Prisoner-Delivery of a Problem-Support Scheme: An Analysis of the Experiences of the Intervention and its Sustainability.

Introduction: Self-harm is highly prevalent in prisons. One possible intervention for this is problem-solving therapy (PST). This thesis looks at a problem-support scheme based on PST which is currently being delivered in a prison in Northern England. A peer-delivery model is being utilised and the scheme is delivered by prisoners known as problem-support mentors (PSMs). This research aimed to understand the experiences of the PSMs and the staff working within the establishment, and to understand how such a scheme can be sustained. Method: PSMs and staff stakeholders were recruited to participate in individual interviews at three time points between February and December 2019. Three time points were used to understand how the participants’ experiences unfolded longitudinally. These interviews were conducted using a semi-structured interview schedule designed to access their experiences of the scheme. These interviews were then transcribed and analysed using Thematic Analysis. Results: Twenty-eight interviews were conducted, and from these interviews five subordinate themes were identified. The first theme ‘appetite for peer-led’ describes the staff participants’ enthusiasm for peer-led schemes. The second theme, ‘need the ‘right’ PSMs’, captured the participants’ beliefs that not all prisoners are suitable for the role. The PSM participants reflected on their own ‘motivation and commitment’ as well as that of their peers. Finally, the ‘impact on PSMs’ and ‘impact on others’ were discussed. Two over-arching themes, of ‘responsibility’ and ‘us and them’, were identified as contributing to many of the described experiences. Discussion: The participants’ experiences of the scheme being based on PST, being peer-led and taking place within a prison are discussed in relation to previous research. There was considerable consistency between the findings of the current research and other research looking at delivering PST-based interventions, with model infidelity being common. The experiences of the scheme being delivered in prison are considered through a psychoanalytical framework of organisational defences. The research is critiqued and practical implications are discussed, including the need for an adequate level of resource for peer-led schemes to be successful.