̽��ֱ�� of Cambridge - suicide

Study reveals high rate of possible undiagnosed autism in people who died by suicide

Anonymous — Tue, 15 Feb 2022 17:20:26 +0000

A team of researchers, led by Dr Sarah Cassidy from the ̽��ֱ�� of Nottingham and Professor Simon Baron-Cohen from the Autism Research Centre at the ̽��ֱ�� of Cambridge, are the first to examine evidence of autism and autistic traits in those who died by suicide in England. They analysed Coroners’ inquest records of 372 people who died by suicide and also interviewed family members of those who died. ̽��ֱ��research is published today in the British Journal of Psychiatry.

̽��ֱ��researchers found that 10% of those who died by suicide had evidence of elevated autistic traits, indicating likely undiagnosed autism. This is 11 times higher than the rate of autism in the UK. ̽��ֱ��research team worked with Coroners’ offices in two regions of England to identify the records.

̽��ֱ��team first examined the coroners’ inquests for each death by suicide for signs of elevated autistic traits indicating possible undiagnosed autism, or a definite diagnosis of autism. Evidence of autism was then checked by an independent researcher to make sure that these decisions were reliable. ̽��ֱ��researchers then spoke to 29 of the families, to gather further evidence to corroborate the elevated autistic traits in those who died. After speaking with the families, the researchers found evidence of elevated autistic traits in more people who died by suicide (41%), which is 19 times higher than the rate of autism in the UK.

Previous research by the same group has shown that up to 66% of autistic adults have thought about taking their own life, and 35% have attempted suicide. Around 1% of people in the UK are autistic, yet up to 15% of people hospitalised after attempting suicide have a diagnosis of autism. Previous research has also found that both diagnosed autistic people and those with elevated autistic traits are more vulnerable to mental health problems, suicidal thoughts and behaviours. ̽��ֱ��new research goes beyond this by examining Coroner’s records related to people who have ended their own life.

Autism is a lifelong developmental condition diagnosed on the basis of difficulties in social and communication skills and in adapting to unexpected change, alongside heightened sensory sensitivity, unusually deep interests in specific topics, and a preference for predictability. There are many barriers to obtaining an autism diagnosis, including limited availability of diagnostic services, leading to long waiting lists. Even post-diagnosis, there are insufficient support services for autistic people.

Dr Sarah Cassidy commented: “Many adults in the UK find it very difficult to obtain an autism diagnosis and appropriate support post-diagnosis. Our study shows that undiagnosed autistic people could be at increased risk of dying by suicide.

"It is urgent that access to an autism diagnosis and appropriate support post diagnosis is improved. This is the top autism community priority for suicide prevention, and needs to be addressed immediately by commissioners of services and policy makers.”

Professor Simon Baron-Cohen added: “Even a single suicide is a terrible tragedy for the person and a traumatic loss for their families and friends. Suicide rates are unacceptably high in autistic people and suicide prevention has to be the number one goal to reduce the worrying increased mortality in autistic people.

“Autistic people on average die 20 years earlier than non-autistic people, and two big causes of this are suicide and epilepsy. We published the preliminary data on elevated suicide rates back in 2014 as a wake-up call to governments, and yet nothing has been done.”

Currently evidence of an autism diagnosis or elevated autistic traits are not usually included in Coroners’ inquests in England. This study highlights the need for Coroners to begin to systematically gather evidence of autism and autistic traits in inquests, to help prevent future deaths. There is also an urgent need to work with the autism community to co-design suicide prevention services.

Reference
Cassidy, S et al. Autism and autistic traits in those who died by suicide in England. BJPsych; 15 Feb 2022; DOI: 10.1192/bjp.2022.21

Adapted from a press release from the ̽��ֱ�� of Nottingham

A significant number of people who died by suicide were likely autistic, but undiagnosed, according to new research that highlights the urgent need for earlier diagnosis and tailored support for suicide prevention.

Suicide rates are unacceptably high in autistic people and suicide prevention has to be the number one goal to reduce the worrying increased mortality in autistic people

Simon Baron-Cohen

Priscilla Du Preez

Two people talking

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Public Domain

Growing old in Georgian England

fpjl2 — Tue, 10 Aug 2021 08:45:08 +0000

A new study examines the words and behaviour of older people who went on to take their own lives in 18th-century England.

Digital support

cjb250 — Wed, 10 Feb 2021 18:00:18 +0000

Research published today shows how digital providers are coming together to support the mental health needs of millions of users unable to access traditional services during the COVID-19 pandemic.

11 hip-hop artists who had something to say about mental health

cjb250 — Wed, 09 Dec 2020 09:55:59 +0000

How hip hop artists are opening up about their struggles with depression and anxiety, helping reduce stigma and encouraging others to seek support.

Most young people with increased suicide risk only display ‘mild to moderate’ mental distress – study

fpjl2 — Wed, 20 May 2020 10:32:01 +0000

̽��ֱ��vast majority of young people who self-harm or experience suicidal thoughts appear to have only mild or moderate mental distress, instead of more obvious symptoms associated with a diagnosable disorder, according to a new study.

As such, measures to reduce suicide risk in young people should focus on the whole population, not just those who are most distressed, depressed or anxious, said Cambridge ̽��ֱ�� researchers during Mental Health Awareness week.

They argue that small increases in stress across the entire population due to the coronavirus lockdown could cause far more young people to be at risk of suicide than can be detected through evidence of psychiatric disorders.

“It appears that self-harm and suicidal thinking among young people dramatically increases well within the normal or non-clinical range of mental distress,” said Professor Peter Jones, senior author of the study from Cambridge’s Department of Psychiatry.

“These findings show that public policy strategies to reduce suicide should support better mental health for all young people, not only those who are most unwell,” said Jones, who is also a consultant psychiatrist at Cambridgeshire and Peterborough NHS Foundation Trust and director of the NIHR Applied Research Collaboration East of England.

“Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious.”

̽��ֱ��Cambridge researchers conducted the study with colleagues from ̽��ֱ�� College London. It was supported by the Wellcome Trust and the National Institute for Health Research, and is recently published in the journal BMJ Open.

Recent studies suggest a broad range of mental health problems – depression, anxiety, impulsive behaviour, low self-esteem, and so on – can be taken as a whole to measure levels of “common mental distress” (CMD).

Researchers analysed levels of CMD in two large groups of young people through a series of questionnaires.

They also separately collected self-reported data on suicidal thinking and non-suicidal self-injury: predictive markers for increased risk of suicide – the second most common cause of death among 10-24 year-olds worldwide.

Both groups consisted of young people aged 14-24 from London and Cambridgeshire. ̽��ֱ��first contained 2,403 participants. ̽��ֱ��study’s methods – and findings – were then reproduced with a separate group of 1,074 participants.

“Our findings are noteworthy for being replicated in the two independent samples,” said Jones.

CMD scores increase in three significant increments above the population average: mild mental distress, followed by moderate, and finally severe distress and beyond – which often manifests as a diagnosable mental health disorder.

Those with severe mental distress came out highest for risk of suicide. However, the majority of all participants experiencing suicidal thoughts or self-harming – 78% and 76% respectively in the first sample, 66% and 71% in the second – ranked as having either mild or moderate levels of mental distress.

“Our findings help explain why research focusing on high-risk subjects has yet to translate into useful clinical tools for predicting suicide risk,” said Jones. “Self-harm and suicidal thoughts merit a swift response even if they occur without further evidence of a psychiatric disorder.”

̽��ֱ��findings point to a seemingly contradictory situation, in which most of the young people who take their own life may, in fact, be from the considerably larger pool of those deemed as low- or no-risk for suicide.

“It is well known that for many physical conditions, such as diabetes and heart disease, small improvements in the risks of the overall population translate into more lives saved, rather than focusing only on those at extremely high risk,” said Jones.

“This is called the ‘prevention paradox’, and we believe our study is the first evidence that mental health could be viewed in the same way. We need both a public health and a clinical approach to suicide risk.”

“We are surrounded by technology designed to engage the attention of children and young people, and its effect on wellbeing should be seen by industry as a priority beyond profit.”

“At a government level, policies affecting the economy, employment, education and housing, to health, culture and sport must all take account of young people; supporting their wellbeing is an investment, not a cost. This is particularly important as the widespread effects of the Covid-19 pandemic unfold.”

Reference:
Polek E, Neufeld SAS, Wilkinson P, Goodyer I, St Clair M, Prabhu G, Dolan RJ, Bullmore ET, Fonagy P, Stochl J, Jones PB. How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open 2020;10:e032494. doi: 10.1136/bmjopen-2019-032494

Around 70% of young people who report self-harming or suicidal thoughts are within the normal or non-clinical range of mental distress.

Even modest improvements in mental health and wellbeing across the entire population may prevent more suicides than targeting only those who are severely depressed or anxious

Peter Jones

Joe Penna

Young woman

Yes

Licence type:

Attribution

Study identifies brain networks that play crucial role in suicide risk

cjb250 — Mon, 02 Dec 2019 01:00:15 +0000

̽��ֱ��facts in relation to suicide are stark: 800,000 people die globally by suicide every year, the equivalent of one every 40 seconds. Suicide is the second leading cause of death globally among 15-29 year olds. More adolescents die by suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. As many as one in three adolescents think about ending their lives and one in three of these will attempt suicide.

“Imagine having a disease that we knew killed almost a million people a year, a quarter of them before the age of thirty, and yet we knew nothing about why some individuals are more vulnerable to this disease,” said Dr Anne-Laura van Harmelen, co-first author from the ̽��ֱ�� of Cambridge. “This is where we are with suicide. We know very little about what’s happening in the brain, why there are sex differences, and what makes young people especially vulnerable to suicide.”

A team of researchers, including Hilary Blumberg, MD, John and Hope Furth Professor of Psychiatric Neuroscience at Yale, carried out a review of two decades’ worth of scientific literature relating to brain imaging studies of suicidal thoughts and behaviour. In total, they looked at 131 studies, which covered more than 12,000 individuals, looking at alterations in brain structure and function that might increase an individual’s suicide risk.

Combining the results from all of the brain imaging studies available, the researchers looked for evidence of structural, functional, and molecular alterations in the brain that could increase risk of suicide. They identified two brain networks – and the connections between them – that appear to play an important role.

̽��ֱ��first of these networks involves areas towards the front of the brain known as the medial and lateral ventral prefrontal cortex and their connections to other brain regions involved in emotion. Alterations in this network may lead to excessive negative thoughts and difficulties regulating emotions, stimulating thoughts of suicide.

̽��ֱ��second network involves regions known as the dorsal prefrontal cortex and inferior frontal gyrus system. Alterations in this network may influence suicide attempt, in part, due to its role in decision making, generating alternative solutions to problems, and controlling behaviour.

̽��ֱ��researchers suggest that if both networks are altered in terms of their structure, function or biochemistry, this might lead to situations where an individual thinks negatively about the future and is unable to control their thoughts, which might lead to situations where an individual is at higher risk for suicide.

“ ̽��ֱ��review provides evidence to support a very hopeful future in which we will find new and improved ways to reduce risk of suicide,” said Professor Hilary Blumberg. “ ̽��ֱ��brain circuitry differences found to converge across the many studies provide important targets for the generation of more effective suicide prevention strategies. “It is especially hopeful that scientists, such as my co-authors on this paper, are coming together in larger collaborative efforts that hold terrific promise.”

̽��ֱ��majority of studies so far have been cross-sectional, meaning that they take a ‘snapshot’ of the brain, rather than looking over a period of time, and so can only relate to suicidal thoughts or behaviours in the past. ̽��ֱ��researchers say there is an urgent need for more research that looks at whether their proposed model relates to future suicide attempts and at whether any therapies are able to change the structure or function of these brain networks and thereby perhaps reduce suicide risk.

̽��ֱ��review highlighted the paucity of research into suicide, particularly into sex differences and among vulnerable groups. Despite suicidal thoughts often first occurring as early as during adolescence, the majority of studies focused on adults.

“ ̽��ֱ��biggest predictor of death by suicide is previous suicide attempt, so it’s essential that we can intervene as early as possible to reduce an individual’s risk,” said co-first author Dr Lianne Schmaal from the ̽��ֱ�� of Melbourne. “For many individuals, this will be during adolescence. If we can work out a way to identify those young people at greatest risk, then we will have a chance to step in and help them at this important stage in their lives.”

Even more striking, despite the fact that transgender individuals are at increased risk for suicide, just one individual in the 131 samples included for the review was identified to be transgender.

“There are very vulnerable groups who are clearly not being served by research for a number of reasons, including stigma and the need to prioritise treatment,” said van Harmelen. “We urgently need to study these groups and find ways to help and support them.”

In 2018, the researchers launched the HOPES (Help Overcome and Prevent the Emergence of Suicide) study, supported by the mental health research charity MQ. HOPES brings together data from around 4,000 young people across 15 different countries in order to develop a model to predict who is at risk of suicide. Over the course of the project, the team will analyse brain scans, information on young people's environment, psychological states and traits in relation to suicidal behaviour from young people from across the world, to identify specific, universal risk-factors.

̽��ֱ��research was supported by the mental health charity MQ Brighter Futures Award Program, National Institutes of Health, Department of Veterans Affairs, NHMRC, Royal Society Dorothy Hodgkin Fellowship, American Foundation for Suicide Prevention, Brain and Behavior Foundation, Robert E. Leet and Clara M. Guthrie Patterson Trust, and For the Love of Travis Foundation.

Reference
Schmaal, L, van Harmelen, A.-L. et al. Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Molecular Psychiatry; 2 Dec 2019; DOI: 10.1038/s41380-019-0587-x

An international team of researchers has identified key networks within the brain which they say interact to increase the risk that an individual will think about – or attempt – suicide. Writing in Molecular Psychiatry, the researchers say that their review of existing literature highlights how little research has been done into one of the world’s major killers, particularly among the most vulnerable groups.

Imagine having a disease that we knew killed almost a million people a year, a quarter of them before the age of thirty, and yet we knew nothing about why some individuals are more vulnerable to this disease. This is where we are with suicide

Anne-Laura van Harmelen

_LewiZ

Depression

Yes

Licence type:

Public Domain

System is failing to prevent deaths following police custody and prison, study suggests

fpjl2 — Tue, 13 Dec 2016 16:31:20 +0000

Getting released from prison or police custody can be a huge shock to those who have been incarcerated. Our new research gives an indication of just how vulnerable these people can be. We found that over a seven-year period, 400 people died of a suspected suicide within 48 hours of leaving police detention.

̽��ֱ��number of people dying in prisons and in police custody has been increasing for several years. There is, rightly, a statutory obligation for every death that occurs within a state institution to be investigated by an independent body. So each death in a prison is investigated by the Prisons and Probation Ombudsman (PPO), while the equivalent in police stations are investigated by the Independent Police Complaints Commission (IPCC).

But for people who die shortly after release from police or prison custody, their deaths are not subject to statutory investigation and are too often invisible.

A dangerous transition

Our research, published by the Equality and Human Rights Commission, looked into non-natural deaths of people who have been released from police detention or prison custody. We found that the data on these deaths is contingent upon the relevant institutions (prisons, police or probation) finding out about the death in the first place – and this can be difficult.

We examined two sets of data: IPCC data on suspected suicides that occurred within 48 hours of release from police detention and data from the National Offender Management Service on deaths of people under probation supervision, which includes those released from prison. We also conducted interviews with 15 custody sergeants – police officers who are responsible for the welfare of a detainee while in a police station – prison officers and others such as representatives of police and crime commissioners (PCCs) and Public Health England.

̽��ֱ��IPCC data suggest that 400 people died between 2009 and 2016 of a suspected suicide within 48 hours of release, although this number declined between the years 2014-15 and 2015-16, as the graph below shows. People who had been detained on suspicion of sex offences accounted for 32% of the 400 total suspected suicides.

We also examined a selection of 41 investigations and summaries of investigations into apparent post-release suicides that were provided to us by the IPCC. Half of these people had pre-existing mental health conditions. These referrals also pointed to inadequate risk assessment, record keeping and onward referral to relevant community-based care providers such as mental health or drug treatment providers.

We then looked at deaths that had occurred within 28 days of release from prison. Despite some issues with the accuracy and completeness of the data, we identified 66 people between 2010 and 2015 who had died from non-natural causes within 28 days of leaving prison. ̽��ֱ��numbers are small and so it is difficult to draw wider conclusions, but we found that 44 of those 66 died from a drug-related death. Of the 66, 35 had served a sentence for an acquisitive offence such as theft, shoplifting or robbery, offences which are commonly associated with drug use.

We also analysed investigations conducted between 2010 and 2015 by the PPO into deaths that occurred in approved premises, also known as bail hostels, within 28 days of release from custody. These investigations seek to understand what, if anything, could have been done to prevent the death. This highlighted problems with supporting drug-using offenders, a lack of confidence among staff and a failure to create a smooth transition from prison into the community.

Staff under strain

These analyses only tell part of the story. Our discussions with custody officers painted a complex picture. They argued that they were getting better at identifying people in custody with mental health conditions but that their ability to deal with them effectively was restricted by factors beyond their control such as a lack of appropriate treatment for people after leaving their care and an inadequate number of beds in mental health hospitals. They told us that the risk assessment tool they use for identifying such people was not fit for purpose because it did not go into enough detail and that they would benefit from additional mental health training. They were also strongly in favour of the responsibility for healthcare commissioning in police stations being handed to the NHS, rather than PCCs, a proposal which was dropped in December 2015.

̽��ֱ��story from prison staff was similar, but they also talked about the use of new psychoactive substances and the negative effects these substances are having on mental health and safety in the prison.

Problems also exist when it comes to the provision of community-based care after people are released. These include cuts to community mental health services and drug services, as well as recent changes to the probation service, which have seen 70% of the service outsourced to the private sector. Such reforms have made communication between prisons and probation providers more difficult. These budget cuts and public sector reforms are having a serious impact on the ability of criminal justice agencies to deal with these issues and prevent any future deaths.

There needs to be an improvement in the way in which data on non-natural deaths is collected. Deaths post-detention should also be subject to similar levels of investigation as those that occur in police custody and prison. It would be naive to suggest that all deaths of people leaving state detention can be investigated, but there is scope for more oversight from both the IPCC and PPO, at least while they are adjusting to life back in the community. At the same time, the government must maintain investment in mental health and drug services to help prevent those most vulnerable when they are released from detention from taking their own life.

This article was originally published on ̽��ֱ��Conversation. Read the original article.

Professor Loraine Gelsthorpe is Deputy Director of the Institute of Criminology, ̽��ֱ�� of Cambridge.

Nicola Padfield is Master, Fitzwilliam College, Cambridge, and a Reader in Criminal and Penal Justice, ̽��ֱ�� of Cambridge.

Jake Phillips is a Senior Lecturer in Criminology, Sheffield Hallam ̽��ֱ��.

Poor access to health care and confusion over post-detention care may have contributed to more than 400 deaths following police custody and prison detention since 2009, a new report has claimed. Here, in an article first published on ̽��ֱ��Conversation, report authors Loraine Gelsthorpe and Nicola Padfield of Cambridge's Faculty of Law, along with their colleague Jake Phillips from Sheffield Hallam ̽��ֱ��, discuss their findings.

Deaths post-detention should also be subject to similar levels of investigation as those that occur in police custody and prison

West Midlands Police

Custody officer assistant

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

Licence type:

Attribution-ShareAlike

Staff-prisoner relationships are key to managing suicide risk in prison, say researchers

fpjl2 — Fri, 03 Jul 2015 14:41:00 +0000

On 1 July 2015, the Government published the Labour peer Lord Toby Harris’ final report of the Independent Review into self-inflicted deaths in custody of 18-24 year olds, which was commissioned to make recommendations on actions that need to be taken to reduce the risk of future deaths in custody.

A team from Cambridge ̽��ֱ��’s Faculty of Law and Prison Research Centre (PRC), in partnership with RAND Europe, was commissioned by the Harris Review to undertake new research on the experience, knowledge and views of prison staff about the nature of suicide risk and its identification and management. Researchers conducted around 50 interviews and focus groups, and observed prisoner assessments across five prisons in England and Wales, including both private and public establishments.

̽��ֱ��researchers found that many prison staff use ‘jailcraft’ — the knowledge and expertise gained through their own experience — to identify and manage at risk prisoners, but staff felt that their capacity to build and exercise this expertise has been adversely affected by a lack of time and budget, and a reliance on blanket risk management procedures.

While some staff held fatalistic views of individual prisoners (‘those who really want to do it will do it anyway’), researchers say that staff who understood the impacts of prison environments, and attempted to proactively ameliorate those impacts upon prisoners, through their relationships with prisoners and practices, were more likely to be effective in preventing deaths.

Such staff placed individual prisoner care at the heart of their work. They used initiative by, for example, ‘creating’ jobs to occupy prisoners’ minds, such as additional cleaning or painting on the wing, or offering in cell ‘distraction packs’ that included Sudoku puzzles or crosswords.

“While some prison staff felt that suicide attempts could be described as acts of manipulation, many saw it as a cry of pain. ̽��ֱ��prison officers who recognised the complex interaction between prisoners’ imported vulnerabilities — such as addiction or illiteracy — and their environment and situations, felt more empowered to gauge the risks of self-harm or suicide and intervene to prevent situations from escalating,” said the PRC’s Dr Amy Ludlow, who led the research.

̽��ֱ��team say their findings highlight the importance of “high-quality relationships between prisoners and staff for identifying and managing suicide risks in an increasingly austere prison environment”.

However, many of the staff interviewed for the research felt that budget-reduction policies, including ‘Benchmarking’ and ‘New Ways of Working’, had adversely affected their capacity and expertise to manage suicide risk proactively, rather than reactively. Many staff expressed frustration at having too little time for personalised, integrated care.

Many of the study’s interviewees described staff losses from early redundancy packages being compounded by high staff sickness — often, they reported, because of work-related stress. In some prisons, researchers observed senior managers undertaking prison officer work such as serving meals to make up for the short fall.

One prison manager told researchers: “Benchmarking has put us between the devil and the deep blue sea. We’ve had to implement it even though we know it’s damaging the prison”.

Staff reported that there were currently too few staff on prison wings, and those staff present were often less effective than they could be because of inconsistent staff deployment, the use of agency staff, low morale and infrequent or inadequate training.

Many staff also reported that social and educational activities in prisons had been reduced as a result of budget cuts, with whole wings of prisoners routinely ‘banged up’ (confined to their cells) for almost all of the day.

“We know from this and other studies that there are a number of protective factors related to the prison environment that impact on the likelihood of suicide," said the PRC’s Professor Alison Liebling.

“Part of this story is how well a prison responds to prisoners’ needs during acute periods of distress. But it is also important that a prison provides an environment where prisoners have meaningful activities and human contact, both for prisoners who are and those who aren’t seen as at enhanced risk of self-harm,” she said.

Researchers found the Assessment, Care in Custody and Teamwork (ACCT) process that dominates the ways in which prisoners at risk are identified and managed — and was credited with contributing to the decline in suicide that began in the mid-2000s — was now often being approached as a ‘tick box’ exercise because staff felt that they ‘haven’t got time to deal with [risk] any other way’.

Staff described an over-reliance on ACCTs, with the result that support was not focused on prisoners most in need of it. Many cited a fear of blame for deaths in explaining their ‘defensive’ use of ACCT. Staff described feeling unfairly blamed when things go wrong, and unrecognised for their successes in preventing deaths by a system that does not understand the resource constraints within which prison work is carried out.

̽��ֱ��research also found that adequate support for staff in preparing for inquests was important in securing positive oriented learning experiences from deaths in custody. While some staff reported evidence of positive change to practice following inquests, some staff, particularly managers, expressed frustration that some ‘pretty straightforward lessons’ were not learned by all staff from inquests.

Some staff and managers were equally of the view that ‘self-inflicted deaths (SID) could act as catalysts for reflection and changes to practice that make SID prevention more effective’, and staff reported looking for an achievable model of effective practice. One member of prison staff reported that “listening to colleague’s stories and experiences would help you grow. Retrospective learning from such incidents would be great. We do too little of it now — we’re always in defensive mode”.

̽��ֱ��team’s findings have helped inform some of the Harris Review’s 108 recommendations about how more deaths in prisons can be prevented: through improved training for staff; recognition of the importance of — and investment in — caring, personalised and respectful staff-prisoner relationships; better information flows between relevant agencies; and a focus on lesson learning following all incidents of self-harm and suicide.

“ ̽��ֱ��Harris Review has raised important questions that demand the attention of policymakers,” said Ludlow.

“My hope is that our study will be a catalyst for further dialogue about suicide prevention, which will complement the Review’s thorough work. There are some dedicated prison staff whose knowledge and experience should inform next steps, as should the insights of the many excellent volunteer prisoner Listeners who support fellow prisoners at times of crisis. That sustained reductions in the rate of suicides in prison were achieved post 2005 suggest that systematic efforts to prevent them can work, given the right organisational context,” she said.

Ludlow points out that the Harris Review states that, by and large, the policies that National Offender Management Services promulgates through Prison Service Instructions are sound and, if implemented, would deliver good practice.

“While suicide risk is intense, multifaceted and dynamic, the protective potential impact of staff-prisoner relationships and the prison environment should give us hope that more deaths can be prevented given adequate resource and leadership, and genuine political commitment to some of the welcome fundamental critiques raised by the Harris Review about the size of our prison population, and experiences of imprisonment that too frequently inadequately support prisoners in their journeys towards non-offending lives,” Ludlow said.

̽��ֱ��full findings of this study are now available online.

̽��ֱ��research team will host a roundtable event to discuss this and related research at the ̽��ֱ�� of Cambridge on 8 September 2015. For more information about the event, contact Dr Amy Ludlow.

In the wake of a recent increase in prisoner suicide, new research commissioned by the Harris Review on the views and experiences of prison staff suggests that identifying and managing vulnerable prisoners requires the building of staff-prisoner relationships, ‘knowing the prisoners and understanding what makes them tick’. However, prison staff say that this has been adversely affected by the need to deliver budgetary savings.

̽��ֱ��protective potential impact of staff-prisoner relationships and the prison environment should give us hope that more deaths can be prevented given adequate resource and leadership

Amy Ludlow

ESRC Prison Research Centre film

Staff who understood the impacts of prison environments, and attempted to proactively ameliorate those impacts upon prisoners, were more likely to be effective in preventing deaths.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes