Suicide rate up for male inmates in England
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Male prisoners in England and Wales have a five-fold increased risk of suicide in comparison to their peers in the general population, UK researchers report.
The findings imply a need for “improved suicide prevention in prisoners, particularly identification and treatment of mental illness in prisoners,” said study author Dr. Seena Fazel, of the University of Oxford.
England and Wales, which together house about 70,000 male inmates, have one of the highest incarceration rates in Western Europe. Research has shown that rates of suicide tend to be higher among prisoners than among those in the general population, but the disparity among UK inmates had not been previously quantified.
To investigate, Fazel and co-authors examined data recorded by HM Prison Service on men in custody in English and Welsh prisons who committed suicide between 1978 and 2003.
During that 25-year study period, 1,312 men aged 15 years and older died by suicide, the researchers report in The Lancet, a medical journal.
The overall disparity in suicide among male prisoners versus those in the general population ranged from a four-fold to six-fold difference, the report indicates. On average, however, male prisoners were five times more likely to commit suicide than were their same-age peers who were not incarcerated, a rate “even greater than previously thought ... (that) has been increasing steadily over recent decades,” Fazel and colleagues note.
What’s more, the suicide rate was highest among 15- to 17-year-old boys, who were 18 times more likely to commit suicide than were their same-age non-incarcerated peers, the report indicates. This was “a surprising finding,” Fazel notes, but since only 28 suicides were recorded among this age group, the data “should therefore be interpreted with caution,” the report indicates.
Fazel and colleagues did not investigate the reasons for the higher suicide rate among incarcerated men, but they speculate that it may partly be explained by socioeconomic class differences. Previous research conducted among men in the general population found that those from the lowest socioeconomic class were twice as likely to commit suicide as those from other socioeconomic classes.
On the other hand, the researchers add, the excess suicide among male prisoners may also be accounted for by the inmates’ pre-incarceration characteristics, including their use of drugs and symptoms of any serious mental disorders.
“Such considerations, however, reinforce the need for comprehensive improvements in safety and suicide prevention initiatives in English and Welsh prisons including, for example, improved management of prisoners with mental illness and access to psychiatric services, removal of potential ligature points, and optimum training of prison staff,” the researchers conclude.
Fazel also recommends that there be “more research into how to screen effectively for suicide risk and intervene to reduce this risk.”
In an editorial accompanying Fazel’s study, two Austrian researchers maintain that the “core message” of the study “is not new,” since researchers worldwide have consistently reported that “suicide rates in custody exceed those in the general male population.”
They add that while socioeconomic status may explain the increased suicide rates among inmates, it does not explain the rise in the rate of suicide among inmates.
In contrast, write Drs. Stefan Fruhwald, of Community Mental Health Services in Caritas St. Poelten, and Patrick Frottier, of Justizanstalt Mittersteig in Vienna, evidence shows that the majority of individuals who commit suicide - inmates as well as those in the general population - “have serious mental disorders.”
Based on that evidence, Fruhwald and Frottier “are convinced” that the increasing suicide rate among inmates can be explained by the corresponding increase in the number of inmates with severe mental illness, they write.
Echoing the need for more mental health treatment in prisons as well as suicide risk assessment for each prisoner, they conclude that the suicide rate may spike even further “if the policy of care for incarcerated individuals is not changed.”
SOURCE: Lancet, September 15, 2005.
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