Suicide in recently released prisoners: a population-based cohort study

Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, UK.
The Lancet (Impact Factor: 45.22). 08/2006; 368(9530):119-23. DOI: 10.1016/S0140-6736(06)69002-8
Source: PubMed

ABSTRACT Several studies have been undertaken on suicide in custody, but few on suicide after the release from prison. We undertook a population-based cohort study to investigate suicide rates in recently released prisoners in England and Wales.
We used the database of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness for England and Wales to identify all individuals who died by suicide or who received an open verdict at the coroner's inquest between 2000 and 2002. These records were linked to a Home Office register to identify all such deaths in people within 1 year of release from prison in England and Wales. We compared suicide rates per 100,000 person-years in these released prisoners with rates in the general population by using the indirectly age-standardised mortality ratio.
We identified 382 suicides occurring in 244 988 individuals within 1 year of release from prison; a suicide rate of 156 per 100 000 person-years. 79 (21%) suicides occurred within the first 28 days after release. In all age groups, suicide rates were higher in recently released prisoners than in the general population. The overall age-standardised mortality ratio for recently released prisoners was 8.3 (95% CI 7.5-9.3) for men and 35.8 (25.4-50.2) for women.
Recently released prisoners are at a much greater risk of suicide than the general population, especially in the first few weeks after release. The risk of suicide in recently released prisoners is approaching that seen in discharged psychiatric patients. A shared responsibility lies with the prison, probation, health, and social services to develop more collaborative practices in providing services for this high-risk group.

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Available from: Daniel Pratt, Apr 04, 2014
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    • "difference in mortality rates between former prisoners and non-imprisoned offenders of similar age and gender was substantially smaller and even became nonsignificant when former prisoners were compared with nonimprisoned offenders who were similar regarding age, gender, and propensity score. Our finding that former prisoners were more likely to die after release from prison is in line with other reports (e.g., Binswanger et al. 2007; Farrell and Marsden 2007; Joukamaa 1998; Kariminia et al. 2007; Pratt et al. 2006; Spaulding, Allen, and Stone 2007). The magnitude of the standardized mortality risks of ex-prisoners observed in our study, and in the other 24 studies, differed substantially between studies (Table 1). "
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    • "The leading causes of death were heterogeneous, including drug overdose, cardiovascular disease, homicide, suicide, motor vehicle accidents and cancer (Binswanger et al., 2007). International studies have shown suicide to be a major cause of death in the post-release period (Binswanger et al., 2007; Joukamaa, 1998; Kariminia et al., 2007; Pratt et al., 2006). However, little is known about the health-related experiences, medical and mental health needs, and risk perceptions of former inmates during the transition from prison release to the community. "
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    ABSTRACT: In many states, budget constraints are prompting earlier release of prison inmates. Prior studies have demonstrated elevated mortality rates in the post-release period but little is known about the health experiences of former inmates in the transition from prison to the community. The objective of this study was to understand the health-seeking experiences, perceptions of risk, and medical and mental health needs of former prisoners in the first two months after release from prison. Participants consisted of 29 former inmates within the first two months after their release from prison to the Denver, Colorado area. Using qualitative methods, trained interviewers conducted individual, in-person, semi-structured interviews exploring participants' experiences with health, mental health, and health care since release. Interview transcripts were coded and analyzed utilizing a team-based approach to inductive analysis. We found that health-related behavior occurred in the context of a complex life experience, with logistical problems exacerbated by emotional distress. Major themes included 1) transitional challenges; 2) cognitive responses including perceptions about personal risk, knowledge and priorities; 3) emotional responses including pronounced stress, fear, anxiety, disappointment; and 4) health behaviors. Former inmates reported multiple challenges, poor transitional preparation preceding release, and inadequate or absent continuity of mental and physical health care in the context of significant emotional distress and anxiety. Improved release planning, coordination between the medical, mental health and criminal justice systems may reduce the risk of poor health outcomes for this population.
    International Journal of Law and Psychiatry 07/2011; 34(4):249-55. DOI:10.1016/j.ijlp.2011.07.002 · 1.19 Impact Factor
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    • "I argue that contemporary Anglo-American societies (not just Britain, but Britain represents a typical example) are particularly bad at reintegrating and re-accepting individuals who have committed offenses back into wider society (see Petersilia, 2003; Travis, 2005). Evidence of this failing can be found in the rates of released prisoners being returned to prison (Kubrin and Stewart, 2006), as well as in the high rates of suicide among recently released ex-prisoners in the United States (Binswanger et al., 2007), Australia (Kariminia et al., 2007) and the United Kingdom (Pratt et al., 2006). Equally telling is the preoccupation that the Anglo-American media has with the release of prisoners – a prime example of which was the media-fueled panic following the British government's recent decision to release a large number of prisoners 18 days earlier than their scheduled release date to clear space in the overcrowded prison system (Ford, 2007). "
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