Prison Suicide Research Articles

Psychological therapy for the prevention of suicide in prison: study protocol for a randomised controlled trial

BackgroundSuicide is the leading cause of preventable death in prisons. Deaths from suicide in prison are significantly, and persistently, elevated compared to those living in the community. Psychological therapies have been shown to be a potentially effective means of alleviating suicidal thoughts, plans and behaviours, but patients located in prison often have no access to evidence-based psychological interventions targeting suicide. The objectives of this programme of research are to investigate the clinical and cost effectiveness of a new psychological therapy programme delivered to male prisoners at risk of suicide.MethodsThe PROSPECT trial is a two-armed single blind, pragmatic, randomised controlled trial and will recruit a target sample size of 360 male prisoners, identified as at-risk of suicide, across 4 prisons in the North of England. Participants will be randomised to receive a psychological talking therapy (Cognitive Behavioural Suicide Prevention, CBSP) plus treatment as usual, or treatment as usual alone. Co-primary outcomes (Suicide Ideation and Suicide Behaviours), as well as related secondary outcomes, will be assessed at baseline and at 6-months follow-up. An intention to treat analysis will be conducted with primary stratification based on prison site and lifetime history of suicide attempt (yes/no). A nested qualitative process evaluation will investigate the nature and context in which the intervention is delivered, with specific focus upon the facilitators and barriers to the implementation of the therapy within prisons.DiscussionThe key outputs from this trial will be to determine whether a psychological therapy for suicidal prisoners is clinically and cost effective; and to generate a project implementation platform that identifies how best to implement the new intervention across the broader prison estate.Trial registrationISRCTN (reference ISRCTN14056534 https://www.isrctn.com/ISRCTN14056534; 24th September 2021). Registration confirmed prior to participant recruitment commencing. Modifications to protocol are listed on the study website at ISRCTN.

Trauma and imported vulnerability in prison suicides

Suicide rates in prison are much higher than in the community. Significant data supports an approach to understanding this phenomenon that sees suicide as the outcome of incarcerated people bringing their vulnerability with them into prison combined with the pain and deprivation they experience on the inside. This article uses a personality development approach to argue that part of prisoners’ imported vulnerability – which puts them at a higher risk of suicide – results from a life trajectory marked by trauma. To this end, I draw on repeat qualitative interviews with 29 prisoners in Latin America who attempted suicide while incarcerated. Based on a study of their life trajectories, I argue that pre-prison trauma plays a role in suicide in prison by shaping prisoners’ personalities to make them more susceptible to negative emotions and reduced tolerance to distress, adversely impacting their modes of approaching and responding to the world.

Suicide in prison in the North of Italy (1993-2022): a case-control study examining differences between suicides inside and outside prison.

Prisoners constitute a group at suicide risk, showing higher relative rates of suicides than the general population. However, there is limited knowledge about the characteristics of those who die by suicide in Italian prisons. Based on the total sample of suicides of the Institute of Forensic Medicine of Milan (1993-2022), suicides in prison (N = 120) were matched by age and gender with cases that occurred outside prison (N = 300) and compared with them. The considered variables were sociodemographic, clinical, and suicide-related. Univariate analyses and logistic regression model were performed. In univariate analyses, suicides in prison showed higher rates of ethnicity different from white Caucasian, lower rates of depression, higher rates of alcoholism, addiction, respiratory system diseases, hepatitis, and amyotrophic lateral sclerosis, lower use of any medication, and in particular psychotropic medications, and a higher percentage of violent suicide method versus nonviolent compared to suicides outside prison. In the logistic regression model, ethnicity, depression, and addiction were the only features differentiating suicides in prison from ones outside prison. Particular attention should be paid to inmates with non-white ethnicity and those with addiction. Ensuring adequate access to psychiatric care and implementing comprehensive suicide prevention strategies within Italian prisons is crucial.

Prison mental health in South-East Asia: A narrative review.

South-East Asia is a densely populated region with a considerable, however, under-prioritized mental health burden. Little is known about the mental health burden and services status in the prisons of the region. We aimed to investigate the individual country-wise prison mental health status in South-East Asian region. We performed a narrative review based on the evidence available in PubMed, Scopus, PsycINFO, Google, and Google Scholar considering the review objectives. We highlighted country perspectives on total population, prison numbers, prisoner numbers, the prevalence of psychiatric disorders and suicide among prisoners, prison mental health services, current challenges, and ways ahead. We discussed the prison mental health of five countries (Bangladesh, India, Indonesia, Nepal, and Sri Lanka). We found overcrowding (131.4%-215.6%) in the prisons, a high prevalence of psychiatric disorders in the prisons (40%-100%), negligible prison mental health services, and a lack of data on prison suicide with some variations among the five countries. Among the countries, Bangladesh has the highest prevalence (66.4%-100%) of psychiatric morbidity with an absence of a mental health system. Prison mental health in tSouth-East Asia is a neglected domain and warrants attention regarding ensuring adequate mental health services to the prisoners as there are high unmet mental health needs and an absence of poorly supported mental health needs.

Exploring the factors influencing prison incentive scheme status among adult males: A prospective longitudinal study

Despite its impact on imprisonment, no quantitative study has examined the factors related to people's status on prison incentive schemes. This study addresses this gap by using administrative data to explore the factors related to the status of 405 men on a prison incentive scheme. Results revealed that those who had a prior history of passing prison drug tests at time 1, and spent more time imprisoned during the follow-up period, were more likely to be on the highest level of the scheme one year later at time 2. In contrast, those who had a history of past involvement in misconduct, referrals for serious self-harm/attempted suicide in prison, not taken a prison drug test, property offences, and greater periods of custody at time 1 were more likely to be on the lower levels of the scheme at time 2. The potential implications for theory, policy, and practice are discussed.

Worldwide incidence of suicides in prison: a systematic review with meta-regression analyses

Suicide is a leading cause of death during imprisonment. This systematic review aimed to synthesise available evidence of prison suicide incidence worldwide. We systematically searched the scientific literature, data repositories, and prison system reports, supplemented by correspondence with prison administrations. We included reports on people living in prison but excluded studies in preselected groups (by age or offence type). Absolute numbers and incidence rates of suicide mortality per 100 000 person-years by sex and country were extracted from 2000 to 2021. IQRs were used to describe the suicide incidence in different world regions. Incidence rate ratios comparing suicides of people living in prison with age-standardised general populations were calculated. We conducted meta-regression analyses on national-level and prison-level factors to examine heterogeneity. The study protocol was pre-registered with PROSPERO, CRD42021296819. We included three scientific studies, 124 official reports, and 11 datasets from email correspondence. Between 2000 and 2021, there were 29 711 reported suicides during 91·2 million person-years of imprisonment in 82 jurisdictions worldwide (sex-specific data available for 13 289 individuals: 12 544 [94·4%] male and 745 [5·6%] female individuals). There were large variations between countries, with most studies reporting suicide rates in the range of 24-89 per 100 000 person-years in both sexes (22-86 in male individuals and 25-107 in female individuals). In meta-regression analyses, Europe (vs other regions), high-income countries (vs low-income and middle-income countries), and countries with lower incarceration rates (vs those with higher incarceration rates) had higher suicide rates. Incidence rate ratios between people who are incarcerated and age-standardised general populations in the same jurisdictions were typically in the range of 1·9-6·0 in male and 10·4-32·4 in female individuals. Prison services worldwide, and particularly in Europe, should prioritise suicide prevention. Assessment and management of suicide risk in female individuals living in prison need particular attention due to excess mortality relative to community-based populations. Interpretation of synthesised data needs to be done with caution due to high heterogeneity between jurisdictions. Agencia Nacional de Investigación y Desarrollo, Economic and Social Research Council, and Wellcome Trust.

‘Unforeseeable’ and ‘inevitable’: Constructions of prison suicide in Scotland’s Fatal Accidents and Sudden Deaths Inquiries

‘Unforeseeable’ and ‘inevitable’: Constructions of prison suicide in Scotland’s Fatal Accidents and Sudden Deaths Inquiries

'Unforeseeable' and 'inevitable': Constructions of prison suicide in Scotland's Fatal Accidents and Sudden Deaths Inquiries.

Rates of suicides are on the rise in Scottish prisons. Fatal Accident and Sudden Deaths Inquiries (FAIs) carried out by sheriffs following these deaths provide a valuable source of knowledge regarding how the criminal justice system understands and responds to incarcerated people's suicides. Informed by literature in critical suicide studies and narrative criminology, we conducted an abductive, narrative qualitative analysis of 37 FAI reports of incarcerated people's suicides published between 2016 and 2021, in Scotland. We argue that the FAIs explicitly individualise incarcerated people's suicides, deploying explanatory narratives of (1) mental illness, (2) social history and (3) problematic substance use, while (4) simultaneously emphasising and undermining incarcerated people's testimony and agency. By conceptualising suicide as paradoxically 'unforeseeable' and 'inevitable', these narratives shift blame onto the individual while absolving the prison system. Our analysis contributes towards understanding of how institutional procedures are implicated in social scripts and practices around suicide in Scottish prisons.

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.

Elements of State and Federal Prison Suicide Prevention and Response Policies

There are no mandatory national standards for custodial suicide prevention and response programs in the United States. While some professional organizations do offer accreditation, those programs are optional. Recent research on jails found that most facilities have formal suicide prevention policies, but they differ in their comprehensiveness. Little is known about the elements of state and federal prison suicide prevention policies. This study involves an analysis of state- and federal-level department of corrections suicide prevention and response policies. Elements of each jurisdiction’s policies were compared against a list of best practices, developed by professional organizations and correctional suicide scholars, for suicide prevention and response. Results revealed that, on average, department policies contain about half of the recommended elements, and that some policies, including those that could improve the culture of each institution, are not included in most departmental policy documents.

Prof. Nevzat Tarhan: "Do not let sexuality fall through the floor."

Sexual abuse and pedophilia have once again come to the fore with the publication of the case files related to businessman Jeffrey Epstein, who was accused of sexual abuse of children in the USA and committed suicide in prison. President of Üsküdar University, Psychiatrist Prof. Nevzat Tarhan evaluated the issue of pedophilia.

교도소 수형자의 부정적 자동적 사고가 자살실행력에 미치는 영향

The purpose of this study was to examine whether the effect of prisoners' negative automatic thoughts on capability suicide through aggression is enhanced by cognitive fusion. Moderated mediation analysis was conducted by SPSS 25.0 and SPSS PROCESS Macro. The data of 500 prisoners were collected. The results of the study showed that there was a full mediation effect of aggression on the relationship between negative automatic thoughts and capability for suicide among prisoners. In addition, the aggression induced by negative automatic thoughts was further strengthened by cognitive fusion. Lastly, this study found that the mediation effect of aggression moderated by cognitive fusion was also significant from the moderated mediation model analysis. This finding suggests that the higher the level of cognitive fusion, the greater the impact of negative automatic thoughts on capability for suicide through aggression. The results in this study highlight the importance of psychological problems in interventions to prevent prisoner suicide and suggest meaningful information for theoretical intervention models in correctional psychology.

The contributing factors to suicide in Italian prisons: An 11‐year analysis (2010–2020)

AbstractBackgroundSuicide is a leading cause of death globally, with approximately 800,000 deaths annually and accounting for 1.5% of all deaths. Risk factors are multifaceted, encompassing individual factors (such as genetics, family history and mental illnesses) and environmental factors (such as economic conditions, social support and life events). In prisons, suicide rates are markedly higher than in the general population, particularly in Italy, where the prisoner suicide rate is approximately 20 times that of the non‐incarcerated population. There is, however, little research on suicide in Italian prisons.AimsTo analyse the characteristics of all people who died by suicide in Italian prisons between 2010 and 2020.MethodsWe carried out a records‐based cohort study analysing official data from the Italian Ministry of Justice on prison suicides between 2010 and 2020. The data were cross‐referenced and, when required, supplemented with information from Ristretti Orizzonti, a journal specialising in health and living conditions in prisons, as well as from the website of ISTAT (Italian National Statistical Institute), newspapers, radio broadcasts and news agencies.ResultsFactors associated with an increased risk of suicide in prisons were nighttime periods, the months of June, July and October, a relatively brief duration of detention (&lt;6 months), having been convicted of murder, male gender, being about 40 years old, having access to hanging materials and being interned (i.e. subjected to the execution of custodial security measures) or awaiting trial. Prison overcrowding was not a risk factor for suicide.ConclusionOur findings hold substantial implications for suicide prevention in Italian prisons as they suggest both characteristics of individuals and characteristics of the institutions that could be taken as risk indicators. This knowledge can inform the development of targeted interventions to manage both individual and environmental factors better, leading to improved prison conditions and reduced suicide rates. Furthermore, our research establishes a foundation for more systematic and in‐depth investigations that could further improve suicide prevention strategies in Italian prisons, ultimately influencing policy changes in both practice and research, including perhaps establishing a national database on every completed suicide in prisons.

(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.

Utilizing Peer Safety Companions to Prevent Suicide in Prisons.

A variety of strategies have been implemented to identify, target, and prevent suicide in correctional settings. In recent decades, some prisons have adopted policies that use other incarcerated individuals to support people who have been identified as being at high risk of suicide. There has been little research on these policies and, of the few studies that have been conducted, all have relied on data from a single facility. This study takes a national approach by exploring how many departments of corrections (DOCs) include incarcerated individuals as part of their suicide prevention strategies and the characteristics of those programs. This study is an analysis of suicide prevention policies from state DOCs and the Federal Bureau of Prisons (BOP) in the United States. The BOP and 15 state DOCs have written policies pertaining to the use of incarcerated individuals as components of suicide prevention programs. These programs differ in their expectations for incarcerated individuals, with some focusing solely on observation of people in crisis and others emphasizing befriending and mentoring.

SUICIDALNOST OSUĐENIH U ZATVORU – FAKTORI RIZIKA I TEORIJSKI MODELI

Suicide in prison represents one of the leading causes of death among inmates, with a rate two to nine times higher than in the general population. This is a multidimensional problem that requires systematically established preventive responses and dedication to preventive activities at different levels. Since many risk factors of socio-demographic, psychosocial, institutional, psychiatric, and criminological nature can precede the act of committing suicide, this phenomenon can be understood through an integrative approach through, existing theoretical models covering three domains: the penological domain, through the “Deprivation Model”, “Importation Model”, and Combined Model; the sociological domain, through the application of Durkheim’s model of suicidality to the prison context; and the psychological domain, through Interpersonal Theory, Theory of Stress, and Theory of Reactive Aggressiveness. The aim of this paper is to review the scope of the problem of suicide among inmates by linking risk factors to different theoretical models that explain the etiology of suicide in prison. The paper uses analysis and synthesis of theoretical and empirical findings through the study of relevant literature from different scientific data sources

Understanding experiences of suicidality within women’s prisons in England: a systematic review of the qualitative literature

PurposeSuicide and suicide-related incidents have increased within women’s prisons in the UK. This paper aims to synthesise the findings of qualitative literature, to gain a deeper understanding of the how women and staff in English prisons experience and explain the causes of their suicidal behaviours.Design/methodology/approachA systematic search of five electronic databases, namely, MEDLINE, APA Psychological Information Database (Psycinfo), Cumulative Index to Nursing and Allied Health Literature (with full text – CINAHL), Psychology and Behavioural Sciences Collection and APA PsycArticles, was completed in January 2023. This study’s search strategy returned 1,714 articles, 7 of which were included for review. To identify relevant themes within the data, Thomas and Harden’s (2008) framework was applied. Quality appraisal was conducted by using Joanna Briggs’ Institute Checklist for Qualitative Research (Joanna Briggs Institute, 2021).FindingsFour themes were determined, which describe the causes of suicidal behaviours in women’s prisons in England; mental health and trauma, lack of support from services and staff, contact with family and self-harm as a coping strategy. Important sub-themes were also identified including the prison environment and poor relationships with staff.Practical implicationsFurther qualitative research is needed, however, the findings suggest greater support is required to aid positive mental health, including the provision of trauma informed coping strategies and improved staff training.Originality/valueTo the best of the authors knowledge, this is the first systematic review conducted on the factors contributing to women’s suicide in English prisons using qualitative literature.

Suicides in state prisons in the United States: Highlighting gaps in data.

Our objectives were to document data availability and reporting on suicide mortality in state prison systems. The United States leads the world in mass incarceration, a structural determinant of health, but lacks real-time reporting of prison health statistics. This absence is particularly notable in suicides, a leading cause of death that carceral policies play a key role in mitigating. Suicide data for each state prison system from 2017-2021 were gathered through statistical reports, press releases, and Freedom of Information Act requests. We graded states based on data availability. Only sixteen states provide updated, frequent, granular, freely provided suicide data. An additional thirteen states provided frequently updated data but that had little granularity, was incomplete, or was not freely provided. Eight states provided sparse, infrequent, or outdated data, and thirteen provided no data at all. The 2000 Death in Custody Reporting Act requires that states provide these data freely, yet the majority of states do not. There is a need for reliable, real-time data on suicides, suicide attempts, and conditions of confinement to better understand the harms of the carceral system and to advocate for change.

Resiko Bunuh Diri pada Warga Binaan Pemasyarakatan Dewasa dengan Masa Hukuman ≥ 5 Tahun di Lembaga Pemasyarakatan Kelas IIA Palangka Raya

Correctional Institutions (Lapas), namely institutions that foster convicts so that they are ready to return to being citizens who comply with the values ​​and legal norms of society. The large number of suicide risk cases is due to the government's lack of attention to the psychological conditions of prisoners or correctional inmates. The causes of suicide are depression, encouragement from the heart, social problems, bad experiences that trigger trauma, and heredity. The purpose of this study was to determine and analyze the risk of suicide as well as the inhibiting and supporting factors for suicide risk in adult prisoners with a sentence of ≥5 years in Palangka Raya Class IIA Penitentiary. This research is case research using qualitative research methods or research based on phenomena that occur intensively in an institution. There is a risk of suicide among prisoners in the Palangka Raya Class IIA Penitentiary, while the supporting factors are the lack of human resources in the field of mental health (psychologists) in the Palangka Raya Class IIA Penitentiary, lack of family trust support, feelings of not accepting the condition and sentence sentences that have been given, the environment of the Class IIA Penitentiary in Palangka Raya which exceeds capacity (overload). Inhibiting factors that affect the risk of suicide in prisoners of correctional services, namely, the existence of facilities for worship in accordance with the beliefs held by each prisoner, the availability of educational facilities, facilities for developing handicrafts, sports facilities such as volly ball, futsal, table tennis, social facilities consisting of from family visits, meeting rooms and family support such as regular visits, giving love, understanding and attention.

Barriers and facilitators to help-seeking for mental health problems in prison: A qualitative interview study with incarcerated males in Northern Norway.

IntroductionThe prevalence of mental disorders is considerably higher among incarcerated individuals than in the general population, but this burden is not matched by a proportional use of mental health services. Studies have found that incarcerated males are reluctant to seek help for mental health problems. Gaining knowledge of factors that influence incarcerated individuals to access or avoid professional help for mental health problems is important for tailoring interventions to address the mental health needs of this population. Promoting mental health service utilization among people in prison has the potential to reduce prison suicide rates and increase institutional functioning, thereby providing safer conditions for peers and staff, promoting rehabilitation, and reducing recidivism upon release.ObjectivesThis study explores personal, interpersonal, and systemic aspects that motivate incarcerated individuals to approach or avoid seeking help for mental health problems. While prior studies have primarily focused on barriers to help-seeking, this study also sheds light on facilitators for seeking professional help for people in prison.MethodsIndividual in-depth interviews were conducted with sixteen incarcerated males from three prisons in Northern Norway. The data analysis was inspired by Grounded Theory.ResultsThe majority of participants shared positive personal perspectives related to professional help-seeking, whereas the barriers were predominantly perceived to be of an interpersonal and systemic nature. Aspects that encouraged help-seeking were: regarding mental health treatment as necessary for successful rehabilitation, sufficient knowledge of when and how to contact mental health services, support from peers, having a higher ranking in the prison hierarchy, health services that are out-reaching, and prior positive experiences with professional help. The barriers to professional help-seeking were: lack of information about when and how to access mental health services, challenges with the self-referral system, perceived unavailability of services, confidentiality issues, and a prison climate that favoured a tough appearance.ConclusionsThe participants appeared to be more positive to seeking professional help for mental health problems than reported in previous studies with incarcerated individuals. Interpersonal and systemic aspects were emphasized by the participants as barriers to accessing mental health services; some participants even perceived these services to be unavailable to them. The results are relevant for designing interventions to promote help-seeking for mental health problems among people in prison.Disclosure of InterestNone Declared