The number of suicides among people in prison is higher compared with people of a similar age and sex who are living in the community (Centre for Mental Health, 2021). This is nothing new; year on year these obnoxious statistics are published. People who are in prison are totally dependent on the state for their safety, the high number of suicides would suggest that the state is not doing all it can to provide a duty of care to protect the lives of those in prison.
A self-inflicted death is described as any death of a person who has apparently taken their own life, irrespective of intent. Prisons have seen an unprecedented number of deaths through suicide in recent years (Centre for Mental Health, 2021). Distress, self-harm and suicide attempts are increasing in the prison population and often these are viewed as manipulative behaviours, as opposed to expressions of need and vulnerability.
Data released by the Ministry of Justice on death and self-harm in prison demonstrated that, every 5 days, a person in prison takes their life and, across all prisons, self-harm has increased for the seventh consecutive year (INQUEST, 2020). Safety in custody data (this is the data that covers deaths, self-harm and assaults in prison custody and Immigration Removal Centres in England and Wales) reveals that self-harm incidents were at a record high of 64 552 incidents in the 12 months to March 2020, this was up 11% from the previous 12 months (Ministry of Justice, 2020).
Deaths as a result of suicide of those detained in prison occur at higher rates than among general populations of similar ages. In a study undertaken in 24 high-income countries in 2013–2017 of suicide rates in male prisoners, Zhong et al (2021) reported that suicide rates in male prisoners were 3–8 times higher than in the general population, the rate in female prisoners, however, was usually more than 10 times higher.
The data currently available concerning prison suicide may increase as the impact of COVID-19 is felt throughout the whole of the prison estate. Current data cover assaults and self-harm to March 2020 and therefore would not cover the majority of the COVID-19 outbreak. As is the case with many other sectors of the general population, people in prison are also experiencing the devastating impact of COVID-19 restrictions on their mental health and wellbeing. Being confined to a cell, as a result of a quarantine regime, for 23 hours can cause a feeling of sensory deprivation, with profound and unexpected negative effects on a person's health and wellbeing. The invisible harm that is caused may be more difficult to assess and observe. The frustration and despair of prisoners faced with prolonged isolation in conditions that are unsatisfactory needs to be monitored very closely and reported upon.
Stemming the rates at which prison suicides are occurring is complex; preventing the loss of life in prison by suicide requires those working within the prison service (and this includes nurses) to explore, in a multi-agency way, how the police, the judiciary, prisons and the health services can work together to save lives. Approaches to reduce suicide risk in prisons include risk assessments and management for individual prisoners and targeting those risk factors that are modifiable. Improving assessments and interventions with the aim of reducing suicide risk needs an updated evidence base on risk factors. The appropriate amount of resources is required and this includes the appropriate complement of skilled nurses so as to reduce the unacceptable number of suicides in our prisons. None of this can be done on a shoestring, this requires real commitment and real investment with less rhetoric and fewer platitudes.