Laura Bennett and Judith Dyson review the literature to find out how this issue has become such a problem among inmates and why policies to reduce it are not being implemented successfully

This article explores barriers that prevent or interfere with the implementation of policies for reducing deliberate self-harm in adults in prisons and the levers that aid implementation. An integrative literature review was conducted of 12 studies of deliberate self-harm in the prison service between 2000 and 2012. Data were analysed thematically. Six themes were identified: knowledge; attitudes; emotion; staff skills; environment; and resisting treatment. The authors argue that having identified barriers and levers, the next stage is to address them so that the high levels of self-harm in prison can be reduced.