Death In Prison Research Articles

Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis

Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. There is a wide range of heterogeneous interventions aimed at reducing these harms in this population. Previous reviews have focused on specific interventions or limited their findings to drug use and recidivism and have not explored interventions delivered after release from prison. Our aim is to examine the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. In this systematic review and meta-analysis, we searched Embase, MEDLINE, and PsycINFO databases up until Sept 12, 2023 for studies published from Jan 1, 1980 onwards. All studies evaluating the effectiveness of any intervention on drug use, recidivism outcomes, sexual or injecting risk behaviours, or mortality among people who use psychoactive drugs and who were currently or recently incarcerated were included. Studies without a comparator or measuring only alcohol use were excluded. Data extracted from each study included demographic characteristics, interventions, and comparisons. Pooled odds ratios and risk ratios were calculated using random-effects meta-analyses. We identified 126 eligible studies (47 randomised controlled trials and 79 observational studies) encompassing 18 interventions; receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison (one study; hazard ratio 0·25; 95% CI 0·13-0·48), whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community (two studies; relative risk 0·24; 95% CI 0·15-0·37). Therapeutic community interventions reduced re-arrest at 6-12 months (six studies; odds ratio [OR] 0·72; 95% CI 0·55-0·95) and reincarceration at 24 months (two studies; OR 0·66; 95% CI 0·48-0·96). There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviours and needle and syringe sharing. There are effective interventions to reduce mortality and recidivism for people who use drugs who have been incarcerated. Nonetheless, there are also substantial gaps in the research examining the effect of interventions on risk behaviours and mortality during incarceration and a need for randomised designs examining outcomes for people who use drugs after release. Australian National Health and Medical Research Council.

Suicide While Locked Up in Texas: Risk Factors for Death by Suicide in Custody.

In the United States, suicide is a leading cause of death in prisons and jails, with incarcerated individuals being nine times more likely to die by suicide than the general population. Identifying vulnerabilities at each stage of custody (prebooking, jail, prison) and factors that increase suicide risk can improve prevention efforts. A hierarchical binary logistic regression was conducted on data from the Texas Justice Initiative's Deaths in Custody Report. Variables included race/ethnicity, sex, age at death, days in custody, classification of crime as violent or nonviolent, and custody type of prebooking, jail, or prison. Among main effects, when compared to suicide rates in prison, jail suicide deaths were over three and a half times more likely (OR = 3.61), and the period of prebooking emerged as a period of staggering risk of suicide death, with suicides being over 5,000% more likely than at other stages of custody (OR = 50.86). When interactions were entered, Latinx individuals were at a particularly increased risk of suicide death (OR = 10.46), likelihood of suicide death decreased with each year of age (OR = .89), nonviolent offenders were just under three and a half times more likely to die by suicide when compared to violent offenders (OR = 3.45), and each stage of custody was shown to affect the relationship between age-related rates of suicide in different ways. Results call for further investigation into suicide among understudied populations in corrections, such as Latinx individuals, juveniles in the prison system, and nonviolent offenders, to identify the groups at the highest risk of premature death in correctional systems.

Risk factors of suicide in prisons: a comprehensive retrospective cohort study in France, 2017-2020.

Suicide is a leading cause of death in prison and the suicide rates are several times higher in the prison population than in the general population in most countries. Of the studies that have investigated risk factors for suicide in prison, few have controlled for possible confounding factors. The aim of this study is to identify risk factors of suicide among people in French prisons, over a four-year period. All incarcerations that occurred in France during 2017-2020 were eligible. Sociodemographic, criminal and prison characteristics were collected for each incarceration from data of the National Prison Service. Survival univariate and multivariate analyses were performed with a Cox regression model. 358,522 incarcerations were included, of which 449 ended in suicide during the follow-up. The median length of prison stay was 5.1months. The median age at prison entry was 30years and 95.8% of incarcerations involved men. The overall suicide rate was 173 [157-189] per 100,000 person-years. Factors associated with suicide in the multivariate model (p<0.05) were the early stage of incarceration and in particular the first week (HR = 7.6 [5.4-10.8]), violent offences and in particular homicide (HR = 3.0 [2.1-4.2]), French (HR = 1.7 [1.2-2.4]) and other European nationalities (HR = 2.1 [1.4-3.3]), age above 40 (HR = 2.0 [1.5-2.6]), pre-trial incarceration (HR = 1.8 [1.4-2.3]), being separated (HR = 1.6 [1.1-2.3] and having a high school diploma (HR = 1.4 [1.0-1.8]). Factors associated with suicide in prison are complex and involve individuals' criminal history as well as conditions of incarceration. These characteristics may be relevant to focus suicide prevention efforts.

Rejecting Defeat and Approaching Liberation: Palestinian Prisoners’ Hunger Strikes

Hunger strikes have been central to the ways in which Palestinian prisoners confront the Israeli carceral regime; demand changes in the ways prisons are run; and demand their most basic rights. Indeed, the earliest documented hunger strike dates to as early as 1968, with demands that included refusals to address Israeli jailers with ‘sir', and having access to pens and notebooks. The recent martyrdom of Khader Adnan on his eighty-seventh day of a hunger strike against his detention highlighted both Palestinian prisoners' continuous resort to hunger strikes, and Israeli violent responses to this act of confrontation whenever it is used by prisoners. Hunger strikes have been analysed and discussed by multiple scholars to shed light on this practice both in Palestine and other global sites of carcerality. The literature on hunger strikes, however, is abundant with analysis that draws on the concepts of biopolitics and necropolitics. Applying these concepts involves conceptualising prisons as sites intended for the civil and social death of prisoners, or depicts prisoners as bare life and objects of modes of management over their life and death. Yet, an approach that centres the power over life and death, and that presents freedom or its negation as that of the moment of approaching death, falls into a trap that Palestinian political prisoner Walid Daka (2021) warns of in his brief discussion of hunger strikes [from a text read as part of a conference on carcerality, entitled ‘Control Through Time']. Such an analysis, for instance, views death as the sole space over which the captive body has power, as Achille Mbmebe argues in ‘Necropolitics'. My article, however, seeks to investigate and discuss Palestinian prisoners' recourse to hunger strikes in a different vein. To conceptualise hunger strikes and their history in Palestine, the article argues that one has to situate the practice as part of an ever-evolving repertoire of prisoners' responses aiming to constitute political subjectivities that reject defeat, that dream and work for liberation, and that constantly counter attempts at moulding consciousness. Hunger strikes offer yet another example of prisoners' attempts to smuggle freedom from the confines of their cells. The article will engage with the long history of Palestinian prisoners' hunger strikes (collective and individual), with prisoners' own descriptions of hunger strikes, and with several theoretical and conceptual understandings of hunger strikes to shed light on this practice’s political meanings. In doing so, the article hopes to situate hunger strikes within the broader sets of confrontation practices used by Palestinian prisoners, and which constantly dream, and work for, a liberated geography.

National Survey of Oncologists' Knowledge, Attitudes, and Practice Behaviors: Caring for Cancer Patients Experiencing Incarceration.

Cancer is the leading cause of illness-related death in state prisons in the United States. The experiences of physicians providing oncological care to individuals experiencing incarceration are underexplored. The study aims were to evaluate knowledge, attitudes, and practices of oncologists caring for cancer patients who are incarcerated. An online survey was distributed to a random sample of 150 oncologists from the American Society of Clinical Oncology and the American Society for Radiation Oncology from July 2020 to December 2021. Statistical analyses included two proportion Z-test, Fisher's exact test, Kruskal-Wallis test, and Cramer's V to estimate factors associated with attitudes and barriers to care. Of the 55 respondents (36.7% response rate), 21 were medical oncologists and 34 were radiation oncologists. Academic center oncologists were more likely to report caring for incarcerated patients than community or private practice oncologists (p = .04). Most (53%) incorrectly reported "heart disease" as the leading cause of death, as opposed to "cancer" (15% identified correctly). Oncologists practicing at both academic and community centers were more likely to report care coordination barriers than oncologists at academic or community centers (p < .01). We identified potential barriers in caring for incarcerated cancer patients. Future studies should explore ways to improve care coordination between oncology teams and prisons.

Death in detention in Dakar prisons: epidemiological and medicolegal aspects

Introduction: The death of a prisoner is a suspicious death requiring systematic medico-legal involvement to determine the circumstances and causes of death. The objective of this study is to determine the profile of people who died in detention in Dakar prisons, to analyze the epidemiological and medicolegal aspects and to propose some preventive measures. Methodology: This is a retrospective study analyzing the causes of death of prisoners in prisons in the Dakar region who were autopsied, from January 2014 to December 2018 in the pathological anatomy and cytology department of the Aristide Le Hospital. Dantec. The data was collected from autopsy reports upon requisition with the aim of determining the circumstances and causes of death of the detainees. Our data was collected using individual collection sheets and subsequently analyzed with Word and Excel software. Results: The average age of the deceased prisoners was 42.4 years. The most represented age group was between 30 and 39 years old with 02 cases/06 or 33.3% with a male predominance. The three penitentiary establishments among the eight (08) recorded cases of death in our study. The Rebeuss Prison recorded 4 cases of death, the Liberty VI Penal Camp and the Special Pavilion each recorded one (01) case of death. Regarding the circumstances of death of detainees, we have identified five (05) cases of natural deaths: three cases of cardiac arrest (myocardial infarction, and or acute pulmonary edema), one suffocation and one case of death of unknown etiology, and a violent death by firearm. Conclusion: Death in a prison environment must be considered suspicious, because people deprived of their liberty have the same right to respect for their life and their dignity as any other person. Our research shows that most deaths in custody are due to natural causes, untreated medical problems or violent deaths. To limit deaths in prison, authorities must take preventive measures to eradicate the causes.

Responding to ‘wicked problems’: policy and governance on drug-related deaths in English and Welsh prisons, 2015-2021

BackgroundPrison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021. MethodsThematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's ‘wicked problems’ conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving. ResultsThere was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two ‘wicked problems’ of increasing rates of drug use and mental illness which collide in the prison setting. ConclusionThe PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons.

Suicide mortality among individuals in federal prisons compared with the general population: a retrospective cohort study in the USA from 2009 to 2020

IntroductionSuicide is one of the leading causes of death in US prisons. Yet, administrative data lags years behind and reporting rarely accounts for differing age distributions between suicide rates between...

Suicide Risk Screening and Assessment before and after the COVID-19 Pandemic in New Inmates.

(1) Background: Suicide is the main cause of death in Italian prisons. The largest number of inmates who killed themselves was recorded during three years of the COVID-19 pandemic. This study aimed to explore psychosocial risk factors for suicide among inmates incarcerated before and after the onset of COVID-19. (2) Methods: At prison reception, inmates underwent clinical interviews and were assessed using the Blaauw Scale and Suicide Assessment Scale. Psychological distress, measured by the Symptom Checklist-90-R, was compared between inmates admitted before and after COVID-19. Regression analyses were run to examine psychosocial vulnerabilities associated with suicidal intent in newly incarcerated individuals at risk of suicide. (3) Results: Among the 2098 newly admitted inmates (93.7% male) aged 18 to 87 years (M = 39.93; SD = 12.04), 1347 met the criteria for suicide risk, and 98 exhibited high suicidal intent. Inmates who entered prison after the onset of COVID-19 were older and had fewer social relationships. They had a higher prevalence of recidivism and substance abuse, along with elevated levels of psychological distress. An increase in perceived loss of control, anergia, obsessive-compulsive symptoms, phobic anxiety, and paranoid ideation emerged as the factors most strongly associated with high suicidal intent. (4) Conclusions: These findings support the value of psychosocial screening in promptly identifying inmates at risk of suicide, enabling the implementation of targeted, multi-professional interventions. Future research should replicate these results, with a focus on longitudinal studies that monitor the same inmates throughout their incarceration period.

Assessment of awareness and attitude o f medical students about physicians’ participation in capital punishments in India — a cross-sectional study

Abstract Introduction: In the context of capital punishment in India, the involvement of physicians raises ethical concerns, given the fundamental principle of 'do no harm.' This study aims to evaluate the awareness and attitudes of undergraduate medical students in a Chennai-based medical college regarding physicians' participation in capital punishment. Methods: A survey employing Google Forms was conducted among 154 randomly selected medical students. The questionnaire, validated for content, comprised 13 statements assessing awareness and attitudes toward physicians' involvement in capital punishment. Descriptive analysis was applied to interpret the collected data. Results: The study revealed a notable lack of awareness among medical students concerning physicians' roles in capital punishment in India. Merely 19.3% of participants were knowledgeable about the various responsibilities physicians undertake in judicial hanging, including certifying the prisoner's fitness for hanging, confirming the prisoner's death post-hanging, and ensuring humane conditions for the execution. Despite limited awareness, the predominant attitude among participants was one of disapproval towards physicians' participation in capital punishment. Conclusion: This study underscores the inadequate awareness among medical students regarding physicians' involvement in capital punishment. Despite this limited awareness, the prevailing attitude among participants leans towards the disapproval of physicians participating in such practices.

Prisoner’s Rights: An In-depth Study on the Prison Infrastructure, Psychological and Physical Health of Prisoners, and Unnatural Deaths in Prison

India is a nation with the second highest population in the world with a moderate crime rate, thus naturally, overcrowding in prisons in India has been a prevalent issue since long back. Overcrowding in prison is the result of the slow pace of the judiciary in conducting the criminal procedures. It is evident by the fact that the number of under trial prisoners is more than the number of convicted prisoners. In such a scenario it is of massive importance that the rights of the all prisoners are adequately protected. However, in reality, it is far from being the case. The authors have studied and analysed the prominent issues that arise from a lack of competent ground staff and poor infrastructure within prisons, such as poor mental and physical health among prisoners, corruption among prison officials, and arbitrary activities inside prisons across India. The authors have shown in this paper that how poor infrastructure in prison leads to unnatural deaths in prisons, by analysing the statistics provided by the NCRB. After a thorough analysis of the current scenario of prisons in India, the authors have studied the respective current circumstance in reference to international and UN conventions, as well as human rights. We conducted an in-depth psychological research of the inmates' conditions in the prison, as well as the psychological adversities caused by overcrowding, familial deprivation, dread of the unknown, and isolation.

Reducing Facial Stereotype Bias in Consequential Social Judgments: Intervention Success With White Male Faces

Initial impressions of others based on facial appearances are often inaccurate yet can lead to dire outcomes. Across four studies, adult participants underwent a counterstereotype training to reduce their reliance on facial appearance in consequential social judgments of White male faces. In Studies 1 and 2, trustworthiness and sentencing judgments among control participants predicted whether real-world inmates were sentenced to death versus life in prison, but these relationships were diminished among trained participants. In Study 3, a sequential priming paradigm demonstrated that the training was able to abolish the relationship between even automatically and implicitly perceived trustworthiness and the inmates’ life-or-death sentences. Study 4 extended these results to realistic decision-making, showing that training reduced the impact of facial trustworthiness on sentencing decisions even in the presence of decision-relevant information. Overall, our findings suggest that a counterstereotype intervention can mitigate the potentially harmful effects of relying on facial appearance in consequential social judgments.

(Re)constructing Prisoner Death Investigations: A Case Study of Suicide Investigations from England and Wales

(Re)constructing Prisoner Death Investigations: A Case Study of Suicide Investigations from England and Wales

(Re)constructing Prisoner Death Investigations: A Case Study of Suicide Investigations from England and Wales

Because states must rebut the presumption of responsibility, all prisoner deaths must be investigated. These investigations frequently illustrate the tip of an iceberg of rights abuses and systemic hazards but have largely escaped analysis in prison-monitoring scholarship. Focusing on suicides, we assemble some of the first evidence illustrating how the staff of the Prisons and Probation Ombudsman, who investigate prisoner deaths in England and Wales, seek to prevent further deaths. Ombudsman investigations are widely regarded as ineffective, yet there are competing constructions regarding why this is and what could be done to improve outcomes. As a result of organizational norms and constraints, ombudsman staff have offered narrow accounts of prisoner suicides, focusing on the failure of frontline staff to comply with prison policies. By contrast, prison staff and coroners have focused on systemic hazards or “accidents waiting to happen,” including imprisoning people with severe mental illness, illegal drugs, unsafe facilities, and inadequate staffing. These differing constructions lock penal actors into an unproductive cycle of blame shifting that contributes to high suicide numbers. We reconceptualize prisoner deaths as occurring at the intersection of systemic hazards, organizational contexts, and individual errors. We hope that this reconceptualization facilitates broader investigations that are more likely to prevent prisoner deaths.

Death in Prison: increasing transparency on next of kin notification and disposition of remains

BackgroundPolicies for next-of-kin (NOK) notification and disposition of remains surrounding death are unclear across the United States’ (US) carceral systems. The goal of this study was to collect data on carceral system policies pertaining to NOK notification and disposition of remains for individuals who are incarcerated. We collected publicly available operational policies for the Federal Bureau of Prisons, Immigration and Customs Enforcement, 50 state prison systems, and the Washington D.C. jail for a total of 53 systems.ResultsApproximately 70% of systems had available policies on NOK notification and disposition of remains. Few systems had information on time constraints for NOK notification, notifying parties or designated contacts person, and ultimate disposition of unclaimed remains. Several systems had no accessible policies.ConclusionsAcross the US, carceral systems vary in policies for notifying NOK after the death of an incarcerated individual and their processes for the disposition of remains. Carceral and health systems should work towards standardization of policies on communication and disposition of remains after death of an individual who is incarcerated to work towards equity.

Death in prison through a philosophical equity-informed lens.

Death in prison through a philosophical equity-informed lens.

In this June issue

In line with several other journals we co-publish the Australian Commission on Safety and Quality in Health Care Low Back Pain Clinical Care Standard. It describes the early clinical management of people who present with a new acute episode of low back pain. The background to how the standard was developed and finalised are described in an introductory editorial. Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency health care provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focused on prevention and chronic health management appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons. We publish an editorial on this topic to accompany the paper written by a team from Victoria and Queensland. A group from the neurosurgery department of the Royal Brisbane and Women's Hospital report that the availability of cranial access equipment outside Queensland tertiary centres is limited. Inter-hospital transfers are likely to persist in Queensland and so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted. They surveyed senior theatre nurse or surgical service directors from rural and regional Queensland hospitals located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Life-threatening thoracic trauma requires emergency pleural decompression, and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children is challenging, even for experienced clinicians. A team from Melbourne report that the Mid-Arm-Point (MAP) technique, a procedural aid for use with injured adults, is also a safe site for pleural decompression in children <4 years and with a very minor modification is safe in children ≥4 years. An excellent study from Queensland describes the demographics, presentation characteristics, clinical features and cardiac outcomes for Aboriginal and Torres Strait Islander patients who present to a regional cardiac referral centre ED with suspected acute coronary syndrome (ACS). The authors conclude this cohort with suspected ACS have a high burden of traditional cardiac risk factors, regardless of whether they are eventually diagnosed with ACS. These patients may benefit from assessment for coronary artery disease regardless of age at presentation. In a nice paper, James Mallows explores the concept of collegiality, something considered to be any extra-role behaviour that is discretionary, not recognised by a formal reward system and that promotes the effective functioning of the organisation. There are few studies examining collegiality in the medical profession and none looking at collegiality among emergency physicians (EPs). He explores the perceptions of different ED health care professionals on the meaning of collegiality among EPs, the benefits of collegiality and behaviours they identify as indicative of collegiality. He identifies distinct themes and behaviours indicative of collegiality among EPs. Promoting these behaviours could improve staff well-being, ED efficiency, patient safety and productivity. Continuing with the previous theme, team culture underpins team performance. Psychological safety is a critical component of team culture for high performing teams. A group from the Gold Coast Hospital decided to explore this further. They conclude that familiarity of team members and leaders is critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams. The focus in this issue is on the anaesthetic component of the Fellowship training programme.

Study of Trend and Pattern of Death of Prisoners in Judicial Custody in the State of Bihar and its Medico Legal Aspect

Study of Trend and Pattern of Death of Prisoners in Judicial Custody in the State of Bihar and its Medico Legal Aspect

What can coronial cases tell us about the quality of emergency healthcare for prisoners in Australia?

This research aimed to examine the legal and regulatory obligations of authorities and healthcare professionals in the provision of prison emergency health services and to identify problems in the provision of emergency care to prisoners by using case examples from coronial findings. Review of legal and regulatory obligations and a search of coronial cases for deaths related to the provision of emergency healthcare in prisons in the past 10 years in Victoria, New South Wales and Queensland. The case review identified several themes - issues with prison authority policies and procedures that delay access to timely healthcare or compromise the quality of care, operational and logistical factors, clinical issues and stigmatic issues including prison staff attitudes to prisoners requesting urgent healthcare assistance. Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency healthcare provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focussed on prevention and chronic health management, appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons.

Death, trauma and grief: the case of the prison

ABSTRACT This paper critically analyses deaths in prison in England and Wales. It focuses on how the state’s ‘truth’ about the nature and extent of these deaths has been challenged and develops an alternative perspective which situates these deaths in the context of a system built on violence and systemic indifference and where state agents are protected by a culture of immunity and impunity. It also illustrates the often-abysmal treatment of the families of dead prisoners and the struggles they have engaged in, alongside the charity INQUEST 1 , to establish the actual truth about the deaths of their relatives and to hold to account those responsible for these deaths, many of which were preventable. The paper concludes by outlining a range of radical alternatives to the current baleful situation including humanising prisoners and removing the stigma of less eligibility which has prevailed for 200 years and has legitimated the pain and punishment inflicted on them by the state.