends on the outside, from correctional officers, and finally from health staff. The perception of the program: Some of the questions focused on the perception of the CDS program (confidence in and attitude toward the CDS program, perceived effectiveness of the CDS program). Perceived suicide risk: The items used to measure risk perception referred to the sense of control. The study found that the greater the underestimation of risk, the greater the sense of control. Self-consciousness: 8 items adapted to the prison population were developed to measure selfconsciousness based on the scale developed by Fenigstein, Scheier, and Buss (1975). Les sujets répondaient à l ensemble des questions à l aide d échelles de réponses en quatre cinq points. Results 3

4 The study found that inmates were more likely than professionals to believe that support should come from other inmates (M= 3.71/2.23; post hoc p<.01) or from people on the outside (M= 4.66/3.52; post hoc p<.01). The implementation of the program was found to have an impact on expectations. Inmates held in prisons where the program had not been implemented expected more support from correctional officers (M= 3.31/2.10), from people on the outside (M= 4.93/4.53; post hoc p<.01) or des professionnels de santé (M=3.75/3.66 ; post hoc p<.05) than inmates held in a prison where the CDS program had been implemented. The study also found that in prisons where the CDS program had been implemented, inmates were more likely to expect support from other inmates (M=3.76/3.62; post hoc p<.05) than inmates held in prisons where the program had not been implemented. The study found that CDS inmates were more likely than health professionals to believe that an inmate can help to reduce suicide in prison (post hoc p<.01). Compared to other inmates and professionals, CDS inmates were found to be more likely to believe that they are able to identify an inmate at risk of suicide (post hoc p<.01). Pour expliquer le sentiment de contrôle face au risque suicidaire, nous avons réalisé une analyse de régression multivariée en utilisant une méthode de sélection pas à pas. Cette méthode de régression inclut l ensemble des prédicteurs et éliminent séquentiellement les contributions les plus faibles jusqu à fournir un modèle optimal. Regression analyses were performed using the items measuring the sense of control as dependent variables and the different aspects of the situation as explanatory variables. The feeling that an inmate can help to reduce suicide in prison is explained by self-consciousness and the feeling that CDS are volunteer par les détenus CDS and by a positive attitude toward the idea that fellow prisoners provide care and support to suffering inmates, by self-consciousness, by expected support from medical staff and by the idea that CDS inmates can be effective in providing support par les détenus ordinaires. Discussion There were three major findings. First, the implementation of the peer prevention program appears to cause a change of the field for inmates, who consider that peers have a key support role to perform in preference to correctional officers and people on the outside, who are less likely to be perceived as a source of support. Second, the study found that suicide risk tends to be underestimated among CDS inmates compared to ordinary inmates and (above all) health professionals, who represent a legitimate point of view on the question of suicide (for want of providing an exact point of view). This finding is indicative of a significant limitation of the program, particularly on account of the role performed by CDS inmates in calling attention to suicide risk. Finally, there is a functional relationship between the sense of control among inmates, the level of self-consciousness and inmates perception of the situation. The perception of the program and CDS inmates provide role norms concerning the behavior or attitude of inmates toward suicide, enabling self-regulation at the level of risk perception (Duval & Wicklund, 1979; Carver & Scheier, 1981). From a practical point of view, support and accompaniment aimed at reducing the risk of underestimation should aim to transmit knowledge about risk perception biases, beyond 4

5 more common knowledge (i.e. relationship of support, listening skills, knowledge of suicide, first aid). The provision of support to CDS inmates also needs to consider the impact of isolation in prison and the associated tendency to center on the self. References Carver, C. S., & Scheier, M. F. (1981). Attention and self-regulation: A control theory approach to human behavior. New York: Springer-Verlag. Daigle, M.S, Daniel, A.E., Dear, G.E., Frottier, P., Hayes, L.M., Kerkhof, A., Konrad, N., Liebling, A., & Sarchiapone, M. (2007). Preventing suicide in prisons, part II. Crisis, 28, Duval, S. & Wicklund, R.A. (1972). A theory of objective self awareness. New York: Academic Press. Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43, Hall, B., & Gabor, P. (2004). Peer suicide prevention in a prison. Crisis, 25, Hayes, L.M. (1995). Controversial issues in jail suicide prevention, part 2: use of inmates to conduct suicide watch. Crisis, 16, Hull, J.G., & Levy, A.S. (1979). The organizational functions of the self: an alternative to the Duval and Wicklund Model of Self-awareness. Journal of Personality and Social Psychology, 37(5), Kouabenan, D.R., Dubois, M., De Gaudemaris, R., Scarnato, F., & Mallaret, M.-R. (2007). Methicillin-resistant staphylococcus aureus risk perception by healthcare personnel in a public hospital. Social Behavior and Personality, 35, 1, Mullet, E., Duquesnoy, C., Raiff, P., Fahrasmane, R., & Namur, E. (1993). The evaluative factor of the risk perception. Journal of Applied Social Psychology, 23, Slovic, P. (1987). Perception of risk. Science, 236, Snow, L., & Biggar, K. (2006). The role of peer-support in reducing self-harm in prison. In G.E. Dear (Ed.), Preventing suicide and other self-harm in prison (pp ). Basingstoke, UK: Palgrave-Macmillan. 5