Prevention of Suicidal Behavior in Prisons
An Overview of Initiatives Based on a Systematic Review of Research on Near-Lethal Suicide Attempts
Abstract
Abstract.Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners.
References
(2000).
Training staff in suicide awareness . In G. TowlL. SnowM. McHughEds., Suicide in Prison. Oxford, UK: BPS Blackwell.(2009). Psychiatric disorders and suicide in the nation's largest state prison system. Journal of the American Academy of Psychiatry and the Law, 37, 188–193.
(2014). Management of suicidal and self-harming behaviors in prisons: Systematic literature review of evidence-based activities. Archives of Suicide Research, 18, 178–184.
(2013). Prison population statistics. London, UK: House of Commons Library.
(2003). The mental health of prisoners. Advances in Psychiatric Treatment, 9(3), 191–199. 10.1192/apt.9.3.191
(2001). Identifying suicide risk in penal institutions in the Netherlands. The British Journal of Forensic Practise, 3(4), 22–28.
(2006). Stressful segregation housing and psychosocial vulnerability in prison suicide ideators. Suicide and Life-Threatening Behavior, 36, 250–254. 10.1521/suli.2006.36.2.250
(2005). Learning from near misses: Interviews with women who survived an incident of severe self-harm. Howard League Journal, 44, 57–69.
. (2009). The Bradley Report: Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system. London, UK: Crown.
(2013). Suicide in prisoners: An italian contribution. The Open Criminology Journal, 6, 18–29.
(2007). Preventing suicide in prisons, Part II. Crisis, 28(3), 122–130. 10.1027/0227-5910.28.3.122
(2006). Preventing suicide in prison: A collaborative responsibility of administrative, custodial, and clinical staff. Journal of the American Academy of Psychiatry and the Law, 34(2), 165–175.
(1990). Prison suicide in England and Wales: 1972-1987. British Journal of Psychiatry, 151, 218–221.
(2002). The RUSH program – real understanding of self-help: A suicide and self-harm prevention initiative within a prison setting. Australian Psychologist, 37, 237–244. 10.1080/00050060210001706926
(1999). Punishment first verdict later: A review of conditions for remand prisoners in Scotland at the end of the 20th century. Edinburgh, UK: Scottish Executive.
(2008). Suicide in prisoners: A systematic review of risk factors. Journal of Clinical Psychiatry, 69, 1721–1731.
(2011). Prison suicide in 12 countries: An ecological study of 861 suicides during 2003-2007. Social Psychiatry and Psychiatric Epidemiology, 46(3), 191–5. 10.1007/s00127-010-0184-4
(2013). Suicide in prisoners with bipolar disorder and other psychiatric disorders: A systematic review. Bipolar Disorders, 15(5), 491–495.
(1997). Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry, 170, 447–452.
(2001). Prevention of suicide in a large urban jail. Psychiatric Annals, 31, 447–452.
(2003). The relevance of suicidal behaviour in jail and prison suicides. European Psychiatry, 18, 161–165.
(2005). The epidemiology and prevention of suicide by hanging: A systematic review. International Journal of Epidemiology, 34, 422–433.
(2004). Peer suicide prevention in a prison. Crisis, 25(1), 19–26.
(2014). Self-harm in prisons in England and Wales: An epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet, 383(9923), 1147–54. 10.1016/S0140-6736(13)62118-2
(2009). Suicide. Lancet, 373, 1372–1381.
(2008). Improvements to suicide prevention training for prison staff in England and Wales. Suicide and Life-Threatening Behavior, 38, 708–713.
. (2008). Prison service order 4800: Women prisoners. London, UK: Author.
(2008). Offending behaviour programmes: Development, application, and controversies. Chichester, UK: John Wiley & Sons. 10.1002/9780470713341
(2011). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. British Journal of Guidance & Counselling, 39(2), 194–195.
(2011). Characteristics of and trends in subgroups of prisoner suicides in England and Wales. Psychological Medicine, 41(11), 2275–2285.
(2013). A national case–control study of risk factors for suicide among prisoners in England and Wales. Social Psychiatry and Psychiatric Epidemiology, 48, 1177–85. 10.1007/s00127-012-0632-4
(2002). Bullying among prisoners: Evidence, research and intervention strategies. London, UK: Brunner-Routledge.
(2005). Psychiatric and social aspects of suicidal behaviour in prisons. Psychological Medicine, 35(2), 257–269.
(2005). Using trained inmate observers for suicide watch in a federal correctional setting: A win-win solution. Psychological Services, 2, 20–27.
(2007). Factors associated with mortality in a cohort of Australian prisoners. European Journal of Epidemiology, 22, 417–428.
(2004). Correctional health care systems and collaboration with academic medicine. JAMA, 292, 501–503.
(2007). Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons. Crisis, 28(3), 113–121.
(2004). Reducing suicides in New York State correctional facilities. Psychiatric Quarterly, 75(1), 61–70.
(2014). Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study. BMJ Open, 4(4), e004666.
(2006). An ecological study of factors associated with rates of self-inflicted death in prisons in England and Wales. International Journal of Law and Psychiatry, 29(5), 355–360.
(2004). Prisons and their moral performance: A study of values, quality and prison life. Oxford, UK: Clarendon Press.
(2006). Deliberate self-harm and suicide attempt in custody: Distinguishing features in male inmates' self-injurious behavior. International Journal of Law and Psychiatry, 29(5), 370–385.
(2008). Prison inmate characteristics and suicide attempt lethality: An exploratory study. Psychological Services, 5(4), 351–361.
(2003). Neurobiology of suicidal behaviour. Nature Reviews Neuroscience, 4(10), 819–828.
(2012). The impact of prison staff responses on self-harming behaviours: Prisoners' perspectives. The British Journal of Clinical Psychology/the British Psychological Society, 51(1), 4–18.
(2010). Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: Case-control study. The British Journal of Psychiatry, 197(3), 219–26. 10.1192/bjp.bp.109.075424
(2011). Near-lethal self-harm in women prisoners: Contributing factors and psychological processes. Journal of Forensic Psychiatry & Psychology, 22(6), 863–884. 10.1080/14789949.2011.617465
(2011). Psychosocial influences on prisoner suicide: A case-control study of near-lethal self-harm in women prisoners. Social Science & Medicine (1982), 72(6), 874–83. 10.1016/j.socscimed.2010.12.028
(2009). Interviewing survivors of near-lethal self-harm: A novel approach for investigating suicide amongst prisoners. Journal of forensic and legal medicine, 16(3), 152–155.
(2007).
Implementing dialectical behavior therapy in residential forensic settings with adults and juveniles . In L. A. DimeffK. KoernerEds., Dialectical behavior therapy in clinical practice: Applications across disorders and settings (pp. 112–144). New York, NY: Guilford Press.(2005). Screening for suicide risk factors in prison inmates: Evaluating the efficiency of the Depression, Hopelessness and Suicide Screening Form (DHS). Legal and Criminological Psychology, 10, 1–12. 10.1348/135532504X15295
. (2015). Safety in custody - quarterly update to September 2014. London, UK: Author.
(2002). ACCESS-working to reduce self-harm and bullying among juvenile offenders. Prison Service Journal, 144, 31–35.
. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(6), e1000097. 10.1371/journal.pmed1000097
. (2005). Clinical guideline 26. Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London, UK: National Institute for Clinical Excellence.
. (2011). Self-harm: Longer-term management. London, UK: Author.
(2005). Female prisoners with borderline personality disorder: Some promising treatment developments. Criminal Behaviour and Mental Health, 15(1), 2–16. 10.1002/cbm.33
(2013). Screening for suicide risk in primary care: A systematic evidence review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality.
. (2008). An evaluation of the reception screening process used within prisons in England and Wales. Manchester, UK: Author.
(2013). Prison suicides in Germany from 2000 to 2011. International Journal of Law and Psychiatry, 36, 386–389. 10.1016/j.ijlp.2013.06.018
(2006). Suicide in recently released prisoners: A population-based cohort study. Lancet, 368, 119–123.
. (2015). Help is at hand: Support after someone may have died by suicide. London, UK: Public Health England.
(2012). Prison structure, inmate mortality and suicide risk in Europe. International Journal of Law and Psychiatry, 35, 222–230. 10.1016/j.ijlp.2012.02.012
(2011). The suicidal process in male prisoners making near-lethal suicide attempts. Psychology, Crime & Law, 19(4), 305–327.
(2012). Studying survivors of near-lethal suicide attempts as a proxy for completed suicide in prisons. Forensic Science International, 220(1–3), 19–26.
(2010). Psychiatric disorders in male prisoners who made near-lethal suicide attempts: Case-control study. The British Journal of Psychiatry, 197(4), 313–9. 10.1192/bjp.bp.110.077883
(2013). A typology of male prisoners making near-lethal suicide attempts. Crisis, 4(5), 335–347.
(2013). Psychosocial characteristics and social networks of suicidal prisoners: Towards a model of suicidal behaviour in detention. PloS One, 8(7), e68944. 10.1371/journal.pone.0068944
(2012). Impact on prisoners of participating in research interviews related to near-lethal suicide attempts. Journal of Affective Disorders, 136(1–2), 54–62.
(2009). Risk factors for attempting suicide in prisoners. Suicide and Life-Threatening Behavior, 39(3), 343–350.
(2004). Suicide by prisoners. British Journal of Psychiatry, 184, 263–267.
(2010).
Suicide and self-injury in offenders . In G. TowlD. CrightonEds., Forensic psychology. (pp. 384–397). Chichester, UK: Blackwell.(2006). Suicide in custody. Psychiatry, 5(8), 286–288.
(2010). Suicide in prison: A qualitative study. The Prison Journal, 90(3), 288–312.
. (2013). Report by the Prisoner Ombudsman into the circumstances surrounding the near death of Mr C (aged 30) whilst in the custody of Maghaberry Prison on 19 february 2012. Belfast, UK: Author.
(2010). Systematic review and meta-analysis of interventions relevant for young offenders with mood disorders, anxiety disorders, or self-harm. Journal of Adolescence, 33(1), 9–20. 10.1016/j.adolescence.2009.05.015
(2002). Effectiveness of a dialectical behaviour therapy program for incarcerated female juvenile offenders. Child and Adolescent Mental Health, 7, 121–127. 10.1111/1475-3588.00022
(2009). The health and health care of US prisoners: Results of a nationwide survey. American Journal of Public Health, 99, 666–672. 10.2105/AJPH.2008.144279
(2005). The impact of enhanced thinking skills on self-harm in custody (Unpublished report). London, UK: Her Majesty's Stationary Office.
. (2007). Preventing suicide in jails and prisons. Geneva, Switzerland: Author.
(2012). All-cause and external mortality in released prisoners: Systematic review and meta-analysis. American Journal of Public Health, 102(12), e65–e75.
