Self-harm in a prison mental health unit: a pilot trial of a structured professional judgement approach to risk assessment and safety planning.

Purpose: Evidence to support approaches to reducing self-harm (SH) and suicide in prison settings is lacking, despite increased risk in these settings. This study aims to describe a pilot trial of a health service-improvement initiative intended to provide a structured framework to support mental health clinicians in assessing and managing risk of SH /suicide in a prison setting.

Design/methodology/approach: The authors examined all clinically reported SH incidents in a prison mental health unit over a three-year period. In the third year, the authors piloted a novel intervention, the Suicide/Self-Harm, Legal, Individual, Psychiatric, Safety Plan (SLIPS) framework, aimed at reducing SH and suicide behaviours. Routinely recorded data from clinical notes were used to examine both incidents of SH as well as reported thoughts of SH.

Findings: No statistically significant reduction in the number of SH incidents was observed. An increase in patients reporting thoughts of SH to staff was seen in the post-SLIPS period, potentially reflecting an improvement in patient-staff engagement. Implementation of the intervention was challenging, with just under 20% of individuals in the unit receiving an SLIP assessment or safety plan.

Originality/value: This study focused on a unique population of patients in a prison mental health screening unit and used a novel structured professional judgement approach to developing a framework for supporting clinicians to undertake the difficult job of assessing and managing SH and suicide risk in prison.