Psychiatric and social aspects of suicidal behavior in prisons

WHO Collaborating Centre, David Goldberg Centre, Institute of Psychiatry, Denmark Hill, London.
Psychological Medicine (Impact Factor: 5.94). 03/2005; 35(2):257-69. DOI: 10.1017/S0033291704002958
Source: PubMed


Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention.
To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk.
This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence.
Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders.
The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Download full-text


Available from: Nicola Singleton
    • "A disproportionate number of prison suicides occur in adult male establishments , at the very earliest stages of a prisoner's journey (Crighton & Towl, 1997; Hayes, 2012; Paton & Borrill, 2004). The characteristics of these prisoners who commit suicide appear relatively static across time and jurisdiction (Felthous, 2011), enabling the assembly of a series of internationally accepted risk factors (Fruehwald, Matschnig, Koenig, & Bauer, 2003; Jenkins et al., 1999; Rabe, 2012; Suto & Arnaut, 2010). These factors are important to consider when shaping service delivery, and they are outlined in Table 1. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examines an unusually sustained reduction in suicide rates in a local London prison during the three year period 2008–2011. The likelihood of this reduction taking place by chance was <2:100,000, and its perceived success was such that the prison service recommended an evaluation of its characteristics. This study arose from that recommendation, and it used a retrospective case study multi-method approach (including factor identification, qualitative interviews and triangulation with official documentation) to identify factors which had been associated with the reduced suicide rates. The results endorsed a number of factors which have already been internationally identified as best practice, along with some local innovation factors. Two further pivotal factors emerged through analysis, and they are the key to service improvements. These factors – senior management support for cultural change and cross-professional collaborative working – indicate that positive leadership and multi-agency integration are vital ingredients.
    No preview · Article · Jul 2015 · Journal of Forensic Psychiatry and Psychology
  • Source
    • "At least one other study of suicidal ideation in prisoners has reported a lack of association with alcohol and drug use (Jenkins et al., 2005; Larney et al., 2012). Although the reason why substance abuse and suicide ideation were not significantly related is not clear, it may be that the high prevalence of problematic substance use among prisoners may mean that it is not a useful predictor of suicide ideation in this population. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Suicidal behaviour is a common in prisoners, yet little is known about the factors that may protect against thoughts of ending one’s life. The main aim of the present study was to specify and test a structural model to examine the relationship between three criminal social identity dimensions (in-group affect, in-group ties, and Cognitive Centrality) and suicide ideation while controlling for period of confinement, age, and offense type (violent vs. non-violent). Design/methodology/approach: Participants were 415 male juvenile offenders incarcerated in prisons in Khyber Pakhtunkhwa (KPK) Pakistan. A structural model was specified and tested using Mplus to examine the relationships between the three factors of criminal social identity and suicidal thoughts, while controlling for age, offender type, period of confinement, and substance dependence. Findings: The model provided an adequate fit for the data explaining 22% of variance in suicidal thoughts. In-group affect (the level of personal bonding with other criminals) exerted a strong protective effect against suicide ideation. Originality/value: The research contributes important information on suicide ideation in Pakistan, an Islamic country in which suicide is considered a sin and subsequently a criminal offence. Results indicate that Juvenile offenders’ sense of shared identity may help to prevent the development of thoughts of death by suicide. Consequently, separating and isolating young prisoners may be ill advised.
    Full-text · Article · Jun 2015 · International Journal of Prisoner Health
  • Source
    • "Complex but connected systems of health, social care and criminal justice have emerged to assist women, who, regardless of the type of setting in which they are placed, may have broadly similar care needs (Parry-Crooke, Robinson, & Zeilig, 2012). Rates of mental disorder in prison are high (Fazel & Benning, 2009; Hassan et al., 2011): psychosis in women prisoners is 30 times higher than aged-matched community samples; while personality disorder is over 15 times as high (Jenkins et al., 2005; Singleton et al., 1998). Women report extremely high rates of sexual abuse, domestic violence (>50%), substance misuse (85%), with 70% of women requiring chemical detoxification (Corston, 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Secure provision for women in both the Criminal Justice System and the Health Service has evolved in the last decade, in line with emerging gender-specific policy. Notable gains have been the approach to self-harm in prison and a reduction in the inappropriately high levels of secure hospital care. Although treatment pilots in UK settings are in progress, much practice remains poorly described and insufficiently evaluated. Recent strategic initiatives by both the Ministry of Justice and the Department of Health, as well as the commissioning changes that have followed the Health and Social Care Act 2012, provide a basis for reconsideration and a further paradigm shift. Suggestions for a reinvigorated model of gender-sensitive provision are made, relying on principles of resilience and autonomy.
    Full-text · Article · Nov 2014 · Journal of Forensic Psychiatry and Psychology
Show more