The Self-Harm Assessment and Data Analysis (SADA) Project was set up in Ireland in 2016 to provide robust information relating to the incidence and profile of self-harm within prison settings as well as individual-specific and context-specific risk factors relating to self-harm. In addition, it examines patterns of repeat self-harm (both non-fatal and fatal). The Health Service Executive’s National Office for Suicide Prevention and the National Suicide Research Foundation assist the Irish Prison Service with data management, data analysis, and reporting. This article highlights findings from a report presenting data in the analysis of all episodes of self-harm across the Irish prison estate during the year 2018.1

Episodes of self-harm

Between 1 January and 31 December 2018, there were 263 episodes of self-harm recorded in Irish prisons, involving 147 individuals. The majority of prisoners who engaged in self-harm were male (82.3%), but taking into account the male prison population, the rate of self-harm among males was 3.4 per 100 prisoners. Twenty-six female prisoners engaged in self-harm in 2018, equating to a rate of 19.3 per 100 prisoners, which is 5.7 times higher than the rate among male prisoners.

Methods, severity, and intent

The most common method of self-harm recorded was self-cutting or scratching, which was present in 69% of all episodes. The other common method of self-harm was attempted hanging, which was involved in 20% of episodes. In 27% of self-harm episodes, no medical treatment was required, while over one-half (59%) of all episodes required minimal intervention/minor dressings or local wound management. One in eight episodes required hospital treatment (12%). Over two-thirds (70%) of self-harm episodes were recorded as having no/low suicidal intent, with 17% recorded as having medium intent. Approximately one in eight acts was rated as having high suicidal intent (13%).

Contributory factors

The most common contributory factors to self-harm are shown in Figure 1. The majority of contributory factors recorded related to mental health (45.6%). The category of mental health issues included mental disorders as well as problems with coping and emotional regulation. Substance misuse, including drug use and drug seeking, was the next most common factor recorded (16.3%).

Other findings and recommendations

Other findings highlighted in the report include the following:

• Three-quarters (73%) of self-harm episodes involved prisoners in single cell accommodation. Considering the overall prison population, 51.9% of prisoners who self-harmed were accommodated in single cells in 2018.
• The rate of self-harm was higher among prisoners on remand or awaiting trial than among sentenced prisoners (5.0 vs 3.7 per 100 prisoners).
• In line with previous findings, substance abuse continues to be one of the primary factors associated with self-harm among the prison population in Ireland. The report authors suggest that there is a need for active consultation and collaboration between the mental health services and addiction treatment services for prisoners who present with dual diagnoses in line with action 2.1.24 of Reducing harm, supporting recovery to ‘improve outcomes for people with co-morbid severe mental illness and substance misuse problems’.2

Source: McTernan et al. (2020)

Figure 1: Most common contributory factors to self-harm in Irish prisons, 2018

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2 Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health.  https://www.drugsandalcohol.ie/27603/