On 13 January 2004 Dr Harold Shipman, a doctor convicted of murder, was found dead in his prison cell, following apparent self-hanging. Subsequent media reports tended to give considerable detail about the apparent circumstances of his death.
In 1999 there were, on average, 1.8 self-inflicted deaths per week in prisons in England and Wales, yielding a rate of 0.3 per 10 000 prisoners per week (HM Prison Service, 2001). Preliminary data for 2003 are similar, indicating 1.8 apparently self-inflicted deaths (inquests pending) per week (Reference SeenanSeenan, 2004). In the week following the death of Dr Shipman, five apparently self-inflicted deaths (inquests pending) were reported in prisons in England and Wales (HM Prison Service Safer Custody Group, personal communication, 2004); this apparent peak, however, is similar to that in a comparable week in January 2003.
In Irish prisons, there were nine apparently self-inflicted deaths (inquests pending) between January 2000 and April 2003, yielding a rate of 0.2 per 10 000 prisoners per week (Reference BresnihanBresnihan, 2003). In the week following the death of Dr Shipman, there were two apparently self-inflicted deaths (inquests pending; Reference BradyBrady, 2004), yielding an increased rate of 6.4 per 10 000 prisoners that week (Poisson distribution P=0.0018). While caution must be exercised when interpreting data about rare events, we none the less believe these data merit explanation.
At a population level, one possible explanation relates to prisoners’ average ‘dose’ of exposure to detailed, graphic media coverage of suicidal behaviour, which is known to affect suicidal behaviour in those exposed (the Werther effect). Interestingly, over 90% of prison cells in Ireland have in-cell television, and, while it is difficult to obtain official figures, it appears that the proportion of cells with in-cell television is substantially lower in England and Wales.
As Shaw et al (Reference Shaw, Baker and Hunt2004) demonstrate, prison populations often comprise individuals with multiple risk factors for suicide. We suggest that repeated exposure to vivid, detailed accounts of the methods apparently used in high-profile, apparently self-inflicted deaths in prison may be a critical additional risk factor in this population. We renew calls for responsible reporting of suicidal behaviour and for development of improved prison mental health services.