Impact News

Responding to Violence, Suicide, Psychosis and Trauma

The truth behind prison suicides

A fall last year in the number of prisoners taking their own lives is good news, but while we continue to jail mentally ill people the problem will continue, says Erwin James

A young prisoner at Ashield young offenders’ institution.

‘Sixty-one suicides in a year is as unacceptable as 100’, says Erwin James.

“There is never any room for complacency in our work to prevent these deaths,” said justice minister Shahid Malik in response to the fall in the number of people in prison taking their own lives in 2008. The drop from an average of 91 self-inflicted deaths per year over the previous three years to just 61 last year is noteworthy. (In 2007 eight women took their lives in prisons; only one woman took her life in custody last year.)

Staff vigilance has to be one reason for the lower figure. Prison staff rarely receive good press and it is easy to forget the significant number of prison officers who actually enjoy their job for the right reasons, and who care about the vulnerable people they have to supervise. Another reason has to be the army of volunteers who give their time to those who are struggling with their prison situation, particularly the Samaritans.

The Samaritans managed to get a foothold into our prisons after 15-year-old Philip Knight hanged himself in his cell in Swansea prison in 1990. Kathy Biggar, former vice-chairwoman of the “Sams”, and Jim Heyes, the then governor of Swansea jail, came up with the idea of the Listener scheme, whereby groups of prisoners are trained by the Samaritans to provide listening ears for fellow prisoners in distress.

The scheme was so successful that it was expanded throughout the prison system, so that today one key performance indicator (KPI) in every prison in the country is the provision and quality of its Listener scheme. Most prisons now get at least one visit a month from their local Samaritans who give on going support and training to the Listeners and to prison staff if requested. The relationship that has developed between the Samaritans and our prisons is one of the best social initiatives to have emerged over the past 15 years.

So a bit of good news for the prison service at last. But 61 people dead in a year in our prisons by their own hands is as unacceptable as 100. And let’s bear in mind this figure will have little impact on the overall statistics regarding the likelihood of self-inflicted deaths in prison unless it can be sustained for a few years. The suicide rate for men in prison is five times higher than for men in the community. Women in prison are 36 times more likely to take their own lives than women in the community. And a study published in 2003 found that 72% of those who took their own lives in prison had a history of mental disorder (over half had symptoms suggestive of mental disorder at reception into prison).

Four years ago the then minister for prisons, Paul Goggins, reported in a debate that 20% of all prisoners in the UK had four of the five major mental health disorders.

I used to think that suicide in prison was the ultimate means of empowerment. Prison engenders intense feelings of helplessness. Living with limited choices, little control or responsibility, and shouldering the opprobrium of society can make you feel backed into a corner. In those circumstances, it might not seem to be a totally irrational act. Most people who go to prison contemplate suicide, even if only fleetingly. The evidence shows however that the majority of people who carry it through are mentally unwell. Mr Malik made no mention of that fact. The reality is that the only way to sustain a relatively low prison suicide rate is to address our complacency about jailing mentally ill people.

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Filed under: Suicide, Uncategorized, , ,

The facts about suicide are far less alarming than the media portray

Oliver James, The Guardian, Saturday 24 January 2009

A completed suicide casts a long, dark shadow on families. Yet there is much misinformation about who is at risk and how common it is. Many parents will, I hope, find the facts reassuring. The first myth is that suicide is increasing. Actually, it has been falling for many years: from 6,129 cases in 1994 to 5,576 in 2006, with the decline in numbers occurring almost annually.

The second myth is that it is a young person’s plague. Virtually no children under 14 do it (22 a year, albeit 22 too many) and the total for 15-34-year-olds is 1,400. While it may be the second largest cause of death in 15-24-year-olds (car accidents being the highest), that is because hardly any in this age group die. The real increase in suicide has been in the 35-64-year-olds, up 15% from 2,950 to 3,400.

The third and most widely touted myth is that suicide has become an epidemic among young men, totemic of a “crisis in masculinity”. In 1994, there were 1,850 in the 15-34-year-old male age group, dropping steadily year on year down to 1,200 in 2006. In other words, the real story is that suicide by young men has fallen by over one third.

What is true is that, in much of the world, men outnumber women in completed suicide. In this country, it is at least three times more men. However, this is not some biological given – there are many cultures in which women exceed men. One of the most suicidal groups on earth, for example, is rural middle-aged Chinese women.

It is a curiosity of suicide statistics that the gender differences for those who attempt it are almost exactly the reverse of those who complete it: women are much more likely to deliberately self-harm than men. Superficially, the explanation is that men tend to use much more fatal methods, like hanging or jumping off high buildings, whereas women take ineffective overdoses. However, that prompts the question of why, to which there are as yet no satisfactory answers.

In most developed nations, women are twice as likely as men to be depressed. We know from psychological autopsies that the great majority of people who killed themselves were depressed. That makes it all the stranger that relatively fewer women die this way. A possible factor is that men abuse substances much more than women (about twice as much) – women are more likely to visit their GP and accept pills or therapy. It’s possible that the disinhibition of booze or drugs means men are more likely to take extreme measures to end their lives.

But the remarkably reassuring fact is that only one in 50 young people who attempt suicide dies: 24,000 people aged 10-19 attempt it each year, at least three quarters of them female, but fewer than 500 die. Even allowing for a great many pleas for help, you would have thought that a higher proportion than this would end in tragedy.

All in all, if you are a parent the facts about suicide are a great deal less worrying than the tosh you read in many newspapers. Just as we are
encouraged to fantasise about creepy strangers making off with our little
girls when this is so rare that it is not worth giving the time of day to, so with suicide: forget your teenage Smiths fan for whom the GP wants to prescribe antidepressants: if anything, the person you should worry about is any 35-64-year-old man in the household.

For information about suicide go to samaritans.org/your_emotional_health/about_suicide.aspx.

Filed under: Suicide, Uncategorized, , ,

Dangerous and severe personality disorder – Questions and Answers

The condition known as dangerous and severe personality disorder has, in fact, no legal or medical basis. Yet the government is pouring £126m over three years to develop a variety of DSPD services. David Batty explains

* David Batty
* guardian.co.uk, Wednesday 17 April 2002 09.44 BST
* Article history

What is dangerous and severe personality disorder?

Personality disorder refers to patterns of behaviour or experience resulting from a person’s particular personality that differ markedly from those expected by society and lead to distress or suffering to that person or to others. The government first introduced the term DSPD in a consultation paper Managing Dangerous People with Severe Personality Disorder in 1999, which proposed how to detain and treat a small minority of mentally disordered offenders who pose a significant risk of harm to others and themselves. Specialist services to deal with these people, most of whom are thought to be serious violent and sex offenders, were proposed in the white paper Reforming the Mental Health Act in December 2000.

What are the traits associated with DSPD?

The condition’s characteristics have yet to be clearly defined. But it is thought to be an extreme form of antisocial personality disorder (ASPD) – the diagnosis most commonly associated with psychopathy. The key traits of ASPD include failure to make intimate relationships, impulsiveness, lack of guilt, and not learning from adverse experience. ‘Psychopathic disorder’ is a legal term used in the current mental health legislation to refer to people who have “a persistent disorder or disability of mind… which results in abnormally aggressive or seriously irresponsible conduct.”

How many people have DSPD?

The white paper to reform the mental health act states that 2,00-2,400 people in England and Wales are estimated to have DSPD, although some government officials say there are up to 2,500. According to the Home Office, about 1,400 are estimated to already be in prison. A further 400 are estimated to be patients in high security psychiatric hospitals, with between 300 and 600 at large in the community. About 98% of those with DSPD are believed to be men. However, with the new disorder’s definition still unclear, many psychiatrists contend these figures are just speculation.

Where will people with DSPD be treated?

By 2004 there will be 300-320 high security places to detain, assess and treat DSPD. The 92-bed unit on D-wing at Whitemoor prison, Cambridgeshire, began assessing prisoners last September, offering treatment from March. Another 80 places will be provided at a newly built unit at Frankland prison, Durham, from early 2004. There will be 140 additional places for those with DSPD in special hospitals by April 2004. A new 70-bed unit at Rampton hospital, Nottinghamshire, is due to open in October 2003. Another unit will be built at Broadmoor hospital, Berkshire. DSPD services will also be set up at medium secure prisons and hospitals and in the community to treat and support those assessed as safe to be released or discharged. Community programmes are expected to be piloted in south London and the north-east.

How is DSPD diagnosed?

Assessment on the DSPD unit at Whitemoor high security prison lasts 14 weeks. Inmates undergo psychometric tests to assess their dangerousness and to measure the severity of their personality disorder. They also have a series of interviews with a psychiatrist, while care staff record how disturbed and challenging their behaviour is from day to day. The clinical team then evaluates whether a connection can be made between dangerousness and severe personality disorder by examining the inmate’s past and current offending behaviour and how they interact with other prisoners and staff. Jamie Bennett, head of the Whitemoor DSPD unit, said prisoners would need a long history of sex or violent offences to meet the criteria.

What treatment is there for DSPD?

Inmates at Whitemoor and Rampton receive a psychological therapy called dialectical behavioural therapy (DBT), which aims to help them respond to everyday situations in a problem solving manner rather than emotionally and aggressively. This more positive mindset should enable them to take part in rehabilitation programmes, such as reoffending reduction courses. However, DBT has predominantly been used to treat women with borderline personality disorder who deliberately harm themselves and there is little evidence it will prove effective in helping those with DSPD.

What prompted the DSPD programme?

Much of the impetus for the DSPD programme has come from high-profile cases such as that of Michael Stone, who in 1996 attacked Josie Russell and killed her mother and sister several years after his personality disorder was deemed untreatable. The Home Office regards those with DSPD as “a group hitherto poorly served by criminal justice or mental health services” and believes “the serious nature of the crimes they typically commit has a disproportionate impact on the public’s fear of crime.” The Mental Health Act 1983 only allows people to be committed to hospital where psychiatrists believe the person is treatable and many do not believe personality disorder is. But proposed reform of the mental health act would allow detention of people with PD – even, in some cases, if they had committed no crime.

How much will the programme cost?

The government has set aside £126m over three years to develop high security, medium security and community DSPD services. The prison service has been allocated £70m and the NHS £56m. Although Home Office officials were unable to estimate treatment costs in high security settings, Dr Ian Keitch, head of DSPD at Rampton, said treatment at the hospital was projected to cost £180,000 per bed per year. Although this is £30,000 more than current treatment costs for patients believed to have DSPD, Dr Keitch said this was less than treatment costs for female self-harmers – £200,000. However, he admitted the cost could not be justified on current evidence. Peter Tyrer, professor of community psychiatry at Imperial College, said a £2m three-year research programme to assess the effectiveness of the treatment programmes, should lead to improved cost efficiency.

Why is the term so controversial?

DSPD currently has no legal or medical basis and many doctors regard it as a political invention. A survey of nearly 1,200 psychiatrists published in the British Journal of Psychiatry in 2000 found almost two-thirds disagreed with the plan for detaining people with personality disorders, and almost a third said they might boycott it. There is no firm evidence base for the disorder or the new assessment and treatment programmes. The Royal College of Psychiatrists says there is no “entirely satisfactory” diagnosis of antisocial traits that threaten public safety. A recent study in the Lancet warned DSPD is so vaguely defined that six people would have to be detained to prevent one from acting violently, raising major concerns about civil liberties.

Filed under: Uncategorized, Violence, , , ,

Dangerous people with severe personality disorder British proposals for managing them are glaringly wrong—and unethical

BMJ. 1999 October 30; 319(7218): 1146–1147.

PMCID: PMC1116939
Copyright © 1999, British Medical Journal

Paul E Mullen, professor of forensic psychiatry
Monash University and Institute of Forensic Mental Health, Victoria, 3084 Australia

This summer the British Department of Health and the Home Office jointly issued a paper on Managing Dangerous People with Severe Personality Disorder.1 The paper was apparently “based on the results of extensive informal discussions” and sets out the government’s policy objectives in dealing with what the paper calls the “dangerous severely personality disordered.” The paper avoids descending into the apparently unending debate over what is, or is not, a personality disorder and to what extent personality disorders are treatable and attempts to cut through the gordian knot with what presumably are intended as straightforward and practical proposals for action. If only it were that simple.

This government “framework for the future” proposes legal powers for detaining indefinitely people with dangerous severe personality disorder. Specialists, including psychiatrists, are to be employed both to better identify people with dangerous severe personality disorder and to develop “approaches to detention and management.” Finally a comprehensive programme of research is to be established to support development of policy and practice. The proposals make a point of insisting that “indeterminate detention will be authorised only on the basis of evidence from an intensive specialist assessment” (my italics).

There are people whose antisocial and self damaging behaviours are at least in part a product of abiding character traits such as impulsivity and suspiciousness combined with abnormalities of mental state, including instability of mood and dissociative symptoms. Such distressed and disturbed individuals currently attract little interest from mental health professionals and even less from those who fund services. Clinical experience suggests, however, that such disorders can be improved, if not cured, even if research has failed to pinpoint the best therapeutic approaches. Severely personality disordered individuals are over-represented among recidivist offenders, though such disorders do not inevitably lead to serious offending; nor are serious offenders drawn exclusively from their ranks.

Crime and violence are major political issues. Surveys indicate growing public support for more punitive approaches to offenders,2 and populist governments around the world, be they left, right, or third way leaning, fall over themselves to respond to law and order agendas. In England and Wales section 2 of the Crimes (Sentencing) Act already provides for discretionary life sentences for those convicted a second time for serious violence or a sexual offence. The courts have, however, shown a signal lack of enthusiasm for imposing such sentences, frustrating the government’s carceral enthusiasms. The proposals set out in this document openly acknowledge the hope that the judicial reluctance to sentence on the basis of predicted future behaviour will be reduced if courts are provided with medical evidence that offenders have dangerous severe personality disorder.

What is wrong then with proposals that promise far greater resources for a relatively ignored group of mentally disordered people and at the same time hold out the prospect of increased community safety? If dangerousness was really a characteristic of some personality disordered individuals rather than a characteristic of some acts by some of them; if the proposed special centres, with their multidisciplinary teams armed with “batteries of standardised procedures,” could reliably recognise dangerous severe personality disorder; if these proposals were really about providing care and treatment for the personality disordered; and if health professionals were really judges and jailers charged with maintaining public order, then perhaps these proposals would be worth taking seriously. But none of these assumptions holds true.

Enthusiastic advocates exist for actuarial methods of predicting future criminality, and some place considerable theoretical emphasis on the contribution of personality.3,4 In practice, however, the probability of future offending is predicted most effectively by past offending.5 Variables such as being a substance abuser or having a history of being abused as a child, have significant, if less consistent, associations with increased rates of future violence.4,6 Mental health variables contribute little to such predictive characteristics. A diagnosis of psychopathy, or antisocial personality disorder, often does little more than recycle the history of prior offending behaviours in a different form, producing a potentially spurious association between personality disorder and offending. In practice, therefore, we would be identifying people with dangerous severe personality disorder not on mental health, or even personality, variables but on their past offending, their past history of victimisation, and their current drug and alcohol habits. Except for substance abuse, none of these predictive factors is open to change.

The government’s proposals masquerade as extensions to mental health services. They are in fact proposals for preventive detention, not too far removed from the dangerous offender and sexual predator laws in North America.5They aim to make judges more amenable to imposing discretionary life sentences. They are intended, as Eastman observed in these pages,7 to circumvent the European Convention on Human Rights, which prohibits preventive detention except in those of unsound mind. With their promises of new money and research funding, they hope to bribe doctors into complicity in the indefinite detention of certain selected offenders. Discussion of the ethical dilemmas that these proposals present for health professionals is absent, presumably because they are ethically and professionally indefensible.

There is a crying need for mental health services for severely personality disordered individuals. Such services would decrease the morbidity and staggering mortality associated with these conditions. In the process they would contribute to community safety. The British government’s proposals largely ignore this central issue of developing appropriate treatment services in favour of creating a system for locking up men and women who frighten officials. On first reading this document created both disappointment and foreboding. On more careful consideration it became clear that the contradictions were so glaring, the deceptions so open and palpable, and the agenda so obvious, that these proposals can surely not have any chance of influencing reality.
Top
>References

References
1.
Department of Health; Home Office. Managing dangerous people with severe personality disorder. London: Home Office; 1999. http://www.homeoffice.gov.uk/cpd/persdis.htm http://www.homeoffice.gov.uk/cpd/persdis.htm.
2.
Kury, H; Ferdinand, T. Public opinion and punitivity. Int J Law Psych. 1999;22:373–392. [PubMed]
3.
Hare, RD. The Hare PCL-R: some issues concerning its use and misuse. Legal Criminol Psychol. 1998;3:99–112.
4.
Quinsey, VL; Harris, GT; Rice, ME; Cormier, CA. Violent offenders: appraising and managing risk. Washington, DC: American Psychological Association; 1998.
5.
Heilbrun, K; Ogloff, JRP; Picarello, K. Dangerous offender statutes in the United States and Canada: implications for risk assessment. Int J Law Psych. 1999;22:393–415. [PubMed]
6.
Steadman, HJ; Mulvey, E; Monahan, J; Robbins, PC; Appelbaum, PS; Grisso, T, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psych. 1998;55:393–401. [PubMed]
7.
Eastman, N. Public health psychiatry or crime prevention? BMJ. 1999;318:549–551. [PubMed]

Filed under: Uncategorized, Violence, ,

Seeking solitary: prison gang wars force fearful inmates to plead for segregation

· Jail watchdogs warn of growth of gang culture
· Influx of new generation of violent inmates blamed

* Alan Travis, home affairs editor
* The Guardian, Monday 18 February 2008
* Article history

Gang members

The segregation units in Britain’s high security prisons used to be full of prisoners being punished for breaking the rules or being held in solitary because they were too dangerous to mix with others.

But now the “seg units” at institutions such as Whitemoor in Cambridgeshire are packed with a different kind of prisoner: those so fearful for their safety that they have asked to be isolated for their own protection.

Jail watchdogs have warned that an influx of rival gang members from Britain’s inner cities has fuelled a new wave of fear and violence at the five maximum security prisons.

This new generation, who have been schooled in street gun and gang culture, bring with them deeply held gang allegiances. Once inside they use all their ingenuity to equip themselves with homemade, but nevertheless lethal, weapons to settle scores with rival gang members and protect their illicit trade in drugs and mobile phones.

Ministers have been warned by independent monitoring boards (IMBs) at two of the five prisons that the problem has become so acute that it has now become “extremely difficult” to find enough category A accommodation to separate sentenced members from rival gangs. They confirm that the segregation units at both jails are occupied by a majority of prisoners who have been asked to be isolated for their own safety.

The disclosure of this high-level concern over gang culture in the high security estate comes as the prison population in England and Wales reached a new record at the weekend of 81,918 – just 100 places short of its maximum “bust” capacity.

The latest IMB report from the Whitemoor high security prison says the rising number of prisoners from different gangs has already sparked short periods of unrest on the wings and is now a major problem affecting all five of the high security “dispersal” prisons in England and Wales.

At Long Lartin prison, Worcestershire, the monitoringboard has told ministers that an atmosphere of superficial calm domesticity inside coexists with the threat – and the practice – of violence.

“Some men are known to suffer injuries; others probably go unreported. Many more are fearful and seek protection,” says the latest report from the watchdog to the justice secretary, Jack Straw.

“At least part of the explanation must lie with the wave of young men who have reached prison in the last few years. Typically they are in their 20s and undergoing very long sentences; some of them face more years in prison than they have already lived. Some bring with them deep allegiances and very strong antipathies.”

The IMB’s annual report says that among them are men for whom the use of weapons is not so much a tactical decision but more an expression of a way of life. “They devote much of their energy, influence and ingenuity to equipping themselves with blades and stabbers which, although improvised, have an utterly lethal potential. The rate at which these were being discovered during the middle part of the year was deeply alarming.”

The result is a frequently full segregation unit, the majority of whom are prisoners who have sought protection because of violent threats over debts they can’t repay or because other prisoners simply make life on the wing intolerable for them.

The underlying problem of this armed gang culture in top security prisons is not going to go away, according to the IMB, as long as grave crimes go on being committed in the cities and extraordinarily long sentences are being handed down.

“These prisoners are going to be a great challenge,” it says. “Managing them successfully calls for a substantial effort by all who contribute to intelligence, wing allocation and searching. It also needs the high security estate to make thoughtful and well-informed allocations between its dispersal prisons.”

At Whitemoor the IMB has told ministers that as more gang-related prisoners arrive staff have fewer options. “This is a matter affecting the whole of the high-security estate,” it says. “Prison officers are having to cope with more and more volatile mixes of prisoners because the ability to move individuals around is now very limited.”

A Prison Service spokesman said: “We recognise that gang associations are an issue in prisons, including the high-security estate. Allocation decisions in the high-security estate are based on available intelligence on the individual and the risk posed to him and by him.”

He said that a specific project was under way looking at how best to develop options on how to deal with gang membership. “Governors and directors of prisons are responsible for ensuring the development, implementation and maintenance of a local violence-reduction strategy. This must include consideration of sources of conflict that are imported from outside prison, particularly gang-related issues.”

Current Prison Service policy does not separate rival gang members as a matter of course and says it will be done only where there is an established risk of disorder or to the safety of staff and other prisoners.

An agreed “rotational system” is put into operation when a high number of gang members are present in a single jail.

Filed under: Uncategorized, Violence, , , ,

Calendar – Free Training Dates

One of the biggest problems in arranging in-house training courses is finding mutually convenient dates. Now, at least, you can see which dates are not possible – just click on the link below.


http://www.google.com/calendar/embed?src=impact%40dangerousbehaviour.com&ctz=Europe/London

Thanks

Iain Bourne

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“Razor’s Edge” Course in Nottingham

Dealing with Suicide and Self-Harm, faciltated by Iain Bourne on 22nd and 23rd March and organised by Nottingham HLG (Kevin O’Connor). Follow the link below:

http://www.hlg.org.uk/training.htm

But be quick, there’s only one place left!

Filed under: Impact Training, Suicide, , , ,

Iain Bourne’s Blog

You can now visit Iain Bourne’s Blog at

http://www.drbourne.weebly.com

Contributions and comments are warmly welcomed!

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Dangerous Behaviour Courses in Scotland

Two one-day open access courses are being organised on “Difficult, Disturbing and Dangerous Behaviour” in Scotland during the Spring. These are being organised by Vance Finnon of Blue Skye Consultancy for :

  • 30th May in Dundee
  • 1st April in Edinburgh

If you are interested please go to:

http://blueskyeconsultancy.co.uk/dddbcourse.htm –  for further information

http://fs11.formsite.com/KBFinnon/form244062311/index.html – to book a place

Filed under: Impact Training, Uncategorized, Violence, , , ,