Non-suicidal self-harm amongst incarcerated men: a qualitative study

Published date07 November 2016
Pages157-172
Date07 November 2016
DOIhttps://doi.org/10.1108/JCP-04-2016-0017
AuthorLisa Marzano,Karen Ciclitira,Joanna R. Adler
Subject MatterHealth & social care,Criminology & forensic psychology,Criminal psychology,Sociology,Sociology of crime & law,Deviant behaviour,Public policy & environmental management,Policing,Criminal justice
Non-suicidal self-harm amongst
incarcerated men: a qualitative study
Lisa Marzano, Karen Ciclitira and Joanna R. Adler
Lisa Marzano is a Senior
Lecturer in Psychology,
Karen Ciclitira is an Associate
Professor and Joanna R. Adler
is a Professor of Forensic
Psychology, all at the
Department of Psychology,
Middlesex University,
London, UK.
Abstract
Purpose The purpose of this paper is to understand the needs and motivations of incarcerated men who
self-harm with no apparent suicidal intent. These have received little attention in research and policy, despite
men accounting for a high and increasing proportion of self-harm in prisons.
Design/methodology/approach Semi-structured interviews were conducted with 20 adult male
prisoners with a recent history or thoughts of non-suicidal self-harm. The interviews were analysed drawing
on principles of thematic analysis and discourse analysis.
Findings Against a backdrop of early traumatic experiences and more recent adverse events (including
prison-related ones), self-harm was described by many as a desperate but meaningful coping strategy;
both a means of releasing tension, sadness and frustration, and of being heard in an unresponsive system.
Originality/value These findings echo those of research conducted with women (including women
prisoners) who self-harm, but challenge some of the more negative ways in which non-suicidal male prisoner
self-harm has been portrayed in the (scant) previous literature. As well as pointing to the need for greater
awareness of the complex needs of men in prisons, they underscore the importance of (also) exploring and
perhaps addressing the issue of self-harm separately from suicide, and of striving to make prisons, as well
as prisoners, healthierand better able to cope with pressure.
Keywords Self-harm, Prison, Qualitative, Suicide, Jail, Non-suicidal self-injury
Paper type Research paper
Introduction
Internationally, rates of self-harm amongst prisoners are much higher than in the general
population (Dixon-Gordon et al., 2012). In England and Wales, there were over 30,000 reported
incidents of self-harm in the year to September 2015, involving almost 9,000 prisoners (a little
over 10 per cent of the average prison population) (Ministry of Justice, 2016a). This is an increase
of almost a third compared to ten years ago (Ministry of Justice, 2016a); considerably more than
might be expected from the rise in the prison population over the same period (Ministry of
Justice, 2016b).
At a time when rates of suicidein custody also appear to be increasing (Ministryof Justice, 2016a),
concern overthese figures has tended to centre aroundthe known association between self-harm
and subsequent death by suicide (Owens et al., 2002). Research has shown that approximately
50 per centof those who die by suicide in prison havea history of self-harm (Fazelet al., 2008), with
many deaths occurring fairly soon after a self-harm episode (Hawton et al., 2014). As a result,
previousresearch and policy have tended to focuson self-harm as a risk factor and potentialproxy
for suicide, generally addressing thisissue within a broader suicide preventionframework. In other
words, the emphasis has been upon understanding and monitoring self-harm as a means
towards the identification of suicide risk(Camilleri et al., 1999, p.14),rather than as an issue in its
Received 20 April 2016
Revised 5 July 2016
Accepted 18 July 2016
DOI 10.1108/JCP-04-2016-0017 VOL. 6 NO. 4 2016, pp. 157-172, © Emerald Group Publishing Limited, ISSN 2009-3829
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own right. Whilst understandable, this approach risks overlooking and potentially obscuring the
needs and motivations of prisoners whose self-harm is carried out with no apparent suicidal
intentions or outcomes.
It is difficult to esti mate what proportion of self-inf licted injuries are non-suicidal,particularlyin
UK prisons, where t he term self-harm denotes any act where a prisoner deliberately harms
themselves, irre spective of the method, inten t or severity of any injury(HM Prison Service,
2003a). Neverthe less, there is a growing body of r esearch from North America a nd Europe
suggesting that both prisoners and prison staff often distinguish between different forms and
levels of self-har m (Marzano et al., 2013; Pannell et al., 2003; Lohner and Konrad, 2007), and
that many, perhap s most incidents of self-harm i n custody are not apparently m otivated by
suicidal intent (D ixon-Gordon et al., 2012). Yet, in most countries (including the UK) there are no
specific policies or procedures to address the needs of prisoners who self-harm often
repeatedly, with no suicidal intent, and a rather limited evidence-base to suggest what these
needs may actually be.
The traditional emp hasis on preventing suicide i n custody has meant that much of the l iterature
in this area has foc ussed on suicidal and medic ally severe, near-lethal self-harm( e.g. Marzano
et al., 2011; Rivlin et al., 2013), often rather questionably referred to as serious self-harm
(Arnold, 2005; Liebling, 1992; see also HM Prison Service, 2003a; HMCIP, 1999). In official
policy, non-suicidal forms of self-harm have also tended to be overlooked, arguably reflecting
and reinforcing th e view that these are a sign of poor coping(Liebling, 1995) or, worse,
manipulative, attention seeking, and, as such, unworthy of attention and/or effective
treatment(Snow, 1997, p. 50; for a critique see Marzano, 2010). These negative views have
been shown to be common amongst prison staff (Marzano et al., 2013; Ireland and Quinn,
2007), potentially reproducing the feelings of isolation, low self-worth, and loss of control that
may have led to prisone rs self-harming in the first p lace (Johnstone, 1997; Marza no et al.,
2012). Moreover, th is inattention to non-suicidal se lf-harm may belittle the stress and anx ieties
involved in working with this complex and often challenging behaviour (Paton et al., 2000) in
many cases on a daily basi s, with limited training or supp ort, in establishments where st affing
levels have been significantly reduced in the face of an ever expending prison population (The
Howard League, 2014) and substantial rises in prisoner self-harm, suicide and assaults
(Ministry of Justice, 2016a).
To date, the scant literature on non-suicidal self-injury in custody has focussed almost exclusively
on women prisoners, because rates of self-harm in this population appear to be considerably
higher than amongst male prisoners (Dixon-Gordon et al., 2012; cf. Maden et al., 2000).
However, given their over-representation in the prison population, adult men account for three
quarters of all recorded incidents of self-harm in English and Welsh prisons (Ministry of Justice,
2016a). Furthermore, the number of recorded self-harm incidents in male prisoners has doubled
in recent years (11,534 in September 2006 cf. 23,291 in September 2015), with further increases
in observed rates of self-harm incidents (145 vs 285 per 1,000 prisoners in 2005 vs 2015),
numbers and rates of self-harming male prisoners (respectively, 4,290 vs 7,797, and 60 vs 95 per
1,000 prisoners in 2005 cf. 2015), and hospital attendances due to self-harm by men in custody
(950 in 2005 vs 1,900 in 2015). The reverse trend has been reported in relation to women
prisoners (e.g. there were 11,914 incidents of self-harm in womens prisons in 2006 vs 7,415 in
2016), despite a small increase in incidents since 2014 (Ministry of Justice, 2016a).
In both institutional and community settings, in-depth analyses of non-suicidal male self-harm
have been relatively rare, and have mostly emphasised gender differences, rather than similarities,
with self-harming men being portrayed as more violent than women, as well as less emotional
(see e.g. Snow, 2002; Thomas et al., 2006), and more likely to self-harm as a means to gain
external rewards (such as obtaining attention from staff), rather than for intrapersonal reasons
(e.g. affect regulation) (Power et al., 2015a, b; Claes et al., 2007; Smith and Power, 2014).
For example, the World Health Organisation (2000, p. 11) concluded that incarcerated men with
antisocial or sociopathic personalities may be more prone to manipulative attempts [[]whereas]
for incarcerated women, repeated self-mutilation (such as slashing or burning) may be a
response to the stress brought on by confinement and the prison culture(p. 11). In other words,
the very same behaviour (i.e. repeated self-mutilation) appears to be constructed as a genuine
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