Karen Slade

Suicide is a leading cause of death among individuals in contact with the criminal justice system, with rates far greater than those in the general population. Despite developments in research and practice around suicide prevention, few jurisdictions globally have implemented comprehensive systems or policies across the full criminal justice pathway. In this overview, we present a review of the current evidence base in relation to correctional policy and practice, along with selected examples of good practice in suicide prevention for people serving custodial or community-based sentences, predominantly from England and Wales and Australia. We utilise a social-ecological framework to describe the multi-level factors contributing to suicide risk and various approaches to prevention. While progress has been made, there are still significant gaps in both our understanding and implementation which, if addressed, would meaningfully enhance suicide prevention for this marginalised population.

Background: The mortality rate among people under probation supervision in the community is greater than that among incarcerated people and that among the general population. However, there is limited research on the distinct vulnerabilities and risks underlying the causes of death in this population. In this retrospective cohort study, we examined the individual and criminal justice-related factors associated with different causes of death. Factors were assessed in relation to the type of supervision, distinguishing between those under post-custodial release and those serving a community sentence. Results: The study utilised the official data held by His Majesty’s Prison and Probation Service in England and Wales on the deaths of men and women under probation supervision between 01 April 2019 and 31 March 2021 where the cause of death had been definitively recorded (n = 1770). The high risk of deaths primarily caused by external factors (i.e., suspected suicide (10%), homicide (5%), and drug-related death (26%)) in this population was confirmed. A Gaussian Graphical Model (GGM) demonstrated unique relationships with suspected suicide and drug-related deaths for known suicide risk, history of drug use and recent (< 28 days of death) enforcement action due to a breach of probation conditions. Our findings suggest that that familial violence and abuse may be relevant in suicide and drug-related deaths and that minority groups may experience disproportional risk to certain types of death. Conclusions: This study identified unique risk indicators and modifiable factors for deaths primarily caused by external factors in this population within the health and justice spheres. It emphasised the importance of addressing health inequalities in this population and improved joint-working across health and justice. This involves ensuring that research, policies, training, and services are responsive to the complex needs of those under probation supervision, including those serving community sentences. Only then can we hope to see lower rates of death within this population.

Karen Slade, Thom Baguley and Lucy Justice discuss their recent study.

Dual harm behaviour has recently gained scholarly attention. Dual harm centres on a subset of people who display violent and self-harming behaviour. This study re-examines the differential profile characteristics identified in Europe for those who dual harm, using international data featuring a population study of a state prison system in the south-eastern United States. Three years of data produced 43,489 institutional events, from a custodial population of 22,918. Logistic regression analysis indicates that those who dual harm in custody had an overall rate of infraction 40–70% higher than those who engage solely in violence or self-harm, and five times higher than those without physical harm infractions. Dual harm was associated with higher rates of non-harm incidents (e.g. property damage and disorder), younger age, lower educational achievements on admission and less educational development during imprisonment, greater self-reported mental health need although not substance abuse, and fewer intimate relationships. Dual harm was related to more lethal acts of self-harm such as ligature or ingestion. This is the first study that applies the dual harm profile to prison data within the US. This study supports dual harm as a highly relevant construct within international custodial settings and offers policy implications for this population.

Prison-based violence and self-harm are continuing to rise. Recent research is increasingly showing that for some prisoners, self-harm and violence co-occur, i.e. they engage in dual harm. This study contributes to the developing research and literature focusing on dual harm by presenting an analysis of the dual harm experiences of six men residing in a Category B English prison. Participants were interviewed and their narratives analysed using interpretative phenomenological analysis. Superordinate and subordinate themes were identified, and they shed further light on why men in prison dual harm and what influences their decision to engage in one type of harm over the other at any given time. The findings indicate that co-occurrence is not coincidental. Participants experienced a combination of interlinking factors and complex temporal and experiential relationships underpinning the two behaviours: experiencing difficult and unpredictable environments, an incoherence of sense of self and identity, painful psychological and emotional states, and connections to early adverse experiences. The findings are discussed in line with the growing dual harm research and wider psychological literature. Limitations of the study and future research directions are provided, and implications for policy and practice are suggested.

Background: People held in immigration removal centres have a range of vulnerabilities relating both to disappointment at imminent removal from the country of hoped‐for residence and various antecedent difficulties. An important subgroup in the UK is of foreign national ex‐prisoners who have served a period of incarceration there. Prisoners generally have higher rates of mental disorders than the general population. It is, however, not clear whether foreign national ex‐prisoners in UK immigration removal centres have higher rates of mental disorders than other detainees.Aims: To compare the screened prevalence of mental disorders, levels of unmet needs and time in detention between foreign national ex‐prisoners and others in Immigration Removal Centres in England.Methods: We conducted a secondary analysis of cross‐sectional survey data from a previously published study in one Immigration Removal Centre.Results: The 28 foreign national ex‐prisoners had been in immigration detention for longer and reported greater levels of unmet needs than the other 66 detainees. The highest levels of unmet needs among the foreign national ex‐prisoners were in the areas of psychological distress and intimate relationships. After adjusting for time spent in detention, there was evidence to suggest that foreign national ex‐prisoners had a higher screened prevalence of substance use disorders, autism spectrum disorders and attention‐deficit hyperactivity disorder than the other detainees.Conclusions/Implications for Clinical Practice: This study supports the view that foreign national ex‐prisoners are a vulnerable group within immigration detention who have needs for enhanced and specialist service provision, including appropriate arrangements for health screening and active consideration to alternatives to their detention.

The empirical research on the clinical management of intimate partner stalking perpetrators remains in the early stages of informing forensic practice. This study presents the first known structured review which seeks to inform intervention pathways for this group through illuminating the characteristics associated with intimate partner stalking. A systematic search was conducted across five academic databases, reference lists of papers were reviewed, and ‘experts’ contacted to identify relevant papers. The search strategy identified 2674 papers. Twenty-two studies were selected in line with predetermined inclusion/exclusion criteria and assessed for methodological quality. All studies employed an observational research design; eighteen quantitative, two qualitative, and two mixed methods design studies were included. Data were extracted and subjected to narrative synthesis. Overall, intimate partner stalking perpetrators presented with some similar characteristics to intimate partner violence perpetrators, whilst some characteristics were deemed more prevalent to intimate partner stalking perpetrators. The findings illustrate there are likely to be subtypes of intimate partner stalking perpetrators, requiring a bespoke approach to intervention. Limitations are presented and recommendations made for future research. The wider implications for forensic practice in informing the clinical management of this group and approaches to intervention are discussed.