Increased attention to suicide prevention in English and Welsh prisons is urgently needed in light of new data for male suicide in prison, detailed in a research letter published early online by The Lancet.
There are around 70 000 men imprisoned in England and Wales, one of the highest proportions in Western Europe. Suicide among male prisoners is known to be higher than the general population, although the magnitude has not previously been reliably calculated.
Seena Fazel (University of Oxford, UK) and colleagues assessed the suicide incidence in English and Welsh prisons from 1978–2003 (a total of 1312 suicides) and found that the overall suicide rate was five times greater than that of the general male population of similar ages. The suicide rate among young offenders aged 15–17 years was particularly high— around 18 times that of the general male population of the same age.
Dr Fazel comments: “We have shown that during the past quarter of a century, suicide in male prisoners in England and Wales has been about five times more common than in the general male population of similar ages. This excess is even greater than previously thought, might be especially pronounced in incarcerated boys, and has been increasing steadily over recent decades . . . We cannot draw inferences about causation from these data because some of the suicide excesses seen in prisoners may well relate to their characteristics before imprisonment (such as drug use or serious mental disorder). Such considerations, however, reinforce the need for comprehensive improvements in safety and suicide prevention initiatives in English and Welsh prisons.”
In an accompanying Comment Stefan Fruehwald and Patrick Frottier discuss the high prevalence of mental illness among prisoners as a risk factor for suicide. They comment: “Despite the high prevalence of mentally ill inmates, little treatment is given in jails and prisons. Therefore, a further increase of suicides may have to be expected if the policy of care for incarcerated individuals is not changed. If we seek a change in the increasing trend of suicide in custody, we have to consider three levels of approach: the societal level, the level of prison services, and the individual level. On the societal level, we have to raise the question whether forensic units and the correctional system are adequately replacing traditional mental hospitals. On the level of correctional services, we will have to provide adequate psychiatric care for the increasing number of inmates with severe mental illness. On the individual level, we will need to identify inmates at high risk for suicide. Therefore, all inmates should be assessed on the day of admission with a screening instrument that is easy for prison officers to use.”
From The Lancet