This is the fourth annual report on all recorded episodes of self-harm by individuals in the custody of the Irish Prison Service. The report provides data from all prisons in the Republic of Ireland in 2020 and 2021 arising from the Self-Harm Assessment and Data Analysis (SADA) Project.

Main findings:

• Over a two-year period between 01 January 2020 and 31 December 2021, there were 421 episodes of self-harm recorded in Irish Prisons, involving 217 individuals. There were 225 episodes of self-harm involving 126 individuals in 2020 and 196 episodes involving 91 individuals in 2021. Thus, the number of self-harm episodes was 12.9% lower in 2021 than in 2020 and the number of persons involved decreased by 27.8%. The overall prison population decreased by 0.8% between 2020 (n=3,823) and 2021 (n=3,792). The annual person-based rate of self-harm in 2021, at 2.6 per 100 prisoners, was significantly lower (27.8%) than the rate recorded in 2020 (3.6 per 100) but similar to the rate recorded in 2019 (2.7 per 100). Thus, an episode of self-harm was recorded for 3.6% of the prison population in 2020 and 2.6% in 2021. The COVID-19 pandemic led to unprecedented measures being implemented in prisons, the outcomes of this report suggest that infection control methods did not lead to an increase in self-harm, however the decrease in the prison population should be considered.
• The majority of prisoners who engaged in self-harm in 2020 and 2021 were male (n=172; 79.0%) but taking into account the male prison population, their rate of self-harm was 2.8 per 100 in 2020 and 2.3 in 2021, with a decrease of 17.9% recorded. Thirty-one female prisoners engaged in self-harm in 2020 and fourteen in 2021 equating to rates of 36.9 per 100 in 2020 and 15.6 per 100 in 2021, respectively. This represents a twofold decrease in the rate of self-harm among female prisoners recorded between 2020 and 2021, following a twofold increase between 2019 and 2020 (14.1 versus 20.9 per 100). The rate of self-harm was highest among sentenced prisoners aged 18-29 years in both years, with a twofold decrease recorded in 2021 compared to 2020 (4.9 versus 2.3). Across all age groups, the rate of self-harm was higher among female sentenced prisoners.
• A new category for offence type was introduced to the SADA form in 2020. In 2020, assault including battery and causing harm was the most common offence type recorded by those who engaged in self-harm (44.2%), while in 2021, burglary/robbery/theft was the most common offence type recorded (31.6%)
• Half of all self-harm incidents occurred between 2pm and 8pm in 2020 and 2021 (45.4%; n=191). Most episodes (56.7%) occurred while prisoners were unlocked from cells.
• The rate of self-harm was 2 times higher among prisoners on remand than those sentenced in 2020 (3.0. versus 1.5 per 100) and 2021 (3.1 versus 1.5 per 100).
• 32 out of 126 individuals self-harmed more than once in 2020 (25.4%), while 39 out of 91 individuals self-harmed more than once in 2021 (42.9%). In both years this was more pronounced for female prisoners: 22.1% of male prisoners repeated self-harm in 2020 (n=21 individuals) compared with 35.5% of female prisoners (n=11); while 40.3% of male prisoners repeated self-harm in 2021 (n=31) compared with 57.1% of female prisoners (n=8). A small number of individuals engaged in self-harm more than ten times in both 2020 and 2021.
• The most common method of self-harm recorded was self-cutting or scratching, which was present in 60.8% of all episodes in 2020 and 62.7% of all episodes in 2021. The other common method of self-harm was attempted hanging, involved in 27.9% of episodes in 2020 and 15.9% of episodes on 2021. A fourfold increase in the use of blunt objects was observed between 2019 (n=8) and 2020 (n=33), with twenty-eight females engaging in self-harm involving blunt objects in 2020 compared to under five in 2019. Episodes involving blunt objects stabilised in 2021 (n=17) but they were still twice as high as 2019.
• Three quarters (77.3% and 71.9%) of self-harm episodes involved prisoners in single cell accommodation in 2020 and 2021. Considering the overall prison population, 52.1% were accommodated in single cells in 2020 and 56.7% in 2021. In 2020 and 2021, 67.6% and 73.5% of prisoners who engaged in self-harm were in general population accommodation and a further 18.2% and 14.8% were on protection (including Rule 62 and 63) at the time of the self-harm act.
• No medical treatment was required for almost half of episodes in 2020 (44.9%) and one quarter of episodes in 2021 (24.0%). In 2020 and 2021, 44.5% and 55.6% required minimal intervention or local wound management in the prison. One in ten required hospital outpatient or accident and emergency department treatment in 2020 (n=23; 10.2%), while one in twenty required hospital outpatient or accident and emergency department treatment in 2021 (n=9; 4.6%). Self-harm episodes by male prisoners were associated with increased severity. In 2020, 71.2% of male prisoners who self-harmed required some medical treatment compared with 32.3% of female prisoners, while in 2021, prisoners requiring some medical treatment was equal across both genders (76.4% versus 75.0%).
• More than two-thirds of self-harm episodes were recorded as having no / low degree of suicidal intent in 2020 and 2021 (70.2% versus 64.8%). Twenty-five per cent of episodes were recorded as having medium intent in both years and approximately one in twenty in 2020 and one in ten in 2021 (4.4% versus 10.7%) episodes were deemed to have a high degree of suicidal intent.
• There was a range of contributory factors associated with the episodes of self-harm recorded in 2020 and 2021, relating to environmental, relational, procedural, medical and mental health factors. The majority (45.2% in 2020, 53.7% in 2021) of factors related to mental health issues, 22.7% and 14.0% to relational issues and 15.6% and 15.4% to environmental issues.