Suicide in Prison Among Male Offenders

Suicide among male offenders in prison custody will be explored in this blog. Factors such as age, mental health issues, sentence length, time spent in prison custody and history of self-harm among prisoners and their family will be analysed to give a detailed perspective of factors that can influence suicidal behaviour. Throughout the UK, there are systems in place to monitor deaths and incidents in prison custody. These include systems by The National Offender Management Service (NOMS) and The Ministry of Justice (MoJ) annual statistical bulletin. In addition to this, there is the Prisons and Probation ombudsman. This is an establishment that publishes a report on every fatal incident that happens in prison custody. This assignment will be exploring the above to help understand the treads across age, gender, health, time in prison custody and prisoner history in relation to suicidal behaviour. The Strain Theory by Merton will be discussed. Following this, treatment and rehabilitation for those vulnerable to suicide will be debated, including the idea of improved primary care entailing the idea of creating a safe environment by encouraging supportive and trusting relationships within prison custody and providing activities and choice within the prison environment. To boost the discussion, female offenders and self-inflicted death will also be taken into consideration. While studies have indicated that there is more about suicide and self-harm than any other social psychological phenomenon through extensive research it is still unclear about the causes, prediction, management and treatment of those who are at risk especially those who are incarcerated, with few prisoners who die from self-inflicted death being identified as being high risk of suicide (Snow et al, 2001).

By definition, a death in prison custody is seen as any death of a person in prison custody arising from an incident in or, in very rare occasions, immediately prior to prison custody (Ministry of Justice, 2014). The classification of suicide is sparse but it can be seen as the act of deliberately killing oneself (Spaulding et al, 2010). A death of an individual in prison custody does not just raise criminal justice issues but also significant social and public health matters that go beyond the prison walls (Inquest, 2014). The suicide rate in prisons is almost 15 times higher than that of the general population (Mental Health Foundation, 2004), with recent statistical data showing that in 2014 there were 84 apparent self-inflicted deaths within prison custody with 81 of these being male offenders and only 3 committed by females (National Offender Management Service, 2015).

Suicide in prison and other offender facilities has been a long standing concern for those responsible for the provision of care to prisoners for many years now (Pratt, 2015). It can be disputed that in reality suicide is perceived as a complex behaviour pattern that is prompted by many different factors, like the ones stated above, and differing circumstances (Towl et al, 2000). One dynamic that research seems to suggest as being a major factor for suicidal behaviour among male offenders is age. In relation to age in 2014, 6 of the 81 males who died from self-inflicted behaviour were aged 18-20, 8 were aged 21-24, 14 were aged 25-29, 25 were aged 30-39, 17 were aged 40-49, 7 were aged 50-59 and 4 were aged over 60 (National Offender Management Service, 2015). To gather a deeper understanding of the impact of age on suicidal behaviour, this assignment will view two perspectives – young offenders aged 15 to 29 years old and older offenders aged over 30.

In relation to young offenders, more recently it has been found that suicide is second to accidental death as the leading cause of mortality in young men, not only in the UK but across the world (Pitman et al, 2012). Some research argues that among young men there are more risk factors such as psychiatric illness, substance misuse, lack of education, absence of employment opportunities and single marital status compared to those of an older age (Pitman et al, 2012). As stated earlier, statistics by National Offender Management Service in 2014 found that 28 of the self-inflicted deaths in prison custody were committed by a male under the age of 30 (National Offender Managements Service, 2015).

It has been previously argued that when young male offenders are held in prisons designed for adult men, the risk of intentional self-injury appears increased than when placed in a young offender facility (Towl et al, 2000). The number of deaths in young males in prison custody, and with that the recurring themes, have been an area of concern in regards to research for many years, with 357 male offenders aged 15-17 being involved in self-harm incidents in 2014 (Ministry of Justice and National Offenders Management Service, 2015). Concern for those of a young age who are incarcerated in adult prisons has also been documented a concern since the death of Philip Knight, a 15 year old boy who committed suicide in Swansea prison in 1990 due to a lack of accommodation in a young offender’s facility causing him to be placed in an adult secure prison (Inquest, 2014). Since the serious case review of Philip Knight other documents have been published into the death of children and young people in prison. In 2012, a document named ‘Fatally Flawed: Has the state learned lessons from the deaths of children and young people in prison’ was published. Analysis of the data in Fatally Flawed found that male children aged 18 to 24 years old who had died in custody had frequently experienced numerous shortcomings in their life and generally had complex needs such as histories of substance abuse and a previous past of self-harm (Inquest, 2014). This arguably lead to the conclusion that the needs and problems of those aged 29 and under are not only acute but different from other adult prisoners, therefore suggesting vulnerability in those of a younger age (Inquest, 2014). More recently, since Fatally Flawed, treatment and monitoring of those in a young offenders institute could be seen to have increased due to zero deaths of a male prisoner aged 15-17 in 2014 (Ministry of Justice, 2014).

Only over the last couple of years has the growth in the number of older prisoners become an issue for the prison service, with the number of older prisoners increasing by 42% (Prison Reform Trust, 2002). In the general population, suicide among middle aged men has increased to 25.1 per 100,000 men, which is the highest rate for this age group since 1981 (Phillips et al, 2010). When broken down, the statistics by National Offender Management Service found that of the 81 self-inflicted deaths, 53 were committed by a person aged over 30 in 2014 (National Offender Management Service, 2015) compared to in 2000, when the recorded self-inflicted deaths in prison custody involved nobody aged over 60 (Prison Reform Trust, 2002). These discoveries show that, not only has suicide increased over the past 15 years in older offenders but that figures are more than double in regards to young offenders. A study by Marshall et al concluded that older prisoners are less likely than those in other age groups to harm themselves deliberately (Marshall et al, 2000). However, from a deeper understanding from recent research this conclusion could be contradicted due to the high increase of self-inflicted deaths in this age group compared to others.

Primarily, it can be suggested that overall male offenders aged around 25-39 years old are more at risk of increased suicidal thoughts as research seems to suggest because of the high number of males in this age bracket that died in prison custody due to self-inflicted death in 2014. These findings also reflect on previous years, unlike older offenders which is recently on the increase. However, through having a deeper understanding into age as a factor for suicidal behaviour it can be suggested that suicidal thoughts impact many male prisoners from all age groups. In relation to theory, Merton’s Strain Theory can be applied. The Strain Theory states that social structures within society may pressure an individual to commit a particular act of deviance (Farnworth and Leiber, 1989). This theory touches the origins of deviance to the tensions that are instigated by the gap between cultural objectives and the means individuals have available to achieve these certain goals. It is when these goals and means are not balanced then deviant behaviour is likely to occur. As mentioned before, young males are more likely to suffer from lack of education and an absence of employment, therefore these young male offenders are more likely to turn to deviant behaviour as a way to achieve economic success (Agnew, 2001). There is also a high correlation that exists between unemployment and crime and the structural theory which helps explain this relationship between young males previous factors and suicidal behaviour (Rebellon et al, 2012).

One other factor that can influence suicidal behaviour within prison custody is mental health issues. Around 9 million people are imprisoned around the world, but the number of those with a serious mental disorder such as psychosis or major depression is unknown (Fazel and Danesh, 2002). Therefore, mental health problems could be suggested to be significant in relation to causes of morbidity in prisons (Birmingham, 2003). From this, prison services recognise that prisoners with mental health issues and suicidal indention are at immediate risk from the second they enter prison custody (Farrent, 2001). More recently to this, a report published in 2014 by the National Confidential Inquiry into Suicide and Homicide by people with mental health issues highlights that higher suicide rates from 2008 have been extensively reported and connected to the economic crisis (Department of Health, 2015), showing the interconnecting strands between different concepts that can lead to increased suicidal behaviour. Mental health issues such as depression, alcohol/drug psychosis and hallucinations can be seen throughout both younger and older male offenders (Patel et al, 2007). General statistics estimate that around 10% of male offenders have had previous psychiatric admission before entering prison, with recent research finding 15% of men in prison report symptoms of indicative psychosis (Howard League for Penal Reform, 2015). The rate among the general population is only 4% (Prison Reform Trust, 2015), showing the drastic realisation of how severe mental health is in the male prison population. Other serious mental health problems have been indicated in the male prison population with research suggesting around 62% of male prisoners having a personality disorder (Prison Reform Trust, 2015). There has been much research into the impact of mental health in young offenders which will later be discussed, however elderly mentally disordered offenders are under researched and poorly understood. Research by Fazel et al in 2001 had a significant influence on research of offenders aged over 60. The research demonstrated that high levels of ‘hidden’ psychiatric morbidity in a sample of male prisoners aged over 60 (Curtice, 2002). Hidden psychiatric morbidity could lead to an increase in suicidal behaviour due to a lack of treatment and rehabilitation for those suffering from a mental health issue.  Within the prison environment and the rules that govern everyday life inside prison can have a detrimental effect on a person’s mental health, as can the very poor health care received within prison custody (Birmingham, 2003). Gunn et al (1991) also had a significant influence on the aspect of mental health in older prisoners who had been sentenced. Findings found that more adult men had been diagnosed, using the ICD-10, for psychoses and substance abuse/dependence compared to male youths (Fazel et al, 2001). It should be taken into account other factors which could affect older offenders mental health due to illness such as dementia etc. which is more common among people aged 60 or above.

As stated earlier, there is much more research on mental health issues among young male offenders. Recent research would seem to suggest that the most common mental health issue among young male offender is depression, with health problems such as sleep deprivation and irritability close behind (Farrent, 2001). Research mentioned previously by Gunn et al (1991) found that in relation to young male offenders and mental health, more youths were diagnosed with personality disorder and statistics found that substance abuse/dependence were high in young male offenders too.

Although there is a large amount of research and knowledge into age and mental health as key factors of suicidal behaviour among male prisoners, factors such as sentence length and time spent in custody can also be taken into consideration. Research and statistical data shows that deaths are more likely to occur soon after prisoners have been received in custody (Snow et al, 2001). Since this data from 2001, a deeper understanding of sentence length and time in custody has been created. Lekka et al (2006) concluded that the first phase of imprisonment has the highest risk of suicide. Statistics by Ministry of Justice and National Offender Management Service found that in 2014, there was a recorded 18, 995 cases of self-harm incidents over the course of a year, with 184 incidents happening on the day of arrival. Overall, most self-harm incidents happened between 31 days and 3 months with 4, 595 incidents, with over 14,852 self-harm incidents between 8 days and one year (Ministry of Justice and National Offenders Management Service, 2015). In relation to self-inflicted deaths throughout 2014, there was one on the first day of arrival among male offenders. Statistics also show that there was more self-inflicted deaths between 8 and 3 months (Ministry of Justice, 2014). In comparison to females, there were only 6,780 cases of self-harm incidents throughout the year, with only 36 incidents reported on the first day of arrival (Ministry of Justice and National Offenders Management Service, 2015). Primarily, this means more than five times more males self-harmed compared to women on first day of arrival, with more than double the amount of self-harm incidents per year among males.

Although research seems to suggest that the first phase of imprisonment has the highest rate of suicide, this could be contradicted by statistics from Ministry of Justice and National Offenders Management Service, which show that the time of suicidal behaviour increase is around 8 days to 90 days (Liebling & Maruna, 2013). However, another implication to suicidal behavioural increase could be the sentence length, with research suggesting a higher suicidal tendency among those given a higher sentence length (Towl and Crighton, 2006). In 2014, of the 81 male prisoners who died from self-infliction, 19 were unsentenced, 6 were convicted unsentenced and 5 of the males were serving a sentence of under 6 months. These statistics are relatively low when compared with sentences over 6 months with one male committing suicide serving a sentence between 6 and 12 months, 13 serving sentence between 12 months and 4 years and 24 serving a sentence longer than 4 years (excluding life sentences) (Ministry of Justice, 2014). In relation to life offenders and ISPP’s, 7 were serving ISPP’s and 8 were serving life. This statistical data corresponds with the research suggesting that offenders serving a sentence of over 6 months may be more at harm of suicidal thoughts.

When crime is examined as a whole, factors such as family, peers, education and upbringing are regarded key sociological factors of how a person’s behaviour will be shaped in their future (Maxwell & Blair, 2015). These same factors can be used to argue why a person is more at risk of suicide, with it previously being argued that demographic and factors such as being young, white, single and aspects such as leaving school early, experiencing poor social support and significant social adversity being important factors that could influence suicidal behaviour (Jenkins et al, 2005). Similar research studied the concept of family history and the impact this could have on suicidal thoughts. Research found that a family history of suicidal behaviour may be a useful clinical indicator that a prisoner is at increased risk of suicidal behaviour and may have problems with impulsive aggression (Sarchiapone et al, 2009). Family history and background of suicidal behaviour has been excessively studied. Research by Qin et al (2005) helped offer a deeper understanding of family and background of suicidal behaviour as an element for suicidal behaviour in other family members. Family histories of 4,262 people who had died of suicide and had mental health issues were assessed (Qin et al, 2005). These findings found that a family history of completed suicide and psychiatric illness could potentially significantly increase suicide risk.

In relation to previous history, it is not just a prisoner’s family history of suicidal behaviour which can influence an increase in suicidal thoughts. A lifetime history of attempting suicide, or having suicidal ideation, is frequent in many prisoners (Sarchiapone et al, 2009).  Research would seem to suggest that prisoners with a previous history of self-harm are more likely than those without to show a range of depressive symptoms than their imprisoned peers without such a history, this suggesting a continued vulnerability to self-harm and even suicide (Palmer and Connelly, 2005). This in turn shows the interconnecting connections between mental health of a prisoner and their previous history that can lead to an increase in suicidal thinking. From research by Qin et al (2005), it is clear that upon entry to prison custody, family history of suicide in prisoners should be established in the assessment of suicide risk not only history of prisoner, to therefore reduce self-inflicted incidents and death within the prison custody environment.

In 2000, the Department of mental health of the world health Organisation issued a guide named ‘Preventing Suicide: A Resource for prison offenders’ as part of the WHO worldwide initiative for the prevention of suicide (Konrad et al, 2007). Statistics and research mentioned previously by Pratt (2015) indicates that suicide in prison custody could be regarded as a long standing concern for those working in the prison environment. From the large incidents of self-inflicted behaviour, both incidents and deaths, it is clear that treatment and rehabilitation needs to be worked on in male prisons. Research stated earlier by Lekka et al (2005) found that not only does first phase of imprisonment have a high risk of suicidal thoughts but factors such as psychiatric illness, history of suicidal behaviour and isolation in a single cell could influence suicidal behaviour in a male prisoner. The focus on this essay will now turn to treatment and rehabilitation available for mental health illness, the concept of shared cells and the history of a prisoner’s suicidal behaviour.

The standard of prison healthcare has been a concern for many years, with documents such as Patient or Prisoner published in 1996, highlighting the shortcomings in the prison healthcare system with argument for equivalence of healthcare for those in prison with those in the wider society (Steel et al, 2007). On the other hand and more recently, Reed (2003) argued that admission to prison offers an opportunity to access and to meet the health care needs of a population with high levels of physical and psychiatric morbidity, with many of the prisoners rarely coming into contact with the NHS. Treatment and rehabilitation offered could be in-reach teams within the prison environment (Royal College of Nursing, 2007). An increase in the number of mental health in-reach services across the prison environment could support prisoners and in some prisons, trains staff on how to deal with mental health issues present in the prison environment (House of Commons, 2004). Prisoners who have a mental health issue, which is not severe enough to be transferred to a high secure hospital, could be managed through the same channels of those in the community, with inreach teams forming part of a joined-up approach to care, in which there are both functioning crisis teams and assertive outreach teams available in the custodial environment (Steel et al, 2007). Advantages of this approach are clear, the in-reach teams also offer improved primary care with creates safe environment through the encouragement of supportive and trusting relationships between prisoner and staff. Also statistics find that there was a reduction of 18% in prison suicides in 2005 at the same time in-reach teams were introduced (Howard League for Penal Reform, 2006). However, it is not entirely clear whether statistical data above is due to the new inreach tams available in the custodial environment, as a series of concurrent factors are likely to have contributed to the findings. It should also be remembered that prisons are not hospitals and many prisoners with mental health issues requiring NHS in-patient care remain in prison, due to lack of beds in secure hospitals (Reed, 2003).

Most prisoners who die of self-infliction are in single cells and those in shared cells are normally alone at their time of death (Snow et al, 2001). Single cells are established dynamic risk factors for suicide in prison. The importance of these factors together may represent a disproportionate risk (Cohen, 2008). Elements which could influence suicidal thoughts in those placed in single cells could be little social contact, could become lost in their own thoughts or they may lose hope. These elements and the idea that a single cell allows privacy a distressed inmate would need to act on a suicide plan could be key for what causes increased suicidal thoughts and successful death through self-infliction (Reeves & Tamburello, 2014). In any case, single cells can be readily changed, at least more easily than other dynamic risk factors such as mental health and previous suicidal behaviour.  Results found by Reeves & Tamburello (2014) found that over 7 years there was only one suicide of a prisoner housed in a double cell suggesting less deaths of those in shared cells, as nobody will stand by while someone harms and endangers themselves.

In conclusion, it is clear from research found that male offenders are more at risk of self-inflicted incidents or death compared to females. Factors discussed, such as age, mental health, sentence length and previous background of suicide among prisoner and family can have an extraordinary effect on prisoners, especially when incarcerated in an environment with lack of activities and strict regime. It is clear from statistical data and research mentioned that those suffering with a hidden mental health problem such as psychosis or severe depression are at great risk of suicide due to lack of treatment and rehabilitation.  Although government documents such as Patient or Prisoner from 1996 have highlighted weaknesses in the custodial health system, it can be perceived that treatment and rehabilitation is there for those who are identified on entry to custody of having a mental health issue or previous suicidal thoughts and behaviours. Therefore it is clear that the simplest treatment to decrease and put a stop to suicidal behaviour among male offenders is to conduct and establish upon entry to custody, is to assess family history of suicide, previous suicidal behaviour / thoughts and examine any symptoms which could be linked to a mental health issue. Also, the idea of shared cells proves effective in reducing suicidal behaviour due to prisoners not being alone and having less time alone in a cell by themselves.

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