4. Memorandum submitted by the Prison
Reform Trust
SUICIDE IN
PRISONS
1. Overview: A healthy prison
In his 1999 Thematic Report, Suicide is Everyone's
Concern, the then Chief Inspector of Prisons, David Ramsbotham,
outlined four tests of a healthy prison:
— The weakest prisoners feel safe.
— All prisoners are treated with respect
as individuals.
— All prisoners are busily occupied,
are expected to improve themselves and given the opportunity to
do so.
— All prisoners can strengthen links
with their families and prepare for release.
(HMCIP, 1999: 60)
It is hard for prisoners to maintain their mental
health and dignity when they are forced to defecate in front of
strangers and eat their meals next to a lavatory. It is hard for
prisoners—particularly for those who have experienced abuse
as a child—not to be distressed by regular physical searches,
or the less frequent but more intrusive strip searches which are
part of maintaining security.
The Royal College of Psychiatrists stated bluntly,
"A healthy prison is almost a contradiction in terms."
(JCHR, Ev 186) They presented a detailed picture of negative practical
consequences of imprisonment, any one of which could have serious
implications for a person's levels of emotional distress:
"Separation from family and friends, entry
into an alien environment, sudden withdrawal from drugs and alcohol,
an uncertain future, loss of job and income, the rupture of many
social relationships and supports, all induce mental distress
and disorder."
(JCHR, Ev 186)
2. The effects of the prison environment—overcrowding
The links between overcrowding and the risk
of self-inflicted deaths are not simple. Overcrowding has diverse
causes and consequences, and it would be unwise to try to pin
down a single, direct link between overcrowded prisons and increased
rates of self-inflicted deaths.
However, between January 2005 and the end of
September, 48 of the 60 (four out of five) self inflicted deaths
in custody occurred in prisons that were above their Certified
Normal Accommodation. During this period, half of the prisons
in the system were above their CNA. Prisoners who took their own
lives were disproportionately likely to do so in an overcrowded
prison.
Some of the inherent effects of overcrowding
are clearly related to commonly identified risk factors, for example,
prisons with high turnover tend to:
— have a high proportion of prisoners
in their first month of custody;
— provide fewer hours of meaningful
activity; and
— hold higher proportions of people
who have problems with mental health or drug misuse.
All of these are well-established risk factors
for self-inflicted death. In addition to these, it is likely that
overcrowded prisons are more stressful environments, due to cramped
cells, the strain on basic resources such as diet, showers, and
toilets, and the risk of victimisation by other prisoners.
Staffs, under pressure, have less time to get
to know prisoners personally or to give them caring attention.
Officers are also limited in their ability to gather information
about individuals which could help to identify who is at particular
risk of suicide. This problem has been exacerbated in recent years
by a deliberate policy pursued by Prison Service management to
reduce the number of staff active on a wing at any time. The so-called
"Performance Improvement Process" requires prison management
to cut costs, and the primary target for "savings" is
the reduction of staff numbers.
The increased use of prisons as a fall-back
mental health resource has meant that the number of prisoners
with "imported vulnerability" has risen. A study by
Seema Fazel, at the University of Oxford, found:
— over the past 25 years, the rate
of suicide in prisons has been five times higher than in the general
public;
— the rate for young men 15-17 years
old has been 18 times the rate in the general public;
— although the rates of suicide have
been falling in the general public they have remained constant
in prisons (and hence the gap between prisons and the public is
growing).
3. The effects of the prison environment
(quality of life)
Alison Liebling's research (The Safer Locals
Study) found that the risk of self-inflicted death in a prison
institution was strongly correlated with the level of distress
felt by the prisoners. Liebling and her colleagues found that
prisoners who spent more than six hours in their cells during
the day had significantly higher distress (SCG Group Briefing,
10).
Morven Leese, Institute of Psychiatry, conducted
a statistical analysis of deaths in custody occurring between
1 January 2000 and December 2002. She found that male local
prisons and female prisons had the highest rates of self-inflicted
death. Male local prisons also tended to have the greatest degree
of overcrowding. Leese also found that overcrowding was linked
to reductions in hours of purposeful activity; and that purposeful
activity tended to protect against self-inflicted death.
One of the effects of overcrowding with particular
relevance to the risk of self-inflicted death is the turnover
of prisoners. Anne Owers, Chief Inspector of Prisons, cited in
her evidence to the JCHR a man who had been transferred 30 times
during a two-year period leading up to his death.
A study of deaths in custody among women (Mackenzie
et al 2003) found a combination of factors which contributed
to the women's deaths. These included personal characteristics,
such as drug dependency and depression. But Mackenzie and her
colleagues also found institutional factors, including the type
of prison, loss of contact with loved ones, and constant relocation
immediately preceding the death. Relocation is an inherent consequence
of overcrowding and research demonstrates the link between constant
movement and an increased risk of suicide attempts.
4. Attempting to predict who is at risk
On any day, prison officers have a duty to support
1,200 prisoners who have been identified as being at risk of suicide.
In the years 2000-03, fewer than one in three of the prisoners
who took their lives in custody were on an open F2052SH at the
time.
PRT argues that policies to prevent self-inflicted
deaths, based solely on correctly identifying which prisoners
are at risk, will inevitably be ineffective. There are three principle
reasons for PRT's position:
1. A large proportion of prisoners match
the psychological profile of someone who might be at risk; (indeed,
20% of men and 40% of women prisoners have previously attempted
suicide) therefore prediction of risk is too broad.
2. Rapid turnover of prisoners (the
churn) means that prison staff are unable to become sufficiently
familiar with individual prisoners for them to pick up on signs
of distress.
3. Policies based on targeting individuals
detract from a whole prison approach, implying that the problem
lies with a tiny minority who are at risk, and that it is less
important to ensure that the majority are treated with dignity
and their rights respected.
October 2005
Brief Bibliography
Fazel, S (2005) "Suicides in male prisoners
in England and Wales, 1978-2003", The Lancet, August
2005.
HM Chief Inspector of Prisons (1999) Suicide
is Everyone's Concern, A Thematic Review, London: The Home
Office.
Joint Committee on Human Rights (2005) Deaths
in Custody: Third Report of Session 2004-05, London:
House of Lords/House of Commons Joint Committee on Human Rights.
Leese, M (2002) "Rates of self-inflicted
death and associated factors in prisons in England and Wales 2000-02,"
cited in Safer Custody Group Briefing 10: Purposeful Activity,
Suicide and Self-Harm, HMPS Safer Custody Group.
Liebling, A, Tait, S, Durie, L, Stiles, A, Harvey,
J (2005) "An evaluation of the Safer Locals Programme: Report
to the Safer Custody Group", cited in Safer Custody Group
Briefing 12.
Mackenzie, N, Oram, C, and Borrill, J (2003)
"Self-inflicted deaths of women in custody," British
Journal of Forensic Practice, V, 1: 27-35.
Office for National Statistics (ONS) (1998)
Psychiatric morbidity among prisoners in England and Wales,
London: HMSO.
PRT (2004) written evidence to the Joint Committee
on Human Rights,
Shaw, J, Appleby, L, and Baker, D (2003) Safer
prisons: a national study of prison suicides 1999-2000, The
National Confidential Inquiry into Suicides and Homicides by People
with Mental Illness.
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