Wednesday 19 November 2014

Self-Harm: the Unseen Prison Epidemic

The rising number of prisoners who commit suicide whilst in custody in our prisons tends to be making the news headlines at the moment. The main reason is that this statistic – with all the human misery and pain that lies behind it – is sometimes considered to be a barometer of the escalating crisis within our jails. However, in my view it is the far, far higher number of inmates who resort to self-harm that represents the real epidemic.

Self-harm: a coping mechanism
This week saw yet another damning report issued by HM Inspectorate of Prisons. This time it is HMP Hewell in Worcestershire that is under fire for its high level of violence, and as usual where there is violence, there is often a serious underlying drugs culture on the wings. And thus it is at Hewell, according to the inspectors. Nothing new there then.

While the latest statistics for deaths in custody – one murder and six suicides since the last visit by HM Inspectorate – it was another, equally awful observation that caught my attention: the fact that self-harming is seen many prisoners to be only way they can get “access to basic amenities” at Hewell. If ever there was a stark indictment of the reality of life in our prisons today, I’d say that observation would encapsulate it.

This particular Cat-B establishment, in common with so many others, is both overcrowded and understaffed, according to the Inspectorate, and this, I suspect is what lies behind a significant amount of the self-harming that is going on, just as it does in other prisons up and down the land. So why do many prisoners feel it necessary to injure themselves – usually by cutting their own flesh with disposable razors or other cell-made sharp implements?

A tool for crisis management
Cons know that owing to the current staffing crisis inside the prison system they are likely to be routinely ignored if they follow normal procedures – that is, by submitting written applications, whether these are for major issues, such as transfers to jails nearer their families, extra pin-phone credits so they can contact family members in an emergency or complaints about victimisation or bullying – or more mundane matters, such as property lost in the laundry or a request to speak to their internal probation officer (offender supervisor). Because of scarce frontline staff resources and current overcrowding, the ‘app’ (application) system is often the first area where things simply cease to function, or else go so slowly that nothing ever appears to be happening.

Cutting up, however, cannot be ignored because it involves filing reports and the likelihood that the person injuring themselves will need to be placed on the Assessment, Care in Custody and Teamwork (ACCT) system which is used to monitor prisoners deemed to be a risk to themselves. Put crudely, self-harm is used to get the attention of staff, particularly senior officers on the wings. It is a symptom of the extreme stresses within what is now becoming a highly dysfunctional type of crisis management.

In itself, this is nothing new as any cons or screw will confirm. Every prison has a problem with self-harming because some prisoners rely on hurting themselves as a method of managing stress. Others become addicted to the practice whilst in custody, although a fair number of people who end up inside actually started self-harming in some form or other prior to coming into custody – often in childhood or youth as a response to abuse or other trauma.

A common sight on prison wings
As the lyrics of the haunting song Hurt by Nine Inch Nails put it so eloquently: “I hurt myself today, to see if I still feel, I focus on the pain, The only thing that’s real.” Self-harm can sometimes be seen as a means of exerting control over practically the only thing a person has left: their own bodies. For these reasons, there will probably always be some degree of self-harm going on in our prisons, even without the current crisis.

What is much more disturbing at the moment is that – as the inspectors have found at Hewell – the many problems impacting on the effective management of the Prison Service now seem to be institutionalising the practice as a means through which prisoners manage their own everyday lives. Self-harm is becoming one of the marks of the powerless to gain the attention of those in positions of authority. At the very least, a self-harmer gets a face-to-face interview with a safer custody officer, usually a wing manager. Crude, but seemingly effective.

When I was in prison myself, I came across this in practice mainly in relation to accessing mental healthcare. In some establishments getting an appointment to see members of the mental health team has become virtually impossible unless there has been a major ‘incident’ – usually involving self-harm or at least a credible threat of suicide that has generated a written report by staff. 

As I have noted before in posts on this blog, I’ve assisted fellow prisoners with written applications to have urgent appointments with mental health professionals only to get negative replies back of the “computer says no” variety. However, once a wrist has been slashed with a razor blade (or even just scratched to the point blood has been drawn), the prisoner is taken to healthcare to be patched up and they almost always get an appointment with someone from the mental health team. This practice is quite simply the result of woefully inadequate resources.

More than sticking plaster required
Back in September, Secretary of State for Justice Chris Grayling pledged to improve mental health services in the prisons in England and Wales. In a speech on the subject, he promised to “get to grips with the challenge of mental health in prisons”. Sadly, it’s all pie in the sky at the moment, despite the high proportion of inmates within our prison system who have mental health needs that are often undiagnosed. Everything comes down to budget and resources, particularly too few experienced staff.

Moreover, all too often, erratic or bizarre behaviour by cons is dealt with as a disciplinary issue – sometimes punished by solitary confinement or similar means which can make a bad situation much worse – rather than seen as a symptom of an underlying mental health condition. Without any effective screening system these problems usually go unrecognised unless experienced wing staff spot the warning signs and make sure reports are made to the right professionals in healthcare. While we have acute staff shortages across the prison estate, the risks of serious cases slipping under the radar – at least until it is all too late and someone has either committed suicide or harmed themselves very severely – are much greater. 

Based on my own experience inside different prisons I believe that current levels of self-harm represent a much more accurate indicator of the serious problems afflicting our prisons than the headline suicide figures alone. In many cases, mild incidents of self-harm are quite literally a cry for help or assistance by men and women who are in crisis, but who are being ignored by those who have a legal and moral duty of care. However, when a prisoner resorts to cutting his or her own flesh as an institutionalised means of accessing prison services or amenities – as HM Inspectorate has reported at HMP Hewell – then we really do have a major crisis on our hands, while Mr Grayling and the senior management of the National Offender Management Service (NOMS) all have blood – quite literally – on theirs. 


  1. this happens in mental health units too. chronically understaffed and often staffed by agency staff who don't know the patients and have had a couple days of training (some health care assistants). people self harm as they then will be taken seriously. i count myself very very lucky i haven't gone down this route (i was held against my will for 6 months in an eating disorder unit, restrained 6 times a day and a tube shoved up my nose, it was traumatic on some levels, esp when deprived of possessions or being able to buy them).

    i don't consider it as difficult as prison by any stretch but having your liberty taken away for that length of time on a tiny ward is tough. at one time 8/10 patients were self-harming. it got to a point the staff were only listening to people when they did - partly like a vicious circle because they were so overwhelmed with trying to deal with it!

    it seemed like if you tried to do things reasonably and quietly you'd be ignored, yet if you totally flipped out, started screaming or throwing things people listened then.

    it kind of reinforced an unfortunate pattern (but understandable). people didn't feel listened to and this got them listened to.

    there are a lot of similarities with what you've written above

    hope this wasn't too off topic

    1. Thanks for your very relevant comments - spot on topic, actually! I think that you are right in making these comparisons because in both cases people are held against their will and some come to rely on self-harming as a coping mechanism. It's actually far more common than might be assumed because if you feel utterly powerless, marginalised and ignored by those who have power over you then this is one way to manage those feelings, as well as getting them to take your pain and distress more seriously - as you rightly observe in your comments.

      Of course, since an estimated 70 percent of prisoners in the UK live with some form of mental illness or condition, then it's also not surprising that there are other similarities between hospital wards and prison wings. Prisons are simply not staffed or equipped to deal with serious mental illnesses and many inmates who exhibit symptoms are simply punished for misbehaviour or disobedience, even in Cat-D (open) prisons. I've seen plenty of men - often from ethnic minority backgrounds - dragged off in handcuffs because these understaffed establishments simply can't cope with their behaviour which is seen as 'disruptive' and/or 'eccentric'.