A 17-Year National Study of Prison Suicides in Belgium
Abstract
Abstract.Background: Suicide is a leading cause of mortality in prisoners worldwide, yet empirical data on this matter are lacking in Belgium. Aims: This study sought to describe characteristics associated with a consecutive series of suicides in Belgian prisons from 2000 to 2016 inclusive, in order to inform suicide prevention strategies. Method: All documented cases of suicide (N = 262) were reviewed using a standardized assessment checklist. Official records were abstracted for prisoners' sociodemographic, criminological, and clinical information, as well as for suicide-related characteristics. Results: Over the 17-year study period, suicides accounted for one third of all deaths in Belgian prisons. The average annual suicide rate in Belgium from 2000 to 2016 was 156.2 per 100,000 prisoners. Examination of all cases highlights both individual (psychiatric disorders and a history of suicide attempt) and situational (the early period of incarceration, interfacility transfers, and placement in solitary confinement) factors common in many prison suicides; some of them amenable to (clinical) management, which presents several potential avenues for suicide prevention. Limitations: Given the absence of a matched control group, no conclusions could be ascertained regarding risk factors. Conclusion: Suicide is a common, preventable cause of death among prisoners in Belgium. The results underscore the timely need for national standards and guidelines for suicide prevention in Belgian prisons.
References
2014). SPACE I – Council of Europe annual penal statistics: Prison populations. Survey 2012. Strasbourg, France: Council of Europe.
(2015). A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons. BMC Public Health, 15, 290.
(2014). Management of suicidal and self-harming behaviors in prisons: Systematic literature review of evidence-based activities. Archives of Suicide Research, 18(3), 227–240.
(2005). Demographic, criminal, and psychiatric factors related to inmate suicide. Suicide and Life-Threatening Behavior, 35(1), 63–75.
(2001). Bullying and suicidal behavior in jails. Criminal Justice and Behavior, 28(3), 279–299.
(2013). Misclassification of suicide deaths: Examining the psychiatric history of overdose decedents. Injury Prevention, 19(5), 326–330.
(2015). Suicide risk assessment and intervention in people with mental illness. BMJ, 351, h4978.
(2006). Stressful segregation housing and psychosocial vulnerability in prison suicide ideators. Suicide and Life-Threatening Behavior, 36(2), 250–254.
(2017). The suicidal inmate: A comparison of inmates who attempt versus complete suicide. Suicide and Life-Threatening Behavior. 10.1111/sltb.12374
(2007). Preventing suicide in prisons, part II. Crisis, 28(3), 122–130. 10.1027/0227-5910.28.3.122
(2016). Older offenders deemed criminally irresponsible in Flanders (Belgium): Descriptive results from a retrospective case note study. International Journal of Law and Psychiatry, 46, 35–41. 10.1016/j.ijlp.2016.02.025
(2016). Annual report 2015. Brussels, Belgium: Author.
. (2013). Suicide among male prisoners in France: A prospective population-based study. Forensic Science International, 233(1-3), 273–277.
(2010). Deprivation, importation, and prison suicide: Combined effects of institutional conditions and inmate composition. Journal of Criminal Justice, 38(4), 796–806.
(2014). Prisons and health. Geneva, Switzerland: World Health Organization.
(2017a). Psychiatrische morbiditeit bij gedetineerden in Vlaanderen
([Psychiatric morbidity among prisoners in the Flanders region of Belgium] . Panopticon, 38(4), 231–245.2017b). Suïcidaal gedrag bij gedetineerden in Vlaanderen: Prevalentie en samenhang met psychische distress
([Suicidal behavior among prisoners: Prevalence and association with psychological distress in Flemish prisons] . Tijdschrift voor Psychiatrie, 59(4), 203–211.2017c). Suicidal ideation while incarcerated: Prevalence and correlates in a large sample of male prisoners in Flanders, Belgium. International Journal of Law and Psychiatry, 55, 19–28.
(2011). The health of prisoners. Lancet, 377(9769), 956–965.
(2008). Suicide in prisoners: A systematic review of risk factors. Journal of Clinical Psychiatry, 69(11), 1721–1731.
(2016). Mental health of prisoners: Prevalence, adverse outcomes, and interventions. Lancet Psychiatry, 3(9), 871–881.
(2017). Suicide in prisons: An international study of prevalence and contributory factors. Lancet Psychiatry, 4(12), 946–952.
(2004). Suicide in custody: Case-control study. British Journal of Psychiatry, 185(6), 494–498.
(2007). Risk of suicide in juvenile justice facilities: The problem of rate calculations in high-turnover populations. Criminal Justice and Behavior, 34(10), 1362–1376.
(2015). Swiss prison suicides between 2000 and 2010. Crisis, 36(2), 110–116. 10.1027/0227-5910/a000302
(2015). The influence of prison climate on the mental health of adult prisoners: A literature review. Journal of Psychiatric and Mental Health Nursing, 22(6), 413–422.
(2018). Suicide screening tools for use in adult offenders: A systematic review. Archives of Suicide Research, 22(3), 345–364. 10.1080/13811118.2017.1334611
(2006). Psychiatric effects of solitary confinement. Journal of Law & Policy, 22, 325–383.
(2005). The epidemiology and prevention of suicide by hanging: A systematic review. International Journal of Epidemiology, 34(2), 433–442.
(2004). Peer suicide prevention in a prison. Crisis, 25(1), 19–26. 10.1027/0227-5910.25.1.19
(2018). Restricting the use of solitary confinement. Annual Review of Criminology, 1, 285–310.
(2012). National study of jail suicide: 20 years later. Journal of Correctional Health Care, 18(3), 233–245.
(2016). The cost of prison suicide. London, UK: Howard League for Penal Reform.
. (2005). Institutional conditions and prison suicide: Conditional effects of deprivation and overcrowding. The Prison Journal, 85(4), 490–514.
(2011). Identifying, monitoring and managing prisoners at risk of self-harm/suicide in England and Wales. The Journal of Forensic Psychiatry & Psychology, 22(1), 22–51.
(2013). A national case-control study of risk factors among prisoners in England and Wales. Social Psychiatry and Psychiatric Epidemiology, 48(7), 1177–1185.
(1997). Prison suicide in Finland, 1969–1992. Forensic Science International, 89(3), 167–174.
(2014). Solitary confinement and risk of self-harm among jail inmates. American Journal of Public Health, 104(3), 442–447. 10.2105/AJPH.2013.301742
(1990). Suicidal behavior in jails and prisons in the Netherlands: Incidence, characteristics, and prevention. Suicide and Life-Threatening Behavior, 20(2), 123–137.
(2007). Preventing suicide in prisons, part I. Crisis, 28(3), 113–121. 10.1027/0227-5910.28.3.113
(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.
(1992). Suicides in prison. London, UK: Routledge.
(2006).
(The role of the prison environment in prison suicide and prisoner distress . In G. E. DearEd., Preventing suicide and other self-harm in prison (pp. 16–28). Houndmills, UK: Palgrave Macmillan.2016).
(Suicide, distress and the quality of prison life . In Y. JewkesB. CreweJ. BennettEds., Handbook on prisons (pp. 224–245). London, UK: Routledge.2016). Prevention of suicidal behavior in prisons. Crisis, 37(5), 323–334. 10.1027/0227-5910/a000394
(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.
(2016). The tension between cross-border cooperation in the European Area of Freedom, Security and Justice and the fundamental rights of mentally ill offenders in detention. International Journal of Law and Psychiatry, 47, 136–147.
(2017). Health care in Belgian prisons. Brussels, Belgium: Belgian Health Care Knowledge Centre (KCE).
(2017). Mental health of adults in contact with the criminal justice system. London, UK: Author.
. (2014). The psychology of suicidal behaviour. Lancet Psychiatry, 1(1), 73–85.
(2007). Suicide in New South Wales prisons, 1995-2005: Towards a better understanding. Australian and New Zealand Journal of Psychiatry, 41(6), 519–524.
(1994).
(Prison suicide rates: What do they mean? In A. LieblingT. WardEds., Deaths in custody: International perspectives (pp. 45–57). London, UK: Whiting & Birch.2016). Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: register follow-up in a criminal justice population with substance use problems. Drug and Alcohol Dependence, 162, 176–181.
(2017). Health at a glance 2017. Paris, France: Author.
. (2016). The prevention of suicide in prison. New York, NY: Routledge.
(2015). Cognitive-behavioural suicide prevention for male prisoners: A pilot randomized controlled trial. Psychological Medicine, 45(16), 3441–3451. 10.1017/S0033291715001348
(2006). Prison suicides and self-harming behaviours in Italy, 1990-2002. Medicine, Science and the Law, 46(2), 127–134.
(2012). Prison structure, inmate mortality and suicide risk in Europe. International Journal of Law and Psychiatry, 35(3), 222–230.
(2017). Male suicide rates in German prisons and the role of citizenship. PLoS ONE, 12(6), e0178959.
(2013). Psychosocial characteristics and social networks of suicidal prisoners: Towards a model of suicidal behaviour in detention. PLoS ONE, 8(7), e68944.
(2015). Solitary confinement: The view from Europe. Canadian Journal of Human Rights, 4(1), 143–165.
(2004). Suicide by prisoners: National clinical survey. British Journal of Psychiatry, 184(3), 263–267.
(2006). The effects of solitary confinement on prison inmates: A brief history and review of the literature. Crime and Justice, 34(1), 441–528.
(2018). Attempted suicide: A multilevel examination of inmate characteristics and prison context. Criminal Justice and Behavior, 45(5), 589–611.
(2017). Deciphering suicide and other manners of death associated with drug intoxication: A Centers for Disease Control and Prevention consultation meeting summary. American Journal of Public Health, 107(8), 1233–1239. 10.2105/AJPH.2017.303863
(2012). The hypothesis of a continuum in suicidality: A discussion on its validity and practical implications. Mental Illness, 4(2), 73–78.
(2016). Suicide and suicidal behaviour. Lancet, 387(10024), 1227–1239.
(2012).
(Stress-diathesis model of suicidal behavior . In Y. DwivediEd., The neurobiological basis of suicide (pp. 113–123). Boca Raton, FL: CRC Press.2011). Mentally ill offenders in prison: The Belgian case. International Journal of Law and Psychiatry, 34(1), 71–78.
(2016). World prison population list (11th ed.). London, UK: Institute for Criminal Policy Research.
(2013). Suicidal ideation among inmate-patients in state prison: Prevalence, reluctance to report, and treatment preferences. Behavioral Sciences & the Law, 31(2), 230–238.
(2012). Suicide risk among violent and sexual criminal offenders. Journal of Interpersonal Violence, 27(17), 3405–3424.
(2007). Preventing suicide in jails and prisons. Geneva, Switzerland: Author.
. (2012). Public health action for the prevention of suicide: a framework. Geneva, Switzerland: Author.
. (