Abstract

This study considers how those who work in prisons are affected by and respond to

repetitive self-harm of imprisoned women in English prisons. This paper considers the

perspectives of custodial staff working in this area on a day to day basis. Semi-structured

face-to-face interviews were conducted with 14 prison staff and explored using techniques

of thematic analysis. The interviews examined: the emotional impact of working with and

witnessing self-harm incidents, coping strategies used, training and the support available to

prison staff. Findings indicate the strategies used by staff to cope emotionally with such

incidents and these include presenting a ‘façade of coping’, rejecting support, and becoming

desensitized. It is concluded that staff felt they must portray themselves as coping well with

self-harm in prison even when they were troubled and emotionally affected by it. However,

some did describe accepting help when outside of the prison and this has implications for

how support can be offered in the future. It is recommended that more should be done to

support and train staff in this area.

Key words: Prison staff, suicide, self-harm, women, training, qualitative

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Introduction

Investigating the views and perspectives of professionals and service providers is a very

important, but regularly ignored component when studying repetitive self-harm. This is

often the case in the criminal justice system, especially prisons, where the incidences of self-

harm are high (Ministry of Justice, 2014), and prison staff have daily contact with self-

harming prisoners. Professionals dealing with self-harm often experience a range of worries,

anxieties and difficult emotions which they must deal with (Taylor, Hawton, Fortune, &

Kapur, 2009). Previous research has illustrated that the negative emotions that professionals

often have in this area are not only problematic for the staffs own psychological well-being.

But can also be harmful for their relationships with individuals under their care and may also

have negative consequences towards these relations too. (Marzano, Ciclitira, & Adler, 2012).

As a result of this, people who repeatedly self-harm have been found to limit their contact

with services due to their experience of unfavourable, unsympathetic and stigmatizing

attitudes of staff (James, Bowers & Van Der Merwe, 2011).

Research into the specific impact of self-harm in custody on prison staff is limited

(Marzano, Adler and Ciclitira, 2013; Walker, 2015; Walker et al, 2016a; Walker et al, 2016b);

but some parallels can be drawn between the experiences of prison staff and professionals

working in traditional healthcare settings (Short et al., 2009; Marzano, Adler and Ciclitira,

2013). Some healthcare professionals have viewed self-harm as attention seeking and

‘manipulative’ (Patterson, Whittington and Bogg, 2007; Short et al., 2009), while some staff

have reported frustration, distress and helplessness when working with individuals whom

they perceive to have harmed themselves for ‘non-genuine’ reasons (McAllister et al., 2002).

Some professionals develop antipathy towards self-harming individuals in their care,

attributing the cause of the behaviour to the character of the individual (Huband and

Tantam, 2000); and developing the belief that treatment for self-harm is futile (Friedman et

al., 2006; Patterson, Whittington and Bogg, 2007), particularly if self-harm is perceived as

repetitive and of low severity (Stanley and Standen, 2000). Similarly, many prison staff,

including prison healthcare staff (Marzano, Adler and Cicltira, 2013), report feeling

insufficiently trained to manage prisoners who self-harm, and thus powerless to support

them (Towl and Forbes, 2002; Short et al., 2009; Moses, 2013; Walker, 2015; Walker and

Towl, 2016a). Prison staff have reported feeling bullied into demonstrating concern for

prisoners who self-harm (Pannell, Howells and Day, 2003; Short et al., 2009; Marzano, Adler

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and Cilicitira, 2013). This can lead to prison staff becoming resentful, ultimately causing a

reduction in willingness to support prisoners who self-harm or even to reprimand them for

their behaviour (Pannell, Howells and Day, 2003; Kenning et al., 2010; Marzano, Adler and

Ciclitira, 2013).

Current measures to support prison staff are limited (Justice Committee, 2009;

Moses, 2013; Walker, 2015; Walker and Towl, 2016; Walker et al, 2016b). Presently, after

experiencing self-harm prison staff must be given information on, and assessed for

symptoms of post-traumatic stress; offered a post-incident debrief; and referred to the

prison Care Team (prison staff who, in addition to their regular duties, provide confidential

peer support service to colleagues following a traumatic incident) (NOMS, 2010b). Traumatic

incidents are defined as exposure to the violent death of a prisoner; being assaulted by a

prisoner; being taken hostage by a prisoner; or subjected to the real threat of violence

(NOMS, 2010b). This definition has been criticised for failing to consider the cumulative

effects of frequent, ‘minor’ incidents, or the effect of the individual officer’s relationship with

the prisoner involved (Justice Committee, 2009). Prison staff with a professional healthcare

qualification are usually required to have clinical supervision to practice (Dickson-Swift et al.,

2008). This supports job performance and self-development (McMahon and Patton, 2002),

and enables staff to identify and cope with any workplace stress (Dickson-Swift et al., 2008).

This is not however a requirement for prison officers (Moses, 2013; NOMS, 2015).

Personal characteristics have been shown to have an effect on the impact that

involvement in incidents of self-harm can have on prison staff (Wright et al., 2006).

Optimism and sense of control are linked to symptoms of traumatic stress; and higher stress

levels are linked to lower levels of perceived helplessness and avoidance (Wright et al.,

2006). Wright et al. (2006) suggest these counter intuitive findings could be explained by the

degree to which an individual’s optimism and sense of control represent unrealistically

positive expectations; and similarly, that a low sense of helplessness and avoidance suggests

the belief that they should have been better able to manage a difficult situation. Previous

experience of self-harm in custody is linked to higher trauma in subsequent incidents

(Wright et al., 2006). In some cases, involvement in a death in custody can lead to the

development of post-traumatic stress disorder (Wright et al., 2006). The ways in which

prison staff and health care staff deal with these pressures remain ambiguous and may be

multi-faceted. Although limited, the research on how prison staff approach their work seems

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to propose that they cope by rejecting or become emotional distanced from the prisoner

(Huband and Tantam, 2000); avoid responsibility (Short et al., 2009); have increased alcohol

consumption (Short et al., 2009); avoid difficult shift patterns (Marzano, Adler and Ciclitira,

2013); and have emotional blunting (Marzano, Adler and Ciclitira, 2013). These coping

strategies are largely ineffective for both managing stress and improving job satisfaction

(Mackay et al., 2004; Liebling et al., 2005).

The present study

Each year, it is estimated that 20% – 24% of imprisoned women in England and Wales self-

harm, compared with 5% - 6% of male prisoners (Hawton et al., 2014). Imprisoned women

are more likely to harm themselves repeatedly, approximately 8 times per year; whereas

imprisoned men self-harm approximately twice per year on average (Hawton et al., 2014).

The number of self-harm incidents by women in custody dropped by 50% (Ministry of Justice

[MoJ], 2015) between 2010 – 2013; however, this trend reversed during 2014 when 1,104

women self-harmed in custody, an increase of 6% compared to 2013. Overall, between 2004

and 2014, imprisoned women accounted for 27% of self-harm incidents, but they comprised

only 5% of the total prison population (MoJ, 2015). To date, there has only been a small

amount of research that has focused on the impact on prison staff of working with

imprisoned women who repeatedly self-harm (see e.g., Ward & Bailey, 2011; Kenning et al.,

2010; Short et al., 2009). This study aimed to increase knowledge and awareness of the

effect(s) of repetitive female self-harm on staff working in prisons, on both personal and

professional levels.

Methods

As part of a wider randomised controlled trial that was piloting and evaluating the

introduction of a Psychodynamic Interpersonal Therapy intervention for imprisoned women

who self-harm in three female prisons in England (Walker et al., 2017), which was conducted

from 2012 to 2015, semi structured interviews were conducted with 10 officers, 1 prison

governor and 3 healthcare staff. The interview schedule was informed by previous work in

the field (Ward and Bailey, 2011) and staff were invited to discuss the emotional impact of

working with and witnessing repetitive self-harm incidents by imprisoned women, coping

strategies used, their views on staff support and perceived training needs.

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Participants

Participant recruitment was purposive (Mays and Pope, 1995). Purposive sampling is a form

of non-probability sampling undertaken when strict levels of statistical reliability and validity

are not required because of the exploratory nature of the research (Kidder, 1981). Thirty

prison staff, 10 from each prison, were approached and 14 prison staff were recruited (4

men, 10 women) 7 from one prison, 4 from prison site two and 3 from the last prison. Of

the 14 participants 10 were prison officers, 1 was a prison governor and 3 were healthcare

staff. Table 1 describes the demographic information for the participants in more detail

(pseudonyms are used throughout to protect participants’ confidentiality).

Ethical considerations

Ethical approval for the study was obtained from the Health Research Authority

(12/EE/0179), the National Offender Management Service (NOMS: 76-12), the University

ethics committee where the authors were based and each Prison site. Participants had an

information sheet that contained an assurance of anonymity, information regarding the

study, the possibility to withdraw and the voluntariness of participation. Signed informed

consent was obtained and the findings presented in a way that no one could be recognised.

Insert Table 1 here.

Procedure

The interviews with the prison staff lasted up to 60 minutes and were digitally recorded with

participant’s consent. All interviews were conducted face to face and in a private room

within the prison between January 2014 and January 2015. Before the interview began,

participants read the participant information sheet that presented the aim of the study,

participants then read and signed a consent form. All the prison sites were closed category

for female adults and participants were employed across the three prison sites. Experienced

qualitative interviewers from within the research team undertook interviews.

Data analysis

All interviews were transcribed verbatim and were anonymised to protect the identity of

5

research participants and were individually checked for accuracy by a third member of the

research team. Analysis used the systematic method of thematic analysis proposed by Braun

and Clarke (2006). With this analytic strategy, data exploration and theory-construction are

combined and theoretical developments are made in a ‘bottom up’ manner so as to be

anchored to the data (Braun and Clarke 2006). Each transcript was analysed by looking for

patterns in the data and noting themes or analytical categories. This process continued until

no new themes were found – ‘data saturation’. Themes were then clustered together, noting

overlaps and goodness of fit, to form categories, which are reported in the results section of

this paper. Table 2 presents the main overarching themes and subthemes.

Insert Table 2 here.

Rigor

There has been a great deal of unresolved debate about rigor in qualitative research (Grbich

1999). In assessing the quality of the data collected in this study several factors were

considered. Credibility or confidence in the data was gained by the first author’s prolonged

engagement with the data (Guba and Lincoln 1981). Consistency was maintained by keeping

an audit trail and this involved asking a colleague not involved in the study to check over the

author’s decision and analysis processes. Transferability (neutrality) was evaluated by

providing the raw data to a colleague so they could interpret how themes had emerged.

Results

Coping ‘in’ the prison

Many participants stated they had colleagues who portrayed a ‘façade of capability’ and

behaved as if they had been undisturbed by their involvement in a self-harm incident as it

was perceived as “being part of the job” by participants. However, when away from the

prison they were having difficulty coping with the emotional impact of such incidents on

their own psychological well-being.

“Some staff act a bit tough, “I’m alright, I’m alright,” because they don’t want to let

that guard drop, that you’re an officer and you should be going through the flames,

that’s part of your job. But I have known staff to go to the chapel and light a candle

6

for somebody but they say, “don’t tell any participant that I’ve done that”. And that’s

putting on the bravado face to other members of staff.” (Brenda, officer)

“Please don’t try and be brave, if it’s affecting you [prison staff], if it’s stopping you

from sleeping, if you can’t get it off your head you need to be letting us [prison

management] know and then we’ll do something to help you. But it’s about getting

staff to accept that… There’s some sort of… unwritten rule is that it doesn’t affect you

[prison staff]. But clearly it, you know, you’d have to be inhuman for it not to affect

you.” (Karen, governor)

Participants used the term “de-sensitization” to describe how they and their colleagues

appeared no longer shocked by self-harm by imprisoned women and not panicking during

their involvement in an acute incident. Becoming desensitized was felt to be inevitable due

to the frequency of exposure to repetitive self-harm incidents, and the range of severities

and methods witnessed.

“What I found was really shocking… was staff’s ability to cope with the levels of

stress, because they would just be probably desensitized is the word, to get through

the day.” (Karen, governor)

Some participants perceived desensitization as having several advantages; in addition, to the

emotional protection of the self (self-preservation) – to prevent the situation escalating, to

support the prisoner, to support other participants, and to promote effective decision-

making.

“I think some of the skills I have learnt is to be very calm in a situation. Don’t “oh my

God, you’ve cut yourself!” “Oh, she’s nearly dead, she’s hanging!” Just deal with it as

a matter of fact incident… Don’t make a big drama out of it…Because especially if

you’re the manager in a struggle situation you have to lead that situation, you have

to be there for everybody… You kind of go into operational mode.” (Joe, officer)

“I’ve been here a lot of years and desensitized…I appreciate that it’s still really quite a

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sensitive thing, you have to support them [imprisoned women] with it [self-harm],

don’t react in such crisis, in such panic about it… I realised that you’re clinically or

professionally not benefitting that person [woman prisoner] if you’re in the same

state of mind as them [women prisoners].” (B, healthcare staff)

Several participants went on to state whether their sense of desensitization to the emotional

effects of witnessing repeated self-harm was storing up psychological damage for the future.

“I don’t know if I’m storing it all up and one day I’ll go pop! I very much doubt it but I

don’t know.” (Sandra, officer)

“If you sat and thought about your experiences in the work situation with the clients

that we have day in day out, that you could become very, very unwell yourself.”

(Trudy, healthcare staff)

Methods used for coping ‘on’ the job

The most common method for coping with incidents of repetitive self-harm on the job

seemed to be informal ‘time out’ during the shift, to go for a cigarette or a brew (cup of tea)

immediately after an incident, before continuing with routine work. This was felt to be

acceptable in terms of acknowledging that the experience was difficult, as opposed to

suggesting that coping with it was difficult.

“I was ordered to go for a cigarette afterwards and I went, “No, no, I’m okay”. “No,

you go for a cigarette please” …You’re a little shaken but then you get on and you

move on and there’s something else to deal with.” (Myra, officer)

“For general on going day-to-day incidents we wouldn’t have that [support]. So you

may have it after. You know, if we’ve had a planned removal [of a prisoner] just to go

“is everybody okay? Let’s have a brew, let’s sit down”, or quite a nasty incident of

self-harm.” (Joe, officer)

“If I’m in charge of an incident… I insist on making sure everybody’s ok and making

8

sure everybody has a brew or ten minutes, because your adrenaline s going crazy…

and you just need a bit of down time.” (Bex, officer)

However, the informality of this arrangement was perceived by some participants as a

potential source of conflict as some managers appeared to find it difficult to justify

participants having time away during a shift.

“You can’t just stop the day because that's happened [self-harm incident] … you

might deal with that one incident, you then can’t sit back, take some time, reflect,

support… if a member of staff said to me “I’ve just had a horrendous afternoon… I’m

going to disappear for an hour because I need to clear my head”, I’d have to make

a ... as a manager, you know, obviously care of this person [prison staff], welfare but

at the same time... It’s an operational job, you've [prison staff] got a job to do and

you need to do it.” (Joe, officer)

“That is difficult to manage, that work life balance, but what you find happens is

people [prison staff] think it becomes their right… you’ve got to say no because it’s

got to meet the business need as well, hasn’t it? So it’s about what’s right for them

[prison staff] but what’s right for the business as well.” (Karen, governor)

Some participants appeared resentful at what they perceived as management’s inability to

understand their needs.

“As much as the governors and so on can be supportive they have perhaps never

experienced anything that we experience on the ground floor because they’re so

distant from it... they’ll be supportive one day and trying to get you back into work

the next, and that's the situation. They [managers] don't understand, I don't think, all

the in-depths of what really goes on.” (Myra, officer)

“What good is it the governors knowing all about the ins and outs of everything when

people who are dealing with it day in, day out need to know? They need to be the

experts and the participant need supporting.” (Trudy, healthcare staff)

9

Most participants dismissed the formal support mechanisms or attempted to avoid being

seen to accept support from the Care Team in the prison, who are prison staff that offer

confidential peer support to colleagues following a traumatic incident (NOMS, 2010). No

explicit reason was given for this, although there are many references to participants being

expected to be involved in challenging incidents as part of their role.

“I’ve dealt with a lot of people via the Care Team but generally I know the staff and

will say “I don't want the care team. I’m okay”.” (Myra, officer)

“I personally wouldn’t use them [the Care Team]. I would make a beeline for my

friends in the service and people I trust… I probably wouldn’t necessarily make a

beeline for the Care Team, but they do offer the help.” (Bex, officer)

“We’ve also got our local participant Care and Welfare Team, which is fabulous, but

again, I don’t think people [prison staff] use it much, because there’s an element of,

not bravado but… “this is our job, this is what we do. If you’re coming to a prison

you’re probably going to see people who fight, take drugs, self-harm, shout at you,

swear at you, threaten you with violence” … So, there’s an element of that “get over

it”.” (Joe, officer)

Coping ‘away’ from the prison

It seemed that being away from the prison, allowed many participants to feel abler to

process their reactions to difficult experiences, such as witnessing repeated self-harm; and

were therefore more willing to accept help and support once they had left the prison

environment. Participants were more open to accepting support from the Care Team and

their colleagues by telephone at home, for example, rather than seeing a member of the

Care Team in the prison. This was because some participants continued to experience stress,

troubling thoughts or difficulty coping with a self-harm incident once they had left work.

Also, some participants related this to the desire to hide what they may perceive other

prison staff may see as being a failure to cope with the challenges they are expected to deal

with in the job.

10

“I was given a brief as soon as I entered the prison by the duty governor, who had

come in, and then a brief about the participant who found the body and so on and

then, yeah, support, and they all started, “no, I’m fine,” but I spent at least two

weeks being in contact with nearly all the staff afterwards [away from the prison].”

(Myra, officer)

“They [prison staff] used to phone me up at home in floods of tears because they

kept hearing a prisoner chewing through her skin, and that’s all they could hear.”

(Karen, governor)

Meeting with colleagues away from the prison was also a preferable means of obtaining

peer support.

“All of the staff on the unit… we all met in the pub and a few of us went who were in

uniform and we rang up the people [prison staff] that weren’t in work and they all

came from home and we all sat round and we were all literally kind of “what’s going

to happen now?” And it’s having the support of those people [prison staff] who all

came in from home.” (Sandra, officer)

“I can kind of go away and talk about it [self-harm] with someone… We support each

other quite well, me and [name] bounce off each other and can sort of talk it through

if something’s bothering us. But yeah, I don’t think I need any extra support.” (Ann,

officer)

Once at home, participants identified several stress management strategies that were

unrelated to the prison or their colleagues, including seeing friends and exercising. The

ability to avoid thinking about work whilst at home was also important to many participants.

“You hear about people “oh, I’ll go home, I have to have a bottle of wine because I’ve

had a stressful…” I don’t drink to excess. I’ll drink when I go out. Play some sport, play

rounder’s and stuff like that, and I’ve got quite a good friendship network that go out

11

a lot, go on holidays.” (Sandra, officer)

“I do have a treadmill and I’ve got my own gym, so I guess if I was to drive home

angry [after work] I’d probably spend a bit of time and take it out on a work out.”

(Phil, officer)

“It’s about putting your radio and your keys away before you go home, turn the

music on in the car and just let it ride.” (Ann, officer)

Future training to cope ‘with’ the job

Participants consistently asserted that they had little to no formal training specifically related

to supporting women who self-harm in prison, apart from the generic ACCT training. Many

participants appeared to feel this was inadequate, given that dealing with imprisoned

women who self-harm is a key aspect of their role. They also spoke about being unprepared

for the levels of mental illness seen in imprisoned women.

“A lot of senior officers who are managers of the ACCTs on wings, absolutely no idea,

and they’re the ones that are managing the risk of the self-harm and they don’t know

anything about [self-harm].” (B, healthcare staff)

“I’m a prison officer… So why am I dealing with people with acute mental illnesses

when we’ve got mental health hospitals?... And the way we can deal with people

[imprisoned women] is so limited… we just lock people [imprisoned women] up, we

put them in a room. Compared to a hospital or mental health unit it’s a lot different,

the facilities there… Either give us [the prison and prison staff] those facilities if

you’re going to send us [the prison and prison staff] those people [imprisoned

women with mental health issues] or don’t send us those people [imprisoned women

with mental health issues] in the first place.” (Joe, officer)

Several participants called for formal training and supervision in relation to self-harming

behaviour but highlighted that there were institutional barriers were a main reason why

training was not accessed and these would need to be overcome.

12

“I think more awareness around what self-harm is, why people self-harm, how we

[prison staff] can manage it, ways of coping and ways to help participant… How staff

can offload if they need to if they’re feeling frustrated or it’s [witnessing self-harm]

upset them.” (Ann, officer)

“I think [staff] need supervision, which I’ve been told they don’t get. I think even just

the kind of awareness phase of it, because a lot of them {prison staff] inevitably have

a negative stance with regards to personality disorder because all they see is the

negative side of it, the self-harming, the manipulation.” (Peter, healthcare staff)

“So, we [the prison] haven’t really invested enough where everybody who comes

into this prison who’s going to have contact with residents, mandatory, has to have

introduction to safer custody. We don’t do that. It takes four hours… But everybody

seemed to get keys, everybody managed to get the key talk, but when we said to

them you’ve got to come for a four-hour session, we just don’t seem to be able to get

people there [into training].” (Joe, officer)

Discussion

Fourteen prison staff were interviewed about their experiences of working with imprisoned

women who repeatedly harm themselves. Staff gave accounts that illustrated that they

believed they should not have difficulty coping with challenging incidents such as self-harm

or aggressive behaviour by imprisoned women. Staff described that this should be expected

in a prison environment (Moses, 2013). Consequently, it appeared that staff were reluctant

to ask for, or openly receive formal support from the prison. Staff reported using other

coping strategies in and away from the prison to manage the stress they encountered

because of working in this area. Coping ‘in’ the prison meant that staff had to maintain a

‘façade’ of being untroubled by having witnessed repeated self-harm incidents; even though

they admitted finding this difficult at times. Some staff felt desensitised to the emotional

impact of seeing the imprisoned women’s self-harm due to the high frequency of this

occurrence. However, they worried that this could indicate future psychological difficulties

(Wright et al., 2006). Methods used for coping ‘on’ the job following a challenging situation,

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included staff commonly needing a ‘time-out’ for a drink or cigarette to regroup. This could

cause conflict, as some managers were reluctant to allow this because of the potential

disruption to prison operations. Moreover, staff frequently refused the formal options for

support that the managers offered, such as referral to the Care Team. It is possible that this

is due to prison staff being expected to deal with challenging incidents on a day-to-day basis

(Moses, 2013), and thus suggesting that accepting support implies that they are unsuitable

for the job.

Coping ‘away’ from the prison, many staff accepted the Care Team’s support by

telephone; or met with their colleagues in informal settings such as the pub. Socialising with

friends who were not colleagues, exercising, drinking alcohol and going on holidays were

also identified as coping strategies. Staff largely felt that being unable to ‘switch off’ from the

job once away from the prison was a sign of poor coping. When discussing future training to

cope ‘with’ the job staff indicated that ‘training’ was an important factor. All the staff in this

study reported that they had received no formal training to support imprisoned women who

self-harm, though some were trained to complete the ACCT process. Some staff voiced that

they felt inadequately prepared to cope with the increasing numbers of imprisoned women

presenting with mental health problems. Staff identified institutional issues such as poor

staffing levels and the prioritisation of other training, for example in security, as barriers to

accessing training on self-harm and mental health issues.

There are issues regarding the transferability/generalizability of these findings to

other women’s prisons. This is because this study was conducted in a closed category prison

for female adults, with a predominately female staff sample. Interviewing more male

participants and/or staff dealing with other imprisoned women in different prison settings

may have resulted in a different picture of staff’s responses to repeated self-harm. However,

the themes presented here are supported by evidence from the data itself (Braun and

Clarke, 2006; Gust, MacQueen and Namey, 2012). The techniques of thematic analysis

(Braun and Clarke, 2006) enabled the unique perceptions of individual participants to be

recognised, which could have been rejected as anomalous using other methods (Bird, 1998;

Braun and Clarke, 2006; Flick, 2009). Additionally, purposive sampling was used to ensure

that a range of professional roles within the prisons was represented (Kenning et al., 2010;

Guest, Namey and MacQueen, 2012).

Conclusion

14

From these interviews, it appears that prison staff feel inhibited from accessing psychological

or emotional support from their employers (Justice Committee, 2009; Moses, 2013).

Exploring whether this is a common experience, and whether uptake rates differ across

different prisons, could indicate whether the issue requires addressing at a broader

organizational level. A subsequent investigation into why staff seem to hold negative

attitudes towards formal support and why they do not access the training that is often made

available could be useful in determining how to make it more acceptable, and useful to staff.

Ultimately this could help make support more accessible to prison staff, promote their

health and wellbeing, help improve the morale and satisfaction of prison staff and reduce

work related stress (Towl and Forbes, 2002; Mackay et al., 2004; Short et al., 2009; Kenning

et al., 2010; Marzano, Adler and Ciclitira, 2013; Moses, 2013). Lastly, for staff to be able to

manage their own psychological and emotional wellbeing in response to supporting

imprisoned women who self-harm, it seems that a culture shift is required to permit staff to

admit their needs, and to seek support (Justice Committee, 2009; Kotter, 2012; Moses,

2013). This could be implemented through supervision and by senior staff leading by

example (Kotter, 2012).

15

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Table 1: Descriptive characteristics of participants

Name Grade Gender Length of service in the prison service

Myra Officer Female 8 years

Bex Officer Female 8 years

Ann Officer Female 11 years

Joe Officer Male 23 years

Sandra Officer female 12 years

Frank Officer Male 10 years

Pam Officer female 5½ years

Phil Officer male 23 years

Mira Officer female 18½ years

Brenda Officer female 26 years

Karen Governor Female 28 years

Peter Healthcare Male 1 year

Trudy Healthcare Female 15 years

B Healthcare Female 7½ years

Table 2: Main themes and subthemes in the analysis

Overarching themes Subthemes

Coping ‘in’ the prison Façade of capability

Being part of the job

De-sensitization

Methods used for coping ‘on’ the job Informal time out – ‘brew time’

Conflict and resentment at management

Dismissing or avoiding formal support mechanisms

Coping ‘away’ from the prison Processing reactions to difficult experiences

Peer support away from the prison

Future training to cope ‘with’ the job No formal training for women who self-harm

Unprepared for the levels of mental health

problems

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Institutional barriers

24