Hyde, Sara K S
(2025)
‘Physically efficient, psychologically detached’: prison healthcare staff experiences of, impacts from, and strategies for, working with prisoner self-harm and suicides.
PhD thesis, University of Nottingham.
Abstract
This thesis has considered the experiences of prison healthcare staff working with prisoner suicide and self-harm in 21st century prisons in England and Wales. It was interested in temporality, in how these experiences impacted staff and their practice contemporaneously and over time, as well as how accumulation of such experiences affected them. It explored how healthcare staff may still deliver quality healthcare to those who are suicidal and self-harming, even in the context of ongoing prison crises.
This thesis used processual ontology which conceptualises the world as dynamic, emergent, contingent, giving ‘full reality to relations and becoming’ (Renault, 2016: 22) and a congruent interpretivist epistemology. To further understand the complexities and nuances of healthcare staff responses to prisoner suicide and self-harm as posed by the research questions, a qualitative method was chosen. Qualitative methods ‘are dynamic and capture emergent meanings’ (Bosk, 2014), demonstrating their compatibility, feasibility and usefulness within the ontological approach adopted and as a fitting method for the methodology. 28 semi-structured interviews were undertaken, with three cohorts of participants: former prison healthcare staff, special knowledge stakeholders and senior managers. Data were analysed using reflexive thematic analysis, findings and analysis from which are reported herein.
Participants in this study repeatedly returned to the constrained context – custodial, under funded, under resourced – in which their work with prisoner suicide and self-harm occurred and the implications of this for them, their practice and the prisoners in their care. Prison healthcare staff experiences of self-harm and suicide are not only determined by clinical, psychosocial and environmental factors (Favril et al., 2020), they are also profoundly influenced by governmental factors, the practical outworkings of policy decisions. The pressures, paucity and fast pace of work with those who are suicidal and self-harming are some examples of this, which can lead to disenfranchised trauma in staff. Staff experiences highlighted the need for broader definitions of self-harm to include invited violence. Staff experienced enduring effects from prisoner suicide attempts, even when life was preserved. Staff could experience distress and moral injury as they struggled to preserve prisoner dignity after death. Staff attested to the potential preventability of many suicides, including problems of enacting Assessment, Care in Custody and Teamwork (ACCT) processes and constrained professional curiosity, causing frustration and despair in staff. This thesis argues that some prison suicides could be better understood as another example of Aitchison’s (2024) induced self-violence, nomenclature that renders contributory factors more visible.
Prison healthcare staff acclimatised to working with prisoner self-harm and suicide. This is conceptualised as a dynamic continuum: from strategies that retain the human-ness of staff at one end, through the more prevalent phenomena of normalisation, detachment, desensitisation and dehumanisation. Dehumanisation is a finding for prison staff here and provided examples of the theory of malignant alienation (Morgan and Priest, 1984), in prison healthcare staff practice. Attending coroners’ courts after suicides created significant stress, distress and anxiety for staff. These were further compounded by delays, the jury’s poor understanding of prisons, and adversarial, blame-seeking inquests that responsibilised individual staff, deflecting inquiry from structural or governmental factors. Staff experienced inquests as damaging – before, during and after – creating enduring anxious, avoidant practice and staff attrition, resulting in poorer care for suicidal and self-harming prisoners. In amongst these findings, there was a cohort of prison healthcare staff whose strategies sustained them in an exceptionally tough workplace, enabling them to deliver compassionate healthcare to prisoners who self-harmed and/or were suicidal, at least some of the time. Staff were squeezed, yet still sentient and sustained by finding their work meaningful, by taking action to improve other health outcomes, collegial trusting, and talking and being witnessed.
This thesis aims in some small way to erode the hermeneutical marginalisation of prison healthcare staff experiences, assisting in making visible their experiences and those of prisoners who are suicidal and self-harming, thereby expanding prison epistemology. It rejects responsibilisation and espouses the interconnectedness of all people and things, as such it understands the reduction of prisoner suicide and self-harm, and enhancing prison safety as a collective endeavour. Although this thesis is about subjects more usually correlated with despair and not hope and incorporates some concerning findings – it contains pockets of hope. People, their thoughts and actions, can and do change. Because in amongst the sadness, despair and multiple poor decisions that have led to the prisons permacrisis, there are still people working with compassion and hope, demonstrating another way is possible.
| Item Type: |
Thesis (University of Nottingham only)
(PhD)
|
| Supervisors: |
Tomczak, Philippa J
Jordan, Melanie |
| Keywords: |
Prison, Prison staff, self-harm, suicide, temporality, processual ontology, prison wardens |
| Subjects: |
H Social sciences > HV Social pathology. Social and public welfare |
| Faculties/Schools: |
UK Campuses > Faculty of Social Sciences, Law and Education > School of Sociology and Social Policy |
| Item ID: |
80959 |
| Depositing User: |
Hyde, Sara
|
| Date Deposited: |
25 Jul 2025 04:40 |
| Last Modified: |
25 Jul 2025 04:40 |
| URI: |
https://eprints.nottingham.ac.uk/id/eprint/80959 |
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