Implementation of a national epidemiological surveillance of prison suicide in France

Abstract

Abstract Context Worldwide, suicide is a leading cause of death in prison. In France, suicide of prisoners accounts for more than 100 deaths per year representing about half of the total deaths in prison. Moreover, suicide rates in French prisons are seven times higher than in the community and are among the highest in Europe. Reducing prison suicide is a public health priority inscribed in a joint action plan of both the Ministries of health and of justice. In order to prevent this tragic loss of life, prison services and health services must collaborate for the monitoring and understanding of the risk factors involved. The aims of an epidemiologic surveillance of prison suicide are to gather information about the medical factors and factors related to prison environment, analyze them and eventually produce recommendations for prevention. Methods After months of consultation between Santé publique France, different administrations and professionals working in prison, a common methodology was set up. As from January 2017, whenever a suicide or suspected death occurs in prison, the Direction of the Prison Administration (DAP) informs Santé publique France, who in turn sends to the medical practitioner in charge of the prison health services a questionnaire including the history before detention: morbidity, addiction, attempted suicide, and during detention: contact with prison health services, diagnosis and final contact prior to death. Each year, the DAP sends to Santé publique France the sociodemographic, administrative, judiciary and prison environmental data of the persons. Results In 2017, data were collected for 106 suicides from 71 prisons: 95% males, 49% remand, 44% murder or sexual assault, median incarceration time 96 days. Questionnaires were returned from prison practitioners for 100 cases (94%): regular contact 83%, prior suicide attempt 23%. Conclusions Feasibility of a prison suicide surveillance is only possible with the implication of both prison and health services. Key messages Reducing death by suicide in prison is a public health priority. Feasibility of a prison suicide surveillance is only possible with the implication of both prison and health services.