Suicide in Prisons

Prisoners' Lives Matter

Crighton , David A., Towl, Graham J.

• Publisher: Waterside Press
• Year: 2017
• ISBN:
  9781910979297
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

The definitive guide from two leading authors central to developments in the field. An invaluable book which covers everything from theoretical and community research to precisely what is known about prisoners and the risk of their completing suicide. Covers the Harris Review and Government Response to it as well as the stance of politicians, reform groups and other leading experts on what in 2017 is an escalating problem for UK prisons. Contains analysis and data from over 30 years, bringing together key knowledge and information at a critical time of concern and attention.

Foreword

Lord Toby Harris

Three years ago, I was asked by the Minister for Prisons to lead a review into the self-inflicted deaths of young people aged 18 to 24 in prisons or young offender institutions. My panel included Graham Towl, one of the authors of this book, and many of the statistics here were drawn on during the review process.

The review¹ reported in the summer of 2015 and, whilst some of its key recommendations were initially rejected by the Ministry of Justice, the recent White Paper² clearly draws on many of my review’s ideas.

It looked in detail at the cases of 83 young adults who suffered self-inflicted deaths from April 2007 (the point at which the Assessment, Care in Custody, and Teamwork process was rolled out) until the end of 2013. In addition, we looked at the deaths of the four under-18s who died during the same period.

Our conclusions focussed necessarily on the age group of those cases we had examined, but many of our recommendations were applicable to prisoners of all ages.

It is worth remembering that all of the deaths looked at in the review — or in this book — represent individual tragedies. Whatever the events that led to those who died ending up in custody, the people concerned were also someone’s son or daughter, sister or brother, partner or parent.

The review looked at an enormous body of evidence and indeed it was probably the most comprehensive independent consideration of penal policy in this country for the last 20 or 30 years.

Some clear messages emerged. Each of the deaths examined represents a failure by the State to protect the people concerned. And that failure is all the greater because the same criticisms occur time and time again. Lessons have not been learned and not enough has been done to bring about change. It remains to be seen whether the White Paper and the Prisons and Courts Bill now before Parliament will deliver the transformation needed.

The Government has adopted the review’s recommendation that there should be a clear statement — now to be enshrined in statute — about the purpose of prison and that rehabilitation should be at its core. It is important that this statement acknowledges that all persons who are deprived of their liberty — and this is the sentence of the court — should be treated with respect for their human rights.

The cohort of young adults whose cases we considered had all to a greater or lesser extent been vulnerable. Most had had chaotic lives and complex histories, some had been subjected to child abuse or exposed to violence, and many had been in foster or residential care. Their problems had often been further compounded by mental health issues.

And despite the stereotype found in some newspapers, prisons and YOIs are grim environments that are bleak and demoralising to the spirit. This makes the experience of being in prison particularly damaging to those who are already vulnerable or whose minds are still developing. Moreover, this is exacerbated where regimes are impoverished and restricted as a result of staff shortages and budget cuts. Our analysis of the 87 deaths reviewed convinced us that many of the vulnerable young adults concerned were going through a period of particular distress that might have passed if they had not been spending so much time inside their cell with nothing to do other than to stare at potential ligature attachment points.

It was apparent in the review that operational staffing levels were not adequate. Since then the Government has announced additional staff, but even when these officers are recruited (if indeed current recruitment problems can be overcome) staff numbers will still not have reached the levels that existed only six or seven years ago.

Without adequate staffing it is difficult to see how the objectives set out for rehabilitation can be met. At present, prisoners are not sufficiently engaged in purposeful activity and time is not spent in a constructive and valuable way. Current restricted regimes do not even allow for the delivery of planned core day activities and during the review we came across frequent examples of medical and mental health appointments being missed because there were not sufficient staff to escort prisoners.

Achieving the rehabilitation objective will require a lot more. Leadership will be critical in this — something that Ministers now say that they accept — and this must be focussed on delivering real cultural change in prisons and YOIs that prioritises ensuring that prisoners are rehabilitated, valued and nurtured towards safer and more productive lives.

This will also require a workforce in prisons that is trained and developed to a higher professional standard than at present and staff will need to be motivated, knowledgeable and compassionate.

The review recommended that responsibility for health, education, social care, safety, and rehabilitation should be taken on by a new category of prison officer. The review called this person a Custody and Rehabilitation Officer and they would be specialist and suitably trained professionals with a small enough caseload so that enough time would be given to each prisoner both to understand their needs and to deliver the services needed to address them. This appears to be mirrored in the idea of the ‘dedicated officer’ contained in the Prisons White Paper. It remains to be seen whether this intent is maintained as the proposals are rolled out and implemented.

Of course, a reduction in the overall prisoner population would make it easier for prisons to provide an environment that meets appropriate standards of decency, safety and respect. Whilst society would expect most of those currently in prison to have received a custodial sentence, it is apparent that much more needs to be done to support people and divert them away from the conduct that led them into prison long before they were ever in contact with the criminal justice system.

In the 87 cases examined in the review, many of the young people’s problems and vulnerabilities, including mental health issues, had been evident from an early age. The question has to be asked what went wrong and why did so many of them end up in custody. The appropriate interventions much earlier in prisoners’ lives might well mean that far fewer ended up offending and that far fewer would have ended up in prison.

Prisons are hugely expensive and yet the benefits of this spend, as prisons are presently constituted, are questionable with a relatively low impact on crime and with rates of re-offending that are particularly high among young adults. Reinvestment and redirection of resources into early intervention are likely to deliver better outcomes for the individuals concerned, as well as a smaller and more manageable prison population.

These are policy choices that will require bold and brave Ministers prepared to engage in long-term investment the benefits of which may well not be seen until long after they have left office. I hope this book will help convince them to be bold and brave.

Lord Toby Harris

March 2017

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1. The Harris Review (2015) Changing Prisons, Saving Lives, Report of the Independent Review into Self inflicted Deaths in Custody of 18–24-year-olds, July, OCL, London.

2. Ministry of Justice (2016) Prison Safety and Reform, Cm 9350, Ministry of Justice, London.

Chapter 1

Setting the Scene

Introduction

This book is about suicide in prisons. The approach taken includes a consideration of theoretical perspectives and also a broader consideration of suicide in society. The latter parts of the book draw together research on prisoner suicide. New empirical research into prisoner suicide is also outlined with the largest UK study of its kind. One pervasive theme in the book is how we may most effectively learn from what we know about prisoner suicide and how this may inform prevention.

The brutal reality is that there is generally very little public interest in suicide in prisons. This is despite the extensive recent media coverage of violence in prisons. And this can be selective reporting. For example, staff on prisoner violence is rarely reported in the media, nor is such data routinely provided. The political discourse tends to focus upon ‘hard working staff’ doing a difficult job, and, of course, there is much truth to this, but it is very far from the whole picture. Prison Service staff are by no means alone as public servants in being subject to violence. There appear to be more incidents of assaults on nurses than prison officers yet the media coverage portrays prisons (rather than hospitals) as dangerous places. And there are dangers. But rarely is this put into a broader perspective of those working with prisoners or patients who may have various vulnerabilities by the fundamental nature of such relationships. Ill patients are highly dependent upon healthcare staff and similarly prisoners are highly dependent upon prison staff to ensure that even their basic needs are met. Such vulnerabilities can beget tensions.

Although women in prisons are over 12 times more likely to complete suicide than in the community and for men around six times more likely, overall rates of deaths in custody are lower than in the community using (crude) standardised mortality rates (IAP, 2017). And it is this complex environment of reduced risks of death overall, but increased levels of risk of self-inflicted deaths for those in prisons compared with the community that provides a backdrop to debates around prisoner suicide. Disturbances or protests, also inform such debates around prisoner and staff safety more generally in prisons. Although statistics that support the notion of prisons in any way being ‘safer’ in any sense are rarely reported, it simply does not fit with the popular narrative around prisons. Just as the figure claiming over 12 times greater risk for women comes with (statistical) health warnings so does data on crude standardised mortality rates. The rates of prisoner suicide dropped marginally between 2014 and 2015 although curiously, perhaps because it does not fit with a ‘crisis’ narrative, this does not appear to have been widely reported as such. Nonetheless the overall pattern since records have been kept in 1979 has been one of an upwards trajectory (see Chapter 9 of this volume).

Human rights

It is a human rights perspective that is taken as our starting point in this book. This is not to deny that those imprisoned are often there because of their acts of human wrongs. There is a duty to preserve and protect the lives of those kept within state custody independently of what crimes they have committed. It is recognised that many in the field would take such rights as axiomatic but it may be helpful to be explicit about such matters for two reasons. First, in terms of values and beliefs, by making these explicit at the beginning of this book any resultant biases may be more readily salient for readers. Second, it is important to be explicit about such values and beliefs because so often such matters are left at the level of the implicit, which in practice may contribute to a vacuum of explicit values. This is arguably especially important in Criminal Justice settings such as prisons, where the ideologies and underpinning values of the institutions of Criminal Justice and Health may be in tension, and at times significant tension. From a human rights perspective although the courts are charged with the enactment of our laws, those delivering such judgements tend to come from particular social groups and are visibly male and white with backgrounds overrepresented in public schools. Thus, the idea of a truly independent court system may be, sometimes viewed as arguably limited, in that it disproportionately may be seen as representing the perspectives of the socially privileged in our communities. In this sense judges and prisoners share a commonality in that neither are representative samples from the community and this may well have consequences for all. Perhaps if judges were more representative there would be a greater awareness of the social context of crime, which may serve to decrease the increasingly marked propensity of the courts to imprison and to imprison for increasingly long periods in recent years. If we were to reduce the prisoner population we would predict a reduction in prisoner suicides. The courts clearly have a role to play in this, not just the Prison Service. Nonetheless the courts can only act within the law set by successive governments, so government clearly has a clear leadership role in this challenging area. And more general public opinion may impact upon both government and court decisions.

So, with imprisonment at about twice the levels of the early-1990s it is clear that there has been stiffer sentencing. Successive government administrations have been involved in a political dialogue around who can ‘talk tougher’ on crime and punishment. As indicated above, one key way of reducing prisoner suicide would be to reduce the numbers imprisoned. However, we recognise that any significant rational reduction of prisoner numbers would be predicted, on the data, to result in an increase in the rates of prisoner suicide. But there would be highly likely to be a decrease in the overall numbers of cases of suicide. Oftentimes rates and frequencies are conflated in some of the discussions and debates around prisoner suicide. So, for example, older prisoners are at an inflated risk of suicide compared with younger prisoners. However, there are many more young prisoners who complete suicide. But any such overall decrease in numbers would most probably result in increased proportions of those imprisoned being from categories of offence types statistically associated with over representations in the prisoner suicide figures such as violent offenders and those who commit arson and criminal damage.

Fresh perspectives

The previous core textbook exclusively on this area, Suicide in Prisons (Towl, Snow and McHugh, 2000) distinctively drew together work on research, policy and practice. Although many of the research findings today largely replicate what was known at the turn of the century when that handbook was written there have been some developments in the research and a number of policy changes too along with some shifts in practice. And we have seen above that there have been significant increases in the numbers of people imprisoned. Less well known is the success of the prison service in reducing the percentage of those who complete suicide in the early stages of their imprisonment. That said, the early period of imprisonment still represents, on average, a period of markedly inflated risk of suicide. The make up of the prisoner population has changed too, with for example, proportionately more imprisoned (convicted) sex offenders than ever before in the UK...