1. A real life example of intervention retention and follow up in the community: problem solving for self-harm in prisons

2. National Institute of Health Research
This article/paper/report presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

3. The Research Team and roles
Amanda Perry and Mitch Waterman – Joint PI
Allan House –Intervention specialist
Nat Wright- Prison NHS lead
Ann Hopton – Research Fellow
Christine Butt – NHS liaison
Gerry Richardson – economic evaluation
Jo Greenhalgh – qualitative realist synthesis
Spectrum Community Interest Company

4. Evaluations of Problem Solving Interventions in the community
Use of Randomised Controlled Trials

5. Treatment of self-harm
Key problem: a high prevalence of self-harm in prisons compared to the wider community. (Meltzer Gill & Pettigrew 1994,Singleton Meltzer & Gatwood 1998)
Case control prison study rates 5-6% for men and 20-24% for women (Hawton et al 2014)
Generally anecdotal use of ACCT (Forrester & Slade 2014)
Renewed approach
Further training required (Hawton 2014)

6. Aim of the research
To assess the feasibility of implementing a problem solving training
to reduce self-harm in prisons.
Two phases:
A short training programme to equip all frontline staff with an understanding of the problem solving approach.
2) Detailed training for ACCT prevention co-ordinators and RM Nurses who work with prisoners identified as at risk of self-harm and suicidal behaviour.

7. Where? Who? When?
Four prisons in Yorkshire and the Humber: HMP Leeds, Newhall, Wetherby (YOI), Hull.
Researchers working in the prisons from February 2015
3 month rolling programme of training for staff
3 months implementation with prisoners generally and prisoners on ACCT.

8. A problem solving intervention
MIDSHIPS is a programme of Problem solving therapy devised in New Zealand.
Modified for use in the UK by researchers at the
University of Leeds
and self-harm patients.
7 clear steps to use 8

9. Design training materials

10. Identifying prisoners at risk: the methodology
Screening criteria: Anyone on an ACCT in the previous two weeks Any one with an incident of actual self-harm 3 month period of recruitement
Reasons of opening an ACCT: Suicide intent Self-harm threat or behaviour Low mood Bizarre behaviour Other concerns

11. An example from HMP Hull: the process
Number of open ACCTS between October 7th and 7th January 2016 n=196
Number of incidents who self-harmed or attempted suicide
n=146
32 (22%) individuals transferred or released.
Number of people remaining in the prison at time of clinic appointment
N=114 (78%)
People attending clinic
N=3 people too dangerous
N=3 people lacking capacity/too ill
N=15 people did not consent
N=15 people not eligible
Number of people not attending clinic after call up N=29

12. The intervention measurement
Pre measurement
– outcomes of depression –PHQ-9
Physical and mental health – EQ5-D
Resource questionnaire
Demographic background

13. Follow-up consent form

14. Data provided on consent forms
Telephone numbers Address to be released to Name of parent/carer/professional Address of parent/carer/professional

15. Thank you for listening For more information contact Amanda Perry,
Summary
Thank you for listening
For more information contact Amanda Perry,