Risk of dying by suicide inside or outside prison: the shortened lives of male offenders.

Author:Daigle, Marc S.

The prevalence of suicidal behaviour in prisons, whether attempted or completed suicide, is high in all countries (Fazel, Grann, Kling, and Hawton 2011; Konrad, Daigle, Daniel, Dear, Frottier, Hayes, Kerkhof, Liebling, and Sarchiapone 2007). The same holds true also for suicidal ideation (Jenkins, Bhugra, Meltzer, Singleton, Bebbington, Brugha, Coid, Farrell, Lewis, and Paton 2005). There are two main explanations put forth for this phenomenon. On the one hand, people who break the law may inherently be exposed to numerous risk factors for suicidal behaviour; that is, they are quite simply "suicide prone" (Landsberg, Cox, McCarty, and Paravati 1989). For example, we know that the rate of mental disorders is higher in prisons and that mental disorders are strongly associated with suicide (Harris and Barraclough 1997). This is especially true with opiate-dependent persons, who represent a specific group to be considered when planning suicide prevention in prisons (Gore 1999; Bird 2008). So, on the whole, all these offenders seem to carry these risks with them to prison and continue to carry the risks with them after they are released. In light of this essentially psychological take on the problem, referred to as importation theory, inmate suicidal behaviours are primarily the product of previous experiences and personal characteristics (Camilleri, McArthur, and Webb 1999). On the other hand, being imprisoned constitutes a new stressful event even for healthy inmates, and it is experienced on top of any previous problems and cuts the individual off from a host of key resources (Konrad et al. 2007). According to this more sociologically oriented explanation, known as deprivation theory, situational and environmental factors are what primarily account for the high suicide rates among inmates. Between these two theories, there is evidence to suggest that the former weighs more heavily in the balance. Regardless of these two opposite or complementary perspectives, however, it is important to keep in mind that the correctional system remains responsible for treating those in its charge. As Liebling (1998: 62) stated, "[W]hilst a number of risk factors are, to a large degree, set on arrival within the institution, the effects of the additional stress presented by the prison environment can be manipulated by staff and managers to decrease the risk of suicide."

Attempted suicide

The prevalence of all forms of "non-fatal suicide-related behaviors" (Silverman, Berman, Sanddal, O'Carroll, and Joiner 2007) is significantly higher among female inmates (40.8%) than among male inmates (28%). Excluding instrumental behaviours, however, the rates are lower for both and more comparable (11.9% and 16%, respectively). It has been reported that, on average, female inmates go through 3.4 incidents of the sort in their lifetime, compared with 3.9 incidents for their male counterparts (Daigle and Cote 2006). In the general population, life-time prevalence of non-fatal suicide-related behaviour is much lower, ranging from 2% to 8% (Kerkhof 2000; Nada-Raja, Skegg, Langley, Morrison, and Sowerby 2004). What's more, there is growing evidence to the effect that rates are comparable between the sexes in the general population (Boyer, Saint-Laurent, Preville, Legare, Masse, and Poulin 2000; Kjoller, Norlev, and Davidsen 2004; Langhinrichsen-Rohling, Arata, Bowers, O'Brien, and Morgan 2004; Wichstrom and Rossow 2002). Generally speaking, suicide attempt rates for pre-trial detainees and sentenced prisoners are, respectively, about 7.5 times and nearly 6 times as high as for males outside prison in the general population (Konrad et al. 2007). Unfortunately, all but one of the studies conducted with inmates fail to specify whether their suicide attempts occurred inside or outside prison. According to (Daigle and Cote 2006), 89.4% of the incidents reported by female inmates and 82.6% of those reported by male inmates occurred out in the community. In other words, to our knowledge, only one study clearly shows that there is some "importation" of the problem to prison. This point needs to be clarified, given that "history of suicidality" is one of the five predictors of suicide in prison, along with psychiatric diagnosis, psychotropic medication use, a high-violence index offence, and single-cell accommodation (Fruehwald, Matschnig, Koenig, Bauer, and Frottier 2004).

Completed suicide

The suicide rate in prison populations is from 6 to 11 times as high as for similar age groups in the general population (Bonner 2000; Camilleri et al. 1999; Correctional Service Canada 2004; Daigle 2003; Davis and Muscat 1993; Fruehwald and Frottier 2002; Fruehwald, Frottier, Ritter, Eher, and Gutierrez 2002; Hayes 1989; Kariminia, Butler, Corben, Levy, Grant, Kaldor, and Law 2007; Kennedy and McKeon 2004; Liebling 1995, 1999, 2002; Wobeser, Datema, Bechard, and Ford 2002). For example, the suicide rate in Canadian penitentiaries (Correctional Service Canada 2006) was estimated at 88.87 per 100,000 inmates in 2003-4, compared with 16.1 for Canadian males in the general population (Saint-Laurent and Bouchard 2004). However, we know little about the suicide rate among female inmates. The main reason for this is that, until recently, they represented a small percentage of the general prison population; that is, from 3% to 7% in most countries (Camilleri et al. 1999).

Comparing rates

Suicide rates are generally reported per 100,000 people for a specific territory and for a specific year. In the general population, the rate for a country is calculated by dividing the number of suicides by the mean number of inhabitants in a year. For prisons, how rates should be calculated is still a matter of debate. Instinctively, one would be inclined to divide the number of suicides in prisons by the mean number of persons incarcerated in a year. However, some correctional authorities argue that the denominator should be the total number of inmates admitted in a year (i.e., reception rate). This is a much higher number, especially in facilities for pre-trial and short-sentence inmates that admit and release many people in a year (large turnover). With this formula, it was estimated, in a specific Canadian sample, that the rate would drop to 19.5 per 100,000 (48 suicides/245,613 admissions) from 339.8 per 100,000 (48/14,124 inmates). The proponents of this approach contend that, in a given year, they successively incarcerate many new people who experience the risky first days of confinement. They suggest that the risk is not the same throughout the year and that the mean risk is increased when people are liberated after only a few months. This affects comparisons not only with the general population but also with other types of correctional facilities where the population is more stable (smaller turnover), as in facilities for long-term sentenced prisoners (Crighton and Towl 1997; McHugh and Towl 1997). All the same, O'Mahony (1994: 51) concluded that, methodologically, "the reception rate is so seriously flawed that it is of little or no practical value." More recently, Gallagher and Dobrin (2007) re-analysed the situation for the particular case of juvenile justice facilities. They highlighted the arithmetical relationship between the rates and suggested which method might be best as a function of purpose. Accordingly, administrators might find bed-based rates more meaningful to compare suicide rates across facilities, whereas mental health professionals might prefer person-based rates to describe suicide...

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