HMIP Annual Report 1997-98

6. Suicide

Introduction

6.1 The previous annual report had concluded with the remarks that if it is accepted that imprisonment can add to the suicidal tendencies already suffered by some individuals, then the greatest priority should be directed towards imprisoning fewer people in the first place. This observation followed a year in which there had been a record number of 17 suicides.

6.2 Between 1 April 1997 and 31 March 1998, a further thirteen suicides took place in Scottish Prisons, six of which involved prisoners on remand. One young woman, a convicted prisoner, was included in these tragic figures.

Statistics

6.3 Statistics for self inflicted deaths in recent years are as follows:

1993-94 7

1994-95 16

1995-96 8

1996-97 17

1997-98 13* Subject to FAI

6.4 Comparative statistics by establishment since 1986 are shown below:

(® = Remand © = Convicted)

** Normally counted as one prison, hence total of 23 when there are only 22 establishments.

Comment

6.5 The figures in 1997-98 would appear to reflect the increase in suicides which has been experienced in the wider community in recent years. Indeed, a contemporary study published in the British Journal of Psychiatry shows that Scotland has one of the highest suicide rates in Europe, with more people killing themselves in this way than are dying in road accidents.

6.6 However the death rate in prison seems to have been rising at an even more rapid pace in recent years and amongst other reasons, this may be due to prisoners tending to come from areas where drug abuse is common place. Additional comments on the table at paragraph 6.4 are shown below and are based entirely on self inflicted deaths (attempted suicide is a separate issue).

Open Establishments and Category ‘C’ Prisons

6.6.1 It would appear that the risk of fatalities in these establishments is low.

Young Offenders Institutions

6.6.2 There have been no fatalities at HMYOIs Dumfries and Glenochil in recent years, despite the fact that young men are at the greatest risk in the community. The death at Polmont was the first for nearly five years.

Long Term Prisons

6.6.3 Until 12 April 1997, there had been no suicides for eight years amongst LTPs at Peterhead, Shotts or Glenochil.

Remand Prisons

6.6.4 Figures for deaths among remand prisoners - 11 out of 17 in 1996-97 and 6 out of 13 in 1997-98 - indicate a high rate for this group, with most tragedies tending to take place in the early stages of custody. Remands account for approximately one sixth of the daily prisoner population and for a very significant proportion of the SPS’s annual throughput. Their particular situation includes the added anxiety of not always knowing how long the period of custody will last or the outcome of any subsequent trial. Additionally, the conditions for remand prisoners may be amongst the worst experienced within the prison system, mainly due to the pressures created by overcrowding. In most establishments, such individuals are locked in their cells for long periods with nothing to do, as under Prison Rules they are not required to work. Equally, it is possible that there may be a connection between the high throughput rates at remand prisons and the number of fatalities, as staff may not always get the opportunity to establish close relationships or proper supervision.

6.6.5 Access to the appropriate drug treatment resources and protocols are not always possible for remands, even though drug withdrawal symptoms can lead to both physical and psychological problems. There is good evidence, for example, that withdrawal from methadone is severe in the first few days after any prescription is withdrawn. This unpleasant condition can last for several weeks during which there may be heightened risks of suicide.

6.6.6 The disturbing attrition rate among both remand and convicted prisoners at Greenock shows little sign of abatement. Additionally, the comparative numbers of suicides among remands at Longriggend is of growing concern and it may be that the geographical isolation and the comparative vulnerability of its young male admissions are underlying factors.

6.6.7 Meanwhile at Edinburgh, there has been one suicide in four years, despite the establishment having a high throughput of remands and the second largest population in the SPS. Factors which may be assisting this situation include a comprehensive anti-drugs strategy, which provides for the prescription of methadone and drug counselling for remands. There is an integrated hospital ward, together with excellent psychiatric care which is linked to the community, whilst a well established Listeners Scheme has also been in operation for some time.

Female Institution

6.6.8 One death in 1997 and the cluster of six deaths in the previous two years amongst such a small population of women at Cornton Vale is at odds with any comparable statistics in the community. Some incidents may have been ‘cries for help’ which then unintentionally became fatal, whilst others could have been some form of copy-cat behaviour caused in part by the publicity surrounding these tragedies. However, a number of other factors may be involved; for example, recent research (Dr N Loucks) has demonstrated that female prisoners are more often poly drug abusers than males, whilst their usage was found to be much more closely related to health and psychological concerns.

6.6.9 A high percentage of women offenders have suffered protracted forms of abuse since childhood, but their low self esteem can often be masked by their dependency on drugs. As noted by Dr Loucks, imprisonment in itself may not be a "cause" of suicide, but the experience can exacerbate existing problems and act as a catalyst. This may apply to vulnerable individuals who are facing problems for the first time or during a period of drug withdrawal i.e., during any period of remand.

6.6.10 All suicides at Cornton Vale and at every other location have involved hanging in recent years. This is despite the fact that there have been expensive attempts to remove bars from cells by the installation of anti-ligature windows at many prisons. Nevertheless, it is impossible totally to remove these and the many other means by which prisoners can kill themselves, in the same way as it would not be possible entirely to eliminate suicides in the community.

Ongoing Initiatives

6.7 An SPS Steering Group is directing policy adjustments to the national suicide prevention strategy, following earlier receipt of the reports by Professor Gunn and Dr Power. Progress on the redrafted strategy, which emphasises integration, co-ordination and care, is as follows:

• Pilot schemes have already been introduced at Perth, Barlinnie, Greenock and Cornton Vale. From June 1998 onwards, the delivery phase will be extended to all establishments.
• A full-time National Suicide Prevention Co-ordinator is now working in SPS HQ.
• It is further intended to develop 24 hour patient care facilities for the vulnerable and for those who present a continuous high risk. Enhanced facilities will become available on an evolving basis during 1998-99 but their location will be dependent on the findings of the In-Patient Bed Review Group, which is reporting shortly. Meanwhile, Day Care Units are in operation at Cornton Vale and Edinburgh, with a Unit at Perth due to open in June 1998.
• A research project involving the setting up of a separate database on the prison information network (SPIN) has now been approved and this is intended to provide immediate notification of high risk individuals on their re-admission to prison. Separately, progress still needs to be made regarding the availability of medical notes and psychiatric information to prison medical staff. At present, these are often unavailable at the time of admission.
• At Glasgow Sheriff Court, Mental Health nurses from Barlinnie are now on hand to scrutinise police notes and to interview prisoners before they are admitted to prison. This innovative scheme would be worthy of replication elsewhere.
• All adult establishments are now being actively encouraged to introduce Listener Schemes.
• A pilot scheme involving the introduction of in cell televisions has now been agreed for some prisoners at Cornton Vale.
• Suicide awareness training has received even greater emphasis during 1997-98, the aim being to ensure that the introduction of the redrafted aspects of the Suicide Strategy has the appropriate staff foundation. Core teams have now been trained at establishments and in turn, they will be responsible for cascading their knowledge to all other staff.
• The effect of suicides on prison staff must be considered and in this respect, we note that supporting arrangements at several establishments have greatly improved over the course of the last year. The need for professional counselling will always remain a high priority.

The Future - Focus on Remands

6.8 We believe that priority must continue to be devoted to preventative measures which concern remand prisoners, as it would appear that they are most at risk of death on a daily basis. For example, the need for greater attention to induction arrangements and the assessment of risk is crucial, whilst special care must be taken where there are any drug withdrawal complications. This is particularly applicable during the early periods of custody or where self harm has previously been indicated. Additionally, more therapeutic regimes for remands ought to be provided.

6.9 The provision of in-cell TV (as has now been agreed as a pilot at Cornton Vale) might also help to offset the loneliness, boredom and lack of work, which seem intrinsic to the experience of those who are unconvicted or who have not been sentenced.