Suicide in prisons is the Royal College of
Psychiatrists' response to a Thematic Review on this subject
produced by HM Chief Inspector of Prisons for England and Wales
(1999) called "Suicide is Everyone's' Concern".
The College takes a clinical approach to the prevention of
suicide and the treatment of suicidal thinking. It is emphasized
throughout that to carry out the recommendations, new resources
will be required. More beds and more staff are required in the NHS.
More and differently trained staff are required in the prison
service. Unless services are resourced they are not
services at all.
The commonest method of suicide in prison is asphyxiation,
usually at night. The high risk factors for suicide among prisoners
are similar to those among other citizens: youth, male sex,
depression, alcoholism, and loss of a relative, friend or
partner.
The Thematic Review implies that suicide rates are higher in
prison than might be expected. The College accepts that suicide
rates in prison are very high - too high - but they are not
necessarily higher than can be expected given the vulnerable nature
of the individuals, at high risk of suicide, who are sent to
prison.
The College emphasises the importance of making accurate
diagnoses, if applicable, in all prisoners, and noting the
significance of multiple diagnoses. Every prison should have a
comprehensive primary care service with a secondary care community
mental health team operating within the prison. It recommends that
community drug teams should have access to prisoners and that all
prison doctors should receive specific training in psychiatric and
in drug abuse medicine.
Like the Chief Inspector, the College does not believe that
prisons are suitable environments for people under the age of 18
years. Offenders below this age should be admitted to specialised
institutions. The College also recommends that anti-bullying
programmes should be mandatory in all prisons.
The Chief Inspector draws favourable attention to prisoner
participation observation schemes for suicide prevention. The
College agrees and suggests that several schemes be
considered.
The Thematic Review concludes with a chapter on healthy
prisons, which is strongly endorsed by the College. The Chief
Inspector's key constituents for healthy prison are a safe
environment, treating people with respect, a full constructive and
purposeful regime, and resettlement training to prevent
re-offending.
Overall the Royal College of Psychiatrists welcomes the
Thematic Review, but stresses further points:
- Too many mentally disordered people are being sent to
prison.
- There is a need for a more appropriate model of mental
healthcare delivery within prisons. There is a need for better
screening for suicidal ideas and propensities at reception and for
further assessment and treatment.
- There are inadequate treatment facilities for mentally
disordered offenders outside of prison, and mental health services
in the community need to be amplified so they can play a bigger
role in the care of mentally disordered offenders.
- NHS authorities need to provide more beds for acute psychiatric
care, to make court diversion schemes a practical possibility.
- There needs to be a greater provision of secure beds in the
NHS.
- There needs to be more and better liaison between the prison
health care service and the NHS.
As an aside, the College response draws attention to the fact
that the whole of the criminal justice system, not just the
prisons, is implicated in the mental health problems seen in
prisons and that judges and other lawyers should learn more about
psychiatry, psychology and criminology.
The Royal College concludes by emphasising the mental hygiene
issue of socialisation, which is so difficult in prisons, and the
importance of ensuring that mentally distressed people are not kept
in isolation. Special attention is drawn to the need for all
suicidal prisoners to be in close contact with other people.