Safer cells and surveillance
147. Evidence from all forms of detention cited problems
related to the physical condition of detention facilities, in
particular the existence of ligature points.
This was a particular problem where older, many 19th
century, buildings continued to accommodate detainees. At Broadmoor
for example, we visited one of the women's wards where patients
at high risk of suicide were accommodated in 19th century
buildings which retain ligature points, and which do not provide
acceptable modern standards of accommodation for many seriously
ill patients. The Mental Health Act Commission have suggested
that "poor therapeutic conditions" including in some
hospitals 200% bed-occupancy and an inappropriate mix of patients,
may be a cause of self-harm or suicide.
Wards are often "substandard, frightening and even dangerous".
In November 2003, the Commission for Health Improvement
found that the majority of wards at Broadmoor were lacking in
basic standards of dignity, privacy, cleanliness and amenities,
and concluded that "the overwhelming majority of ward areas
cannot be considered an appropriate, humane environment".
The Mental Health Act Commission has also raised concerns about
the physical condition of high secure hospitals, and in particular
has stated that it is "not possible to deliver a safe and
therapeutic environment" within the older wings at Broadmoor
or unsafe conditions of detention may violate Article 3 ECHR,
as well as Article 8. We recommend that funding should be made
available to ensure that people at risk of self-harm or suicide
are held in decent conditions of detention.
148. Research has consistently shown that if a given
method of suicide is no longer available, although some displacement
may take place, overall suicide levels fall. This has led to the
Prison Service making use of situational suicide prevention strategies
such as safer cells, where obvious ligature points are eliminated.
Safer cells were first introduced in HMP Belmarsh in 1997 with
the aim of reducing hanging. In a safer cell, all the corners
are rounded, the pipes are covered, the light fittings are modified,
and a safe ventilator is placed instead of windows that open and
could therefore be used to attach a ligature. Programmes to remove
ligature points and to provide "safer cells" are in
place in the prison service, police forces, and in secure hospitals.
We were consistently told however, that much remains to be done
to extend this programme to provide sufficient safe cells, and
to deal with the many problems posed by holding detainees in older
buildings. Measures were also being taken in many police forces
to install CCTV in cells as a means of ensuring safety; but the
high costs involved have meant that CCTV remains installed in
only a small number of cells.
149. A preliminary evaluation of the use of safer
cells has been carried out by the Jill Dando Institute of Crime
Science at University College London. This found that "safer
cells were likely to be useful in preventing suicides if implemented
correctly. For example, of the 27 at-risk prisoners who were interviewed,
three spontaneously stated that they would have hanged themselves
had they not been in a safer cell (one of them having tried and
failed). Although some displacement took place, the evaluation
found that these alternative methods such as cutting are less
lethal and leave more time for staff intervention. It is therefore
concerning that the evaluation found that "quite often there
are not enough safer cells within the unit, and prisoners may
have to be prioritised or moved to other locations in order to
be in a safer cell".
We consider that safer cells
should be widely available in all prisons and should be used to
hold at-risk prisoners. However, they should be used alongside,
and not as a substitute for, other suicide prevention strategies
such as comprehensive mental health care, good staff-prisoner
relationships, comprehensive risk assessments and provision of
support through Psychology, the Samaritans or Listeners.
150. Suicide prevention is of course a much more
complex matter than the removal of ligature points and the imposition
of rigorous surveillance; and the safety of detainees is a matter
not just of immediate suicide prevention, but of what is sometimes
termed "relational security",
safety achieved through well-being and quality of life. It
is important to note that the Article 2 positive obligation to
protect life requires that reasonable measures be taken to protect
detainees who are vulnerable to suicide. It does not require the
authorities to impose absolute safety by draconian means. There
are limits to the positive obligation to protect, which must also
be balanced with other Convention rights which protect the quality
of life of a detainee, in particular the right to respect for
private life and personal autonomy (Article 8), and the right
to respect for physical integrity and to freedom from inhuman
or degrading treatment (Article 8, Article 3).
As the ECtHR stressed in Keenan v UK, protection of the Article
2 right to life must be conducted in a manner compatible with
the other Convention rights of a detainee, and in particular the
principle of personal autonomy.
151. A detention regime that respects a detainee's
human rights, rights to respect for private life, alongside, and
balanced with, measures to prevent suicides, is an important element
in detainee safety. We recommend
that strategies for suicide prevention in all forms of detention
should take into account the need to respect the privacy and physical
integrity of people in detention. Excessive focus on control,
at the expense of detainees' well-being, will not prevent deaths
in the long term, and will not assure compatibility with the Convention
152. Nevertheless, we support moves to provide safe
cells in prison and police custody, and to provide similarly safe
accommodation in secure hospitals. It
is a particular concern in relation to deaths in custody that
detainees at known risk of suicide may be held in an environment
which includes ligature points. We recommend that efforts should
continue to provide safe accommodation in all forms of detention.