Continuing concerns about self-harm among women prisoners

Work with offenders analyses the latest Safety in Custody statistics

Yesterday (29 July 2021) the Ministry of Justice and Office of National Statistics published the latest edition of its quarterly Safety in Custody Statistics for people in prison in England and Wales. The current edition covers deaths in prison custody to June 2021 and assaults and self-harm to March 2021.

The self-harm statistics are different for men and women in prison. There were 52,339 self-harm incidents in the 12 months to March 2021, down 19% from the previous 12 months (a 22% decrease in male establishments and a 4% decrease in female establishments). However, taking into account the fall in the prison average population throughout 2020 caused by pandemic lockdowns and the growing court backlogs, the rate of self-harm incidents per 1,000 prisoners decreased 19% in male establishments but increased 12% in female establishments in the 12 months to March 2021.

There is a wealth of evidence about the impact of COVID-19 on all of our mental health but also a growing body of research about how much more difficult it has been for the men and women in our prisons who have been subjected to a very restrictive regime for most of the last year.

Double lockdown

One recent study which included evidence from 19 different prisons found that the two highest risk groups for worsening mental health under lockdown were women and young people under 21 years of age. People were confined to their cells to try to prevent the transmission of the virus but the consequence was that all the usual outlets for typical ‘pains of imprisonment’ had been removed (such as seeing family, engaging in peer relationships, attending work or psycho-social courses). When coupled with social isolation and inactivity for long periods, this led to deteriorating mental health in many. Researchers heard numerous reports of self-harm being used as a mechanism to cope with the enduring isolation caused from being in a cell for extended periods of time, and of normally compliant people becoming aggressive and disruptive.

Researchers found a number of recurrent themes for people experiencing prolonged periods of lockdown in prison. One of the main difficulties was boredom and isolation which allowed negative thoughts to multiply and sometimes get out of control. Being confined within a cell for many hours a day with little interaction made it difficult to remain upbeat and motivated. Some people reported losing their sense of purpose and experienced increased thoughts of powerlessness. Boredom exacerbated the problems of loneliness, with little to divert individuals from their thoughts. Long days with little to do resulted in overthinking about other problems in life. People talked about how overthinking could lead to increased anxiety levels, paranoia or catastrophic thinking for some. This remained a prominent theme for worsening mental health.

Of course at the same time as more people were struggling with their mental wellbeing, getting help became harder. Across all prisons involved in the study, nurses were praised for their availability, consistency and compassion. However, individuals found it difficult to communicate as freely as they would have liked to, given the COVID-safe restrictions in place and the limited time allowance with them. Access to GPs was said to be very difficult for many, and anxiety over their physical health was having a knock on effect on mental health.

People in prison who previously relied on support from health services said they were keenly feeling the gap created by the suspension of the service, especially those who accessed mental health teams to help them stay well. Most people said it was difficult to see mental health workers.

Whilst some felt they had quite extreme or worsening needs, others simply needed an outlet to share how they were feeling. Consequently, some people experiencing new or worsening mental ill-health, had heightened anxiety, distress and confusion.

Given this set of circumstances, it is no surprise that self-harm rates have risen in the last year. However, there was some comfort in the latest set of statistics with reported self-harm levels falling in the last quarter as most prisons began to relax some of the restrictions in their regimes.

We must hope and pray that prisons are able to keep lifting restrictions and that another period of double lockdown does not lie in wait this Autumn and Winter.