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Suicide by prisoners: National clinical survey

  • Jenny Shaw (a1), Denise Baker (a1), Isabelle M. Hunt (a1), Anne Moloney (a1) and Louis Appleby (a1)...
Abstract
Background

The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides.

Aims

To describe the clinical and social circumstances of self-inflicted deaths among prisoners.

Method

A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff.

Results

There were 172 self-inflicted deaths: 85 (49%; 95% CI 42–57) were of prisoners on remand; 55 (32%; 95% CI 25–39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88–96). A total of 110 (72%; 95% CI 65–79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20–35). Eighty-nine (57%; 95% CI 49–64) had symptoms suggestive of mental disorder at reception into prison.

Conclusions

Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.

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Copyright
Corresponding author
Correspondence:Jenny Shaw, National Confidential Enquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Williamson Building, University of Manchester, Manchester MI3 9PL, UK. E-mail: Jennifer.J.Shaw@man.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Appleby, L., Cooper, J., Amos, T., et al (1999) Psychological autopsy study of suicides by people aged under 35. British Journal of Psychiatry, 175, 168174.
Appleby, L., Shaw, J., Sherratt, J., et al (2001) Safety First. Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health.
Coffey, C., Veit, F., Wolfe, R., et al (2003) Mortality in young offenders: retrospective cohort study. BMJ, 326, 1064.
Department of Health (2002) National Suicide Prevention Strategy for England. London: Stationery Office.
Fruhwald, S., Frottier, P., Benda, N., et al (2002) Psychosocial characteristics of jail and prison suicide victims. Wiener Klinische Wochenschrift, 114, 691696.
Hancock, N. (2002) Suicide trends. Safer Custody News, 19, 18.
Her Majesty's Chief Inspector of Prisons (1999) Suicide is Everyone's Concern. A Thematic Review. London: Home Office.
Home Office (2002) Prison Statistics, England and Wales. London: Research, Development and Statistics Department.
Jenkins, R. & Meitzer, H. (1995) The national survey of psychiatric morbidity in Great Britain. Social Psychiatry and Psychiatric Epidemiology, 30, 14.
Liebling, A. (1994) Suicide amongst women prisoners. Howard Journal, 33, 19.
Meitzer, J., Jenkins, R., Singleton, J., et al (1999) Non-Fatal Suicidal Behaviour Among Prisoners. London: Office for National Statistics.
Royal College of Psychiatrists (2002) Suicide in Prisons (CR99). London: Royal College of Psychiatrists.
Shaw, J. (1997) The prevalence of mental disorder in the court population. PhD Thesis, University of Manchester.
Shaw, J., Appleby, L. & Baker, D. (2003) Safer Prisons – A National Study of Prison Suicides 1999–2000 by the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness. London: Department of Health.
Singleton, N., Meltzer, H., Gatward, R., et al (1998) Psychiatric Morbidity among Prisoners in England and Wales. London: HMSO.
Wobeser, W. L., Datema, J., Bechard, B., et al (2002) Causes of death among people in custody in Ontario, 1990–1999. Canadian Medical Association Journal, 167, 11091113.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Suicide by prisoners: National clinical survey

  • Jenny Shaw (a1), Denise Baker (a1), Isabelle M. Hunt (a1), Anne Moloney (a1) and Louis Appleby (a1)...
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eLetters

Suicide in prison- Issues

Ravi Shankar Balu, Medical officer
19 April 2004

We read with interest, Shaw et al’s(2004) Suicide by Prisoners and would like to discuss a few issues.Whilst we acknowledge the value of statistical summaries such as the national clinical survey it should be noted that there are difficulties in applying methods to study the risk inthe community to prison populations, particularly when this information may be is transferred to clinical use. Few guidelines exist and formal assessments for good professional practice exist for such work and we recommend additional factors for future research.

Firstly we would like to comment that the prison by itself is a risk factor; however the clinical survey does not reflect the contextual factors leading to suicide. The suicide behavior is usually transient and a reaction in a particular individual to their set circumstances. In addition to the trait, clinical and personal factors, offenders face otherdynamic factors like, life events, the stress of arrest, trial, and variety of stressors associated with prison life like bullying, intimidation, isolation, that are amenable to change and can be targeted as areas of possible intervention.

Secondly recommendations you have made for the management of suicide in prisons are the same for every inmate and situation. The treatment has to be different from situation to situation, and be shaped by the particular circumstances of the inmate. However the treatments like socialisolation, segregation and strip cells for the prisoner have been found tobe associated with self-harm and thus we are forced to look at alternativemethods of treatment.

Finally, though only small proportion of prisoner’s self- harm, clinicians often face the difficulty of determining varying levels of riskand subsequent management that is often limited to and by the physical resources of the prison environment. The focus of research should be to identify factors actuarially explaining the individual differences amongstprisoners and it would be valuable to identify the characteristics of the prisoners who self- harm compared to those who do not. We propose the answer to this question lies in a combination of internal vulnerability factors and external stressors.

Shaw, J., Baker, D., Hunt, I.M., Moloney, A., Appleby, L. (2004) Suicide by prisoners. National clinical survey. British Journal of Psychiatry, 184.263-267.

Decleration of Intrest: None
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Conflict of interest: None Declared

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