Joint Committee On Human Rights

Joint Committee On Human Rights Written Evidence

21. Memorandum from Dr Alice Mills

PREVENTING DEATHS IN CUSTODY

1. Main causes of deaths in custody

1.1 Traditionally, suicide in prison has been seen as being caused by individual, internal traits or characteristics, such as psychological defects and many early studies mentioned the high preponderance of mental illness/psychiatric contact and substance misuse among those who commit suicide in prison. However, as prisons tend to "specialise" in people with mental health problems and substance misusers, any prediction made on the basis of these factors is likely to generate a high number of false positives. In order to distinguish those at risk from suicide/self-harm from those who are not, it is necessary to look for other indicators of vulnerability.

1.2 More recently, there has been a shift towards understanding suicide in prison as the result of difficulties coping with imprisonment and the pressures of prison life. Such coping difficulties will vary between individuals as they are seen to arise from an interaction between internal factors such as mental health problems which may affect a prisoner's coping abilities, and environmental pressures, particularly the so-called "pains of imprisonment" such as lack of activity or security or contact with family and friends. For example, in her study of prison suicide, Liebling (1992) [241]found that young inmates who were at risk of suicide or self-harm were those who were less likely to have contact with anyone on the outside, less likely to have anything to occupy them during the day and more likely to have problems with other inmates, and were also unable to cope with the resulting isolation, boredom and fear, as well as having a history of psychological problems and substance abuse.

1.3 Difficulties coping with prison life may also explain other so-called "maladaptive" responses to imprisonment. Inmates who find it difficult to cope in prison may withdraw either physically (by going into protective segregation) or psychologically, and such withdrawal may lead to further problems as they may be seen as "weak" by other prisoners, which may leave them open to bullying and victimisation. They may also be vulnerable to violent outbursts or episodes of "acting out" as a result of their own frustrations with prison life.

2. Common Factors

2.1 Research is in general agreement that prison suicides tend to share several common factors. Suicide is more likely to occur in the early stages of a sentence. The Chief Inspector of Prisons (HMCIP 1999) [242]reported that the first 24 hours is a high risk period as about 10% of suicides occur in this period, with 43% occurring within the first month and 80% within the first year. This may be explained by the shock and stress of incarceration which may be even more acute for first-time prisoners. Substance misusers are at particular risk at this time, as they have to cope with the shock of imprisonment, whilst withdrawing from the substance that they have previously been dependent upon.

2.2 Prisoners on remand are also disproportionately represented in the figures. This has largely been attributed to the stress of the remand period, as prisoners face the uncertainty of the court case and sentencing as well as the shock of being in prison, poor conditions, limited activities and overcrowding on remand wings. However, as the remand population has a high turnover, any suicide rate based on the average daily population may be slightly biased towards remand prisoners, and if calculated on the basis on receptions, the suicide rates of sentenced and remand prisoners are roughly similar (Liebling 1999)[243].

2.3 Prisoners who have committed violent and sexual offences may be more at risk of suicide and self-harm. In 1998, 34% of those who committed suicide were charged with violence against the person, but this group made up only 21% of the prison population. Those charged with sexual offences made up 10% of suicide, but 8% of the population (HMCIP 1999). [244]Those serving sentences of four years or more, particularly lifers, are at high risk and this may be due to guilt about the offence, and uncertainty and despair about the prospect of long periods of imprisonment.

2.4 Due to the fact that a large proportion of prison suicides are carried out by those on remand or in the early stage of a sentence, the majority of suicides and incidents of self-harm take place in local prisons, as these are where such prisoners are accommodated.

3. Particular aspects of conditions of detention, or the treatment of detainees, or the cultural background of prisoners or prison officers that contribute to suicide and self-harm

3.1 Prison pressures or the so-called "pains of imprisonment" such as isolation from family and friends, and the lack of constructive activity may contribute to suicide and self-harm if prisoners feel that they are unable to cope with them. For example, the lack of any opportunity to sort out family problems or alleviate anxieties over a relationship due to the constraints of imprisonment may lead to feelings of hopelessness and despair, which may eventually lead to suicide. In the current climate of overcrowding, contact with family may be even harder to maintain if a prisoner is moved far away from their home area due to population pressures, and visits from family can become difficult if not impossible. Prisoners who have difficulty coping with the boredom and inactivity of prison life are more vulnerable to self-destructive acts, and therefore such risk is likely to be more acute in local prisons which tend to have a high prisoner turnover and high levels of overcrowding. This may lead to a large proportion of the population being left with no opportunities for work, education or other activities and being locked in their cells for up to 23 hours a day, as well as less opportunities to arrange visits or make phone calls, and more pressure on facilities such as health care, drug treatment etc. Furthermore, staff may have less time to conduct assessments and offer care to individual prisoners.

3.2 Feeling unsafe or fearful may also contribute to suicide in prison, particularly if prisoners do not see any other way out of a situation where they are being bullied, threatened etc. This risk may be higher if they are in prison for the first time or at the beginning of their imprisonment and have not had any time or opportunity to build up any kind of supportive network, or learnt the skills to avoid threatening situations.

3.3 The masculinity of a male prison environment and the prisoner subculture may discourage inmates from discussing their personal difficulties, as showing that they have problems and particularly talking to staff about them may be seen as a sign of weakness, potentially leaving prisoners more susceptible to victimisation.

3.4 Despite the fact that a history of self-harm can be a strong indicator of vulnerability to suicide, self-harm or suicide attempts are sometimes seen by staff and other prisoners as manipulative, attention-seeking, "gestures" which are deliberately carried out by prisoners for their own gain such as to obtain transfer to a better setting, escape problems with others or be given a phone call to loved ones. Such attitudes may lead staff to dismiss the severity of the prisoners' distress and they may be treated with contempt and disapproval rather than support and help. Viewing these acts as attention seeking or manipulation tends to ignore the real problems that motivate prisoners to commit self-destructive acts, and if there is no response to an act of self-harm, suicide may ensue (Liebling 2001)[245].

3.5 Staff shortages, lack of staff continuity and lack of information sharing can all impair staff ability to identify and care for prisoners at risk of suicide/self-harm. Although personal officer schemes (where one officer is responsible for the welfare of a small group of inmates) may facilitate trust and understanding between inmates and staff, thereby putting them in the best position to notice any problems that prisoners may be having, the effectiveness of such schemes varies between establishments, and they are particularly less likely to be running in local prisons and remand centres, despite the heightened risk of suicide there (HMCIP 1999)[246].

4. Particular aspects of conditions of detention, or the treatment of detainees, or the cultural background of prisoners or prison officers that contribute to other deaths or injuries in custody

4.1 The subculture of prisons and the prisoner hierarchy ensures that certain groups of inmates are at a much higher risk of victimisation and therefore injuries and possibly even deaths in custody. Probably the most "at risk" group, at the bottom of the hierarchy, is made up of sex offenders, particularly child molesters or killers. Many prisoners see the victimisation of sex offenders as legitimate and such attitudes can be reinforced by staff who may tolerate expressions of such hostility. Other vulnerable groups include "grasses" who are seen to have broken a key rule of the inmate subculture, police informers or those in debt to other prisoners.

4.2 Prisoners who have difficulties coping in prison may also be at an increased risk of victimisation and therefore death or other injuries. They may not have the social skills to avoid dangerous situations such as borrowing tobacco from others and being unable to pay this back, particularly when double the initial amount is demanded. In the masculine prison environment, where prisoners and staff are expected to solve their problems through being tough and using violence and aggression, those who show fear, weakness or resourcelessness or fail to stand up for themselves may be more vulnerable to attack by other prisoners. Any attempt to reduce violence may therefore be difficult as prisoners may wish to "save face" to prove their strength and status when faced with aggression. Furthermore, because the inmate subculture clearly rejects any notion of "grassing", informing staff that they are being bullied or intimidated may not be an option for many prisoners as they may fear the repercussions of this more than the initial victimisation.

4.3 Various aspects of the prison environment, particularly relative deprivation and the limited access to material goods, as well as overcrowding and limited supervision may explain why bullying and taxing (intimidation designed to persuade someone to part with goods or money) can flourish within prisons.

5. Practical steps that have already been taken and further steps that need to be taken to prevent suicide and self-harm in custody

5.1 The most recent Prison Service suicide policy (introduced in 2001) places an emphasis on preventing suicide through caring for prisoners who are seen to be at high risk of self-destructive behaviour. Resources are to be concentrated on local prisons through the Safer Locals Programme, and care for prisoners on reception and induction is to be improved to ensure that the early stages of custody are less stressful, prisoners have adequate support and contact with others, and any risk factors can be identified.

5.2 This policy also borrows the concept of a "healthy prison" from the Chief Inspector of Prisons' thematic review of suicide and self-harm (HMCIP 1999) [247]and aims to promote a supportive culture where prisoners are less likely to commit suicide, although it is not really made clear how this might be done. Such a culture should be a key element in any approach to reducing deaths in custody as there is a need to break down ideas that only weak prisoners talk about their difficulties, and ensure that prisoners feel comfortable about approaching staff to discuss their distress.

5.3 Additionally, the policy suggests that mental health staff can help to identify and care for at risk prisoners and support wing staff, and recommends the establishment of detoxification units to reduce the risk of substance misusers committing suicide/self-harm in the early stages of their imprisonment. However, many prisoners may be denied access to such a controlled detoxification if prison medical staff feel that it is unsuitable or do not believe in giving prisoners what they see as "more drugs". Detoxification can also take up to 12 weeks and if a prisoner is moved within this time or released, it may not be possible to complete the programme which can be worse than no programme at all.

5.4 Whilst these measures are helpful not only in terms of reducing the risk of suicide, but also in promoting better mental health, there is a danger that the focus of suicide prevention is moving back towards a medical model, with an emphasis on mental disorder and substance misuse, rather than a multi-disciplinary approach. Although the policy stresses the role of the whole prison community in creating a supportive environment, it does not discuss the role of other staff such as teachers, instructors and probation officers, despite the fact that they spend a considerable amount of time with prisoners, and inmates may choose to confide in them, particularly if they are in distress whilst away from the wing. Such staff therefore also need to be supported to ensure that they are confident in taking measures to prevent suicide/self-harm, and the role of activities such as education in ameliorating prisoners' coping difficulties should not be underestimated (see paragraph 7.8 below).

5.5 Mental health and enhanced suicide awareness training for front line staff in local prisons is also recommended in the suicide prevention policy, and since 2001, all new prison officer recruits have been given training in identifying mental health problems. Whilst this is a positive step, it is not clear why this should not be received by existing officers, particularly as there is a danger that when trainees start training "on the job", they will accumulate negative attitudes from more experienced officers who have not received mental health training.

5.6 In 1999 the Prison Service announced that the use of strip cells for suicidal prisoners would be abolished by April 2000, as this practice was likely to be challenged under Article 3 of the European Convention of Human Rights, which protects the right to freedom from torture or inhuman or degrading treatment or punishment. Strip cells have been widely recognised as unsuitable accommodation for suicidal prisoners, as inmates are deprived of human contact, and they may actually serve to intensify a sense of hopelessness and increase suicidal ideas rather than relieving prisoners' distress.

5.7 Since the abolition of strip cells, "safe cells"; that is, cells that minimise ligature points, have been installed in health care centres and induction and detoxification units. Although such cells may ensure compliance with Article 2 and 3 of the European Convention of Human Rights, they, along with other situational measures such as observation cells with CCTV, may be used as an excuse not to maintain active, supportive contact with the inmate, and may therefore leave prisoners isolated from others, which is likely to exacerbate any feelings of hopelessness and any consequent risk of suicide.

5.8 Prisoners who are vulnerable to suicide/self-harm may also be placed in a prison health care centre for short periods of time in order for staff to observe them and to take them away from the pressures of the normal prison environment. However, prisoners accommodated in health care centres tend not to have access to a range of constructive activity, and being placed there may therefore serve to exacerbate a prisoner's feelings of boredom and isolation. Some commentators have argued that suicidal inmates should be placed in shared accommodation in as normal an environment as possible (Medlicott 1999)[248]. This would ensure that the suicidal prisoner can receive help from their cell mate (who may or may not be a Listener), is less likely to feel isolated and would still be able to participate in the prison regime. Alternatively, vulnerable prisoners could be placed in the facilities for prisoners with special needs which are described in section 7 below.

5.9 Most prisons in England and Wales operate a Listener scheme, where prisoners are selected and trained, usually by the local Samaritans group, to befriend other inmates and support those in distress, using sympathetic but active listening techniques. All discussions are completely confidential, and there is an emphasis on helping prisoners to help themselves, whilst Listeners remain supported by the Samaritans through regular feedback sessions. Listener schemes are designed to supplement the work of staff, as it was seen that prisoners would be better informed about how to cope with periods of despair and would be more likely to recognise the distress of others (HM Prison Service 1997). [249]Although the number of Listeners in high risk prisons has recently been increased, it should be noted that it may be more difficult for schemes to operate in local prisons and remand centres where there is a high turnover of inmates. Additionally, the issue of confidentiality remains contentious, not only because staff resent the idea that they may not be informed if prisoners intend to commit self-harm, but also as prisoners may distrust Listeners fearing they may discuss their problems with staff (HM Prison Service 2001)[250].

5.10 Families and friends also need to be included in caring for those at risk of suicide/self-harm. They may be able to pass on any relevant information or concerns that they may have about an individual prisoner, and they should be kept informed of any changes in a prisoner's mental state. Although the latest Prison Service Order (PSO 2700, issued in November 2002) on suicide and self-harm prevention recommends that after serious incidents of self-harm, prisoners may be given a phone call or an extra visit, it is not clear whether the same provisions would exist for those who are clearly in a state of acute distress, but have not actually self-harmed.

6. Practical steps that have already been taken and further steps that need to be taken to prevent other deaths or injuries in custody

6.1 In 1993, the first national anti-bullying strategy stressed the need for a "whole prison approach" in which staff, prisoners and visitors show a commitment to reduce and prevent bullying. This includes identifying circumstances that are conducive to bullying, constantly reinforcing the strategy to prisoners as soon as they enter an establishment, and challenging bullies and supporting victims of bullying in an effort to change the prison culture. Every establishment is required to have its own anti-bullying policy, and an anti-bullying co-ordinator to regularly review the symptoms of bullying. Policies may include measures such as those to encourage prisoners to report victimisation without fear of being seen as a "grass", and segregating aggressors rather than victims and ensuring they go through an anti-bullying programme. However, not all staff members may be aware of the policies which may lead to wide variations in their effectiveness (Edgar and O'Donnell 1997)[251], and thus there is a need to ensure that all levels of staff are committed to anti-bullying measures.

6.2 Vulnerable prisoners can ask to be placed on voluntary segregation for their own protection (under Rule 45), but this may have several negative consequences. Conditions on segregation wings are seen to be substandard in comparison to those that prevail in the rest of the prisons, and inmates may have little or no access to institutional activities such as work, education and gym. Many vulnerable prisoners, particularly in local prisons, may therefore spend approximately 23 hours a day locked up in their cells, a situation which may increase a sense of boredom and isolation and psychological problems such as severe anger, sleep disturbances and depression, thus potentially enhancing the risk of suicide. In some prisons, Vulnerable Prisoner Units (VPUs) have been developed which offer the prisoners accommodated there conditions which are at least approximate to those on normal location. Work, education and association is provided within the units and prisoners are able to mix more freely amongst themselves. Yet providing separate facilities for work, exercise, education and visiting may be beyond the budgetary and other resources of most establishments.

6.3 Protective segregation may also contribute to the identification of weak and vulnerable groups in the prison, thus adding to their scapegoating and victimisation. It does not address aspects of the prison subculture which stigmatise and persecute such inmates and prisoners who chose to go on protective segregation risk being stigmatised as sex offenders even when they are not, which may make any return to normal location problematic. Such stigmatisation can be dehumanising and cause great distress.

6.4 In order to counter this stigmatisation, challenge the negative subculture and provide better conditions for vulnerable prisoners, some prisons have integrated vulnerable prisoners into the main prison population. At HMP Littlehey vulnerable prisoners are accommodated separately from the rest of the prison, but are encouraged to participate in work, education and exercise with inmates from the main population, and eventually move onto normal location. Staff will not tolerate persecution and as the regime at Littlehey is relatively relaxed, inmates are dissuaded from causing trouble or they risk being transferred. Vulnerable prisoners could certainly be accommodated with ordinary inmates in small units, containing no more than 50 to 70 prisoners, as recommended by Woolf (1991)[252]. Such units would have a liberal regime so that prisoners would not want to risk being moved off the unit and would therefore be less inclined to cause trouble. They may offer improved standards of surveillance and control and can encourage better interpersonal relations between staff and prisoners, and may also have the effect of creating a better sense of community amongst the prisoners accommodated there, which could discourage them from victimising others, and encourage them to support those who are being victimised.

7. Facilities for vulnerable prisoners with coping difficulties/special needs

7.1 In some prisons in England and Wales, distinctive units have been set up for prisoners who have a variety of different problems or "special needs", such as mental disorders, learning difficulties, or substance misuse, which make it difficult for them to cope with prison life. These facilities aim to help such prisoners to cope by keeping them in a sheltered environment such as a separate landing or wing, where they can receive assistance with their individual difficulties and be kept away from other prisoners who may seek to harm them due to their vulnerability. They act as "halfway houses" between the normal prison wings and more specialist locations where vulnerable prisoners are often placed, such as the Rule 45 unit or the health care centre. Such facilities accommodate approximately 40 prisoners and are staffed by small teams of supportive officers who receive little or no extra training for this role, but are specially selected for their more understanding, tolerant approach.

7.2 My doctoral research on the effectiveness and operation of two of these facilities (B1 at HMP Cardiff and St Patrick's wing at HMP Camp Hill) found that they could help prisoners cope in several different ways (Mills 2003)[253]. Firstly, the prisoners accommodated there particularly seemed to appreciate being kept in a more sheltered subsetting, away from the rest of the prison. The facilities ameliorated prison pressures by reducing the unpredictability of prison life and offering a more supportive environment free from the constraints of the masculine prison culture and its need to demonstrate toughness, and the majority of prisoners reported feeling safer there than in other areas of the prison. Furthermore, although both facilities protected the prisoners from others, B1 encouraged inmates to integrate with other prisoners at work, education, association etc, whilst St Patrick's provided opportunities for education and association on the wing, which meant that these prisoners were able to access constructive regimes which they may not be able to do on other specialist locations.

7.3 Secondly, staff played a significant role in creating such an ameliorative environment. Having regular staff working on the facilities meant that better staff-prisoner relations could be built up and officers were well placed to notice any changes or differences in a prisoner's mental or physical state. Staff also seemed to recognise the need to try to understand prisoners' complex problems and be tolerant of their behaviour rather than resorting to disciplinary responses. Many encouraged prisoners to talk to them about their concerns in the hope of alleviating their distress and reducing the isolation of prison life, and during the fieldwork, it became evident that many inmates appreciated the regular officers' approachable, friendly manner. Approximately 40% of prisoners on B1 and 25% of prisoners on St Patrick's reported that they would talk to staff working on the facilities about personal problems. Although these figures do not appear to be high, one study of prison suicide found that only a fifth of prisoners would discuss a problem with someone (including staff, prisoners and others) (Liebling 1992 op cit). Additionally, when asked what they would do if they had a problem with another prisoner, most inmates on both facilities said that they would tell an officer, which suggests that the facilities were able to create a safe environment where inmates feel comfortable about approaching staff about such matters, as suggested in the Prison Service's anti-bullying strategy.

7.4 The research has also shown that there is a need to understand how a prisoner's "special needs" can affect their coping difficulties. The thesis looked at four specific areas of special need found amongst the prisoners accommodated on the facilities—health problems, substance misuse, educational difficulties and physical disabilities—and found that some could have a considerable impact on prisoners' ability to cope. Prisoners with mental health problems may feel too ill to participate in constructive activity due to their medication, which may leave them feeling unable to alleviate any feelings of boredom. Substance misusers who may have previously depended on a substance to cope with life outside of prison, may find it difficult to cope without this in prison and any physical or psychological withdrawal symptoms may also leave them unable to participate in prison life and with an enhanced sense of anxiety and fear. Finally, those with educational difficulties or learning disabilities may be more limited in the way that they can keep themselves occupied whilst in prison and may be more susceptible to feelings of isolation due to greater communication difficulties with family and friends.

7.5 The facilities did, however, provide some specialist assistance to help to meet prisoners' special needs and thus try to alleviate their coping difficulties. For example, St Patrick's wing holds specialist education classes to improve prisoners' basic and life skills as well as giving them some form of constructive activity, and offers access to a community psychiatric nurse who works on the wing three days a week. All staff working on the wing also attend a weekly meeting where individual prisoners are discussed to monitor their progress and note any problems that they may be having.

7.6 In order to help prisoners cope with prison life and thus reduce vulnerability to suicide/self-harm and victimisation, these facilities could be replicated across the prison estate, as they appear to offer a more constructive alternative to situational suicide and victimisation prevention measures. However, they do need to be developed and improved, and as these prisoners have a variety of different problems, a multi-disciplinary approach is necessary with more services to help them with their special needs and thus their difficulties coping in prison. This could be based around the multi-disciplinary mental health in-reach teams which are to be introduced into prisons. These consist of a range of mental health professionals from the community who will provide services to prisoners accommodated on normal prison wings in the same way that they do to patients in the community, and the facilities seem to be an ideal setting for these services. Such mental health teams may also include occupational therapists who can play a significant role in helping prisoners to cope with their imprisonment. Occupational therapy or day care may allow them to express feelings that they are unable to discuss, as well as providing them with constructive activity. In order to best meet the variety of needs that these inmates have, day care could cover a number of different subjects and could be carried out by a team of different staff including officers, teachers, psychiatric nurses, psychologists and drug/alcohol counsellors, particularly as recruiting forensic occupational therapists to run such provision may be difficult due to a shortage of staff specialising in this area.

7.7 Such a multi-disciplinary approach also needs to include comprehensive drug treatment ranging from suitable detox medication, awareness courses and more intensive treatment programmes. Although new detoxification units will go some way towards providing this help, the evidence suggests that current drug treatment provision is unable to cope with the extremely high demand for it, particularly in local prisons. Furthermore, as mental health problems and substance misuse are two issues which may exacerbate any difficulties coping with prison life, there is also a need to ensure that services are provided for prisoners with a "dual diagnosis"; that is, a mental disorder and substance misuse problem. Such prisoners have traditionally fallen through the gap in provision, as mental health services have refused to treat them due to their substance misuse and drug agencies have turned them away due to their mental health problems. The Department of Health (2002) [254]has recently introduced a dual diagnosis strategy which suggests that mental health services will take primary responsibility for patients with a severe mental illness and substance misuse problem, with drug agencies providing them with specialist training and support. Conversely, mental health services should offer support to drug and alcohol agencies to enable them to deal effectively with those with less severe mental health problems, and there is no reason why such a strategy could not be introduced into prisons to provide appropriate care for these prisoners.

7.8 Other agencies and groups could also be involved in providing multi-disciplinary care to prisoners with special needs. The training in mental health awareness which is now given to new prison officer recruits could be given to the staff working in these facilities so that they can identify anyone showing signs of stress or anxiety and give appropriate support. Furthermore, education classes like those provided on St Patrick's wing can provide a forum for prisoners to discuss their concerns with others, including the teachers, within a "humanising" environment, which may go some way to ameliorate the coping difficulties that these prisoners have. However, in order to do this, education should be more broad than the current rather narrow emphasis on basic skills and should include subjects such as art, which may not necessarily lead to a vocational qualification, but may improve prisoners' self-esteem and general attitudes towards themselves and others.

8. Fostering a greater human rights culture

8.1 Fostering a human rights culture in prison is difficult when a negative view of prisoners' rights is likely to be reinforced by those in the outside community to which staff return every day. Among staff, "rights" talk may generate suspicion as they may believe that it will mean that prisoners have more scope to litigate against them. Fear of being blamed for a breach of human rights, particularly in terms of preventing deaths in custody, may lead to an overcautious approach as staff may be tempted to resort to situational measures such as "safe" cells or encouraging prisoners to go onto Rule 45 rather than attempting to reduce their vulnerability by offering them personal support and improving their coping abilities. Furthermore, a human rights approach may generate resentment among staff as they may feel that more attention is being placed on improving conditions for prisoners rather than their own working conditions.

8.2 There is therefore a real need for management commitment to support staff in order to encourage them to adopt a human rights approach. This might include not only training, but also supporting staff initiatives which do promote human rights. The staff working on the facilities discussed in section 7 had many ideas as to how the units could be developed, but these were often ignored due to budgetary constraints, overcrowding and lack of management commitment, leaving staff feeling disappointed and demoralised. If such measures do not receive the appropriate commitment and financial resources, they can be vulnerable to being closed down when, for example, a new governor is appointed, or when a key individual leaves the project, and no-one can be found to take their place.

8.3 Finally, there is also a need to act in the interests of prisoners in order to promote humanity and care in prisons, rather than in the interests of prisons who may wish to simply avoid legal action under the Human Rights Act 1998. This could include utilising more social measures to prevent deaths in custody, such as the facilities for special needs prisoners which attempt to tackle vulnerability, rather than situational approaches which deal in terms of risk and simply trying to manage risk predictors.

5 September 2003

241 Liebling, A (1992) Suicides in Prison, London, Routledge. Back

242 HM Chief Inspector of Prisons (HMCIP) (1999) Suicide is Everyone's Concern: A Thematic Review by HM Chief Inspector of Prisons for England and Wales, London, Home Office. Back

243 Liebling, A (1999) "Prison Suicide and Prisoner Coping", in Tonry M and Petersilia, J (eds) Prisons, Crime and Justice: A Review of Research, Vol 26, Chicago, University of Chicago Press. Back

244 op cit. Back

245 Liebling A (2001) "Suicides in Prison: Ten Years On", Prison Service Journal, No 138, pp 35-41. Back

246 op cit. Back

247 op cit. Back

248 Medlicott, D (1999) "Researching the Prison: Prisoners as Knowledgeable Agents", unpublished paper presented to the British Criminology Conference 1999, Liverpool, 13-16 July. Back

249 HM Prison Service (1997) Caring for the Suicidal in Custody, London, Prison Service. Back

250 HM Prison Service (2001) Prevention of Suicide and Self-Harm in the Prison Service, London, Prison Service. Back

251 Edgar, K and O'Donnell, I (1997) "Responding to Victimisation", Prison Service Journal, No 109, pp 15-19. Back