In the prison system in the United Kingdom, self-harm is a major issue, particularly for women. Overall, women in prison are much more likely than men to self-harm.
It is important to understand self-harm as a form of communication, and sometimes, a kind of currency with which to purchase care, making visible invisible pain.
Self-harm can also be a compulsion to a means of release that is very hard to give up. It is not always a public expression or call for help.
Many patients I have worked with outside custody have disclosed secret rituals of self-harming with no outward signs of disturbance or violence.
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