RAPSS (Risk Assessment for Prisoners at risk of Self-harm and Suicide)
Research type
Research Study
Full title
Development and validation of a risk assessment tool for self-harm in prisoners
IRAS ID
239795
Contact name
Seena Fazel
Contact email
Sponsor organisation
University of Oxford Clinical Trials and Research Governance
ISRCTN Number
ISRCTN41021444
Clinicaltrials.gov Identifier
41021444, ISRCTN
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Research Summary
Rates of self-harm in prisoners are high and have been increasing for some years. Nearly a decade ago, the Ministry of Justice (MoJ) implemented Assessment, Care in Custody and Teamwork (ACCT), a risk management plan, to collect important information for prisoners considered at risk of self-harm and suicide, to assist in reducing self-harm and suicide in prisons. A particular problem has been the assessment of risk of recurrent self-harm on closure of ACCT, for which no structured approach exists. Self-harm has detrimental impacts on an individual’s health and social wellbeing; it has resource and cost implications and may disrupt reintegration on release. Reduction of such risk is therefore important for the MoJ, the NHS, and public health more generally. There are three parts to the project as specified in the brief. We request CAG approval for Stage 1 to access records without consent as detailed later in this application.\n\nStage 1:Development of a risk assessment tool. We will develop the tool using routinely collected information. It will aim to identify risk of repeat self-harm within 3 months following the closure of an ACCT. \nStage 2: Qualitative study. We will then assess the acceptability of the new tool to relevant stakeholders (prisoners, clinicians and prison staff) and examine barriers to implementation.\nStage 3: Prospective study. After information from the qualitative study on feasibility and acceptability has been gathered, we will then conduct a validation study and test whether the tool predicts self-harm in prisoners at the end of their ACCTs.\n
Summary of Results
In this study, we aimed to improve the assessment of repeat self-harm among people in prison, which is common in men's and women's prisons, and managed inconsistently and without a structured approach. We developed and tested a new approach to assess the risk of repeat self-harm, and asked prison staff and people in prison about how and when it could be used.
The study involved data from English prisons, based on more than 1000 people aged 18 and older who had been already identified at risk and were at the end of a suicide management plan. The study used high-quality methods to develop an approach drawn from the rest of medicine and found that a new approach could involve asking about nine individual characteristics of people in prison, such as age, sex, previous self-harm, and various factors related to what had led up to their recent suicide risk management plan, including triggers and any methods used for self-harm. We also examined the different views of staff working in custody and people in prison to identify what they thought about the new tool. The discussions used a format referred to as an 'Action learning Group'. This was a semi-structured process that helped the research team to work out how the tool could be used in practice.
This new assessment was found to be useful in predicting repeat self-harm risk. It could help bridge the gap between the end of an acute suicide care plan and aftercare for people in prison. Additionally, when we consulted with prison staff and prisoners, they welcomed this new approach and recommended how it could be integrated with current processes to provide more comprehensive wrap-around care for people at risk in prison.
REC name
Wales REC 3
REC reference
20/WA/0038
Date of REC Opinion
2 Apr 2020
REC opinion
Further Information Favourable Opinion