Implementing an evidence-based approach to managing suicidality in Irish prisons

In 2021, CES was tasked with the creation of an implementation plan for an intervention to support the management of self-harm and suicidality in the Irish Prison Service (IPS). The Collaborative Assessment and Management of Suicidality (CAMS) framework was to be piloted in several Irish Prisons, with recommendations for scaling up across all IPS sites.

What is the CAMS framework?

CAMS is an evidence-based therapeutic framework that prioritises the suicidal service users’ point of view.

The framework includes:

• Collaboratively addressing the tasks of risk assessment.
• Risk management.
• Treatment planning.

The CAMS framework is generally used within community-based settings by clinicians but its use in detention and prison settings is limited to a few sites in the USA.

Challenges & Barriers

Implementation of the CAMS framework in a detention or prison site presented many challenges. Access to these sites is strictly controlled. Security and risk were major considerations for the project. Gaining complete access to stakeholders was difficult, especially when consultation with service users was required.

The COVID19 pandemic also further restricted access to implementation sites, resulting in project delays and meant that it was not possible to meet detained individuals.

What We Did

Despite these challenges, CES approached this project with a combination of robust methodology and involvement of stakeholder perspectives.

We reviewed national and international evidence relating to implementation of CAMS (in particular in custodial settings), followed by review of national policies and strategies around mental health and the prison service.

To ensure scalability of the framework, the team needed to demonstrate acceptability and relative advantage to stakeholders, as this was crucial for successful implementation of the intervention. As such, stakeholders’ engagement was integrated into all levels of the planning process, to ensure a sense of ownership and buy-in for the implementation process.

The CES team facilitated two-hour workshops with staff and management in 3 prison sites. Staff from these prison sites represented various aspects of the IPS, including healthcare, education, prison management, chaplaincy, probation, psychology, prison officers, addition, and integrated sentence management. Each group identified potential barriers and enablers to implementation and possible strategies or approaches that could remove barriers and exploit enablers to optimise the implementation plan.

The Implementation Plan

CES successfully delivered an initial implementation plan for piloting the CAMS framework in the identified sites, followed by a further plan for scaling up the framework. For the first year of implementation, the plan consisted of three stages:

1. Exploring and Preparing
2. Planning and Resourcing
3. Implementation and Operationalising

Whilst for scaling-up the process, CES used an integrated, stage-based framework to suggest two options:

• Roll out on a phased basis, within each prison or a cluster of prisons
• Implementation of the model across the prison state in its entirety.

Useful resources

Further reading into our work in the area of justice: CES Impact Areas: Justice | Justice

Implementation tools and resources are available here: Tools and resources

More information on the CAMS Framework is available here: Collaborative Assessment & Management of Suicidality (CAMS)