Prison conditions and suicide
1. Overcrowding
The massive increase in the prison population in recent years has caused extreme prison overcrowding. Put simply, overcrowding means too many prisoners, not enough spaces for them, and not enough staff to care effectively for each prisoner. Overcrowding causes prison regimes to be squeezed even further and threaten the ability of a prison to treat a prisoner with decency and compassion. Overcrowding and the consequent movement of prisoners around the estate limit the ability of staff to get to know and develop personal relationships with prisoners (The Howard League for Penal Reform).
2. Reception
The sheer numbers of people being received into local jails from the courts limit the ability of the prison authorities to spend sufficient time with each individual prisoner on arrival at the jail to determine whether they are at risk of suicide. Instead of being a thorough examination of a prisoner’s welfare, the reception interviews are often cursory and frequently take place in a corridor with no health care representative present. This rushed process does nothing to engender a feeling of prisoner safety (The Howard League for Penal Reform). Prisoners often arrive at busy local prison late into the evening, in large numbers, withdrawing from drugs, feeling terrified and in a state of shock. The physical facilities were often cramped and inappropriate for the purpose; contacting relatives was difficult, at the highest risk time, and in the highest risk places, prisoners had access to very little support (Jewkes 2007:433).
3. Bullying
Bullying has been endemic in prisons, particularly those housing young offenders and juveniles, and has an insidious effect on those targeted, causing fear and anxiety and worsening the prison experience for those already deemed vulnerable to risk of self-harm or suicide. Efforts have been made to effectively tackle have been made by the prison service but the result are patchy (The Howard League for Penal Reform).
How many people die in custody in England and Wales?
The development of the Prison Service Suicide Strategy
In August 1992 the Prison Service published an information paper entitled “The Way Forward”, as part of its work to develop a revised strategy towards the prevention of suicide. It incorporated a search of the literature, an analysis of suicides in prison both in this country and abroad, and commissioned independent research by Dr Alison Liebling at the Institute of Criminology in Cambridge into the behaviour and characteristics of male prisoners who attempt suicide or harm themselves. The produced lists of risk behaviours which should alert staff to suicide vulnerability, and of triggers which may hasten the onset of suicidal feelings, “Guide to Policy and Procedures – Caring for the Suicidal in Custody”, issued under Instruction to Governors 1/94. It was implemented from April 1994 onwards through a “cascade” programme of training conducted by staff from each establishment who themselves had attended central training in the delivery of the modules (HM Inspectorate of Prisons 1999:37-38)
The main features of the 1994 strategy were:
- Greater responsibility for all prison staff in caring for the suicidal
- A move away from the reliance on health care staff
- A new form from managing those considered as being at risk (F2052SH)
- Involvement of The Samaritans
- The development of Listener Scheme
(HM Inspectorate of Prisons 1999:38)
The Prison Service has faced a rising number of suicide and high rates of self harm. It has a duty of care to the prisoners in its custody. The recent internal review of the Prevention of Suicide and Self-harm in the Prison Service (HM Prison Service 2001a), which follows publication of a review conducted by the former chief inspector of Prisons, marks a significant change in the previous strategy for dealing with this problem. It set out a vision for the service that emphasizes prevention, pays more attention than previously to self-harm as a problem in its own right and advocate putting significant additional resources into establishment that are at highest risks of suicide – notably large local prisons with a high turnover of prisoners, and female and young offender establishments (HM Prison Service 2001a) cited in Jewkes 2007:433.
Early situational suicide prevention in HM prison service
Traditionally in the UK prisoners at high risk of suicide were often placed in isolation in cells known as strip cells (unfurnished rooms). These cells are typically low stimulus, ligature-free and have minimal furniture (typically only a low built-in bed); although most means of self harm are removed in these cells and the opportunities for committing suicide are, therefore, minimised, there are a number of other unintended effects that the cells can have on prisoners, these include increased isolation, frustration and depression and depression as a result of being held in a particularly abnormal environment and over which the occupant has little control. As result, the use of strip cells in the management of prisoners identified as at risk of suicide or self-harm was officially eliminated by the prison service in 2000 ().
The introduction of safer cells
The vast majority of suicides in prisons (93%) occur by hanging (SCG Construction units, April 2001). This prompted the safer custody group in HM Prison service to develop a new type of prison cell (safer cells) where obvious ligature points were removed, but which were more humane than strip cells. Safer cells were first introduced in HMP Belmarch in 1997 with the aim of reducing hanging. Reducing ligature points has the added advantage that a switch to an alternative method of committing suicide will be slower and increases the chances that staff might be able to intervene. While safer cells still aim to control the facilitators for suicide by removing potential ligature points, they also retain an environment that is as normal as possible, so that the negative effect observed with strip cells can be avoided. In a safer cell, all the corners and rounded, the pipes are covered, the light fittings are modified, and a safe ventilator is placed instead of windows that open and that could, therefore, be used to attach a ligature (www.jdi.ucl.ac.uk).
How do other method compare with safer cells
There was agreement between staff and inmates that safer cells alone could not successfully address self-inflected death and self-harm. The importance of good relations with staff, the listeners’ scheme, a normalised environment, a cell-mate, and on-going support were all mentioned as contributing to the management of self-inflicted death and self-harm. There were nevertheless some agreements that safer cells could be useful in reducing the success of impulsive suicide attempts by hanging. There were seen to be three viable alternatives to the management of hanging: the first two – gated observation cells and CCTV would both need constant monitoring to be successful. The third, sharing cells with other inmates, also requires constant vigilance by the cell-mate, although the emotional and other support from the cell-mate might have a positive effect itself. All three approaches in effect call for the introduction of “Guardians”. But suicide by hanging can be carried out quickly and with the best will in the world, at risk individuals cannot be watched all the time. This, combined with the fact that reliance on guardianship would depend upon successful risks assessment, which is itself problematic, argues in favour of cell design as an important contributory factor in preventing this particular form of suicide (www.jdi.ucl.ac.uk).
Significant investment has been made during the year 2004 that includes:
- A further expansion in mental health service into prison.
- Implementation of a revised health – screening tool on reception into prison to identify those at greater risk.
- The development of a mental health awareness training programme for prison staff.
the Safer Custody Group programs established in November 2000 included the appointment of 30 full time suicide prevention coordinators at the 30 establishment identified as at highest risk, strengthening of The Samaritan – led Listener scheme and improved partnership work with the National Health Service including the provision of increased Mental Health in reach support in establishment. The Safer Locals program consisted of a specific set of interventions in five pilot sites, including major improvement to the built environment. These changes included:
- Newly built first night centres
- New or refurbished reception and induction areas
- Improved receptions screening
- Health Care Centre refurbishment
- Dedicated detox units
- Day care centres
- Safer cells and care suites
- Additional training support
- Increased provision of specialists (e.g. Mental Health in reach) staff
- Increased used of peer support
All the pilot sites were provided with the project manager. Two explicit aspirations for the program were, first, that prisoners would receive better treatment during their first 24 hours and first weeks of imprisonment; and secondly, that this improved treatment will continue else where in the prison as increased attention in these areas of work would gradually bring about cultural change in difficult local prisons (Jewkes 2007:434)
Reduction in suicide rate
The Howard League for Penal Reform has welcomed a drop in suicides figures in 2006. That year saw the fewest prison suicides in a decade. While the pattern for suicides in local prisons remains a cause for concern, the overall picture has some better news to tell. Last year, 64 men and three women killed themselves in prisons n England and Wales. This was a 14 per cent reduction on 2005. the reduction in the number of suicides has occurred despite the immense pressure on the prison system due to record numbers of inmates ().
Record fall for 2006 prison deaths -01 January 2007
The Prison Service has announced that there were 67 apparent self-inflicted deaths among prisoners in England and Wales in 2006, the lowest figure since 1996. That represents a fall of 14 per cent, compared with 78 such deaths in 2005, and follows a fall in 2005. Three of the 67 were female, compared to four in 2005. The prison population hit an all time high during 2006 and contains a high proportion of very vulnerable individuals, many of whom have experienced such troubled lives that the likelihood of them harming themselves is increased. Many more lives are saved than lost. During 2006 prison staff is estimated to have resuscitated over hundred prisoners after serious self-harm incidents. Many hundreds more have been helped by the care and timely interventions of staff ().
Conclusion
Individual factors relating to mental health and drug use play an important role in suicides imprison, but it should be acknowledged that structural factors play a role in offending, in drug, and alcohol abuse, and in the distribution of suicide risk in the community. It is also the case that sentencing practice and vulnerable populations. Prisons are intended to punish by depriving intended to inflict intolerable distress. Material conditions have improved imprisonment may have become increasingly harsh as the predispositions effective, and sentences have become longer. If prisons are to be more rather Use of and faith in the prison should be limited by our increasing knowledge about its negative effects. Once in the hands of the state, prisoners are owed an enhanced duty of care by those who administer prisons.
Suicide prevention in prison requires attention to be paid to the needs and vulnerabilities of the prison population, which differ by prison and with the sentencing climate. Careful consideration should be given in particular to diverting vulnerable groups away from custody and to providing support and opportunities for change in the community. Transitions (between prisons or from one wing to another) should be minimized or used with care (see Harvey 2004). In prison, specialist (mental health) support, adequate training, good reception and induction facilities and procedures, and proactive screening and support are all essential. Attention also needs to be paid to the general prison environment: to levels of activity, to safety, to culture and to staff-prisoners relationships. Some prison environments are clearly more survivable than others. More should be learnt about survivable models of imprisonment and the organizational conditions that render them so, as well as about more constructive alternatives to custody (Jewkes 2007).
Bibliography
Jewkes, Y. (2007) Handbook on Prisons. USA and Canada: Willan Publishing.
HM Inspectorate of Prisons (May 1999) Suicide is Everyone’s Concern: A Thematic Review by HM Chief Inspector of Prisons for England and Wales. Thematic Report.
Liebling, A. Maruna, S. (2005) The Effects of Imprisonment. USA and Canada: Willan Publishing.
April 5, 2007: Suicide and local prison, , accessed 17/11/07.
National Suicide Prevention Strategy for England: Annual Report on Progress 2004, accessed 18/11/07.
Reducing Self Harm and Suicide in Prisons, accessed 10/11/07.
How many people die in custody in England and Wales, accessed 05/11/07.
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Frottier, Patrick, Konig, Franz, Matschnig, Teresa, Seyringer, Michaela – Elena and Fruhwald, Stefan (2007) ‘Suicide Prevention in Correctional Institutions: the significance of solitary cell accommodation, international journal of prisoner health, 3:3, 225.
http://www.hmprisonservice.gov.uk/resourcecentre/pressreleases/index.asp
