Prison Suicide and Prevention Programs

September 10, 2013 is World Suicide Prevention Day

It only took one day for the Ohio prisons director, as well as the American Civil Liberties Union of Ohio, to launch two separate reviews into the suicide of Ariel Castro, the Cleveland kidnapper who was sentenced last month to life in prison, plus 1,000 years, for crimes relating to the kidnapping and sequestration of three women over the course of a decade. Castro had been taken off suicide watch during his trial, after authorities determined he was no longer at risk of taking his own life. While public opinion was far from sympathetic to Castro’s situation, the incident – probably the most high profile prison suicide in recent history – raised the question of what safeguards are in place to prevent or at least reduce self-harm incidents in prison.

A basic Google search shows that inmate suicide – a problem I knew nothing about until recently – is the focus of much research and an array of prevention programs, in Canada and abroad. The issue of prisoner suicide and the larger issue of inmate mental health has been the focus of a number of studies since the 1960’s, by international organizations such as the World Health Organization (WHO) and by national bodies, in Canada, Correctional Service Canada. We seldom hear about inmate suicide, except in high profile cases like that of Ariel Castro. But according to these bodies, its prevalence is cause for serious concern.

Suicide is the most common cause of death in correctional settings. The rate of suicides for prisoners awaiting trial is seven and a half times greater than in the general population, and six times greater for those already sentenced. Between 2003 and 2008, there were 66 suicides committed by inmates in Canadian federal custody. There are no numbers on provincial incarceration. However, a breakdown by province of the numbers we do have suggests that the rate is three times higher in Atlantic provinces than in Pacific provinces.

According to the WHO, many individual and environmental factors account for these numbers, such as the vulnerability of prisoners, who are often among the most high risk groups, such as persons with mental disorders or socially disenfranchised persons with substance abuse problems. These factors, added to the psychological impact of arrest and incarceration, and the day-to-day stresses and indifference inherent in a correctional setting, mean that many cannot deal with these issues on their own, and will rarely voice their concerns, fears or feelings.

With respect to specific profiles, inmates whose crimes were crimes against the person, such as violent and sexual crimes, are at much higher risk of committing suicide than inmates incarcerated for property or financial crimes (a profile which Ariel Castro clearly fit). In addition, the vast majority of inmates who commit suicide have a history of drug or alcohol abuse. In Canada, studies have shown that Aboriginal offenders are two to three times more likely than the general population to self-harm while detained, leading authorities in recent years to build facilities in closer proximity to reserves, and thus in closer proximity to family and friends, in an attempt to lower the suicide rate of Aboriginal inmates.

Although many prison systems throughout the world have undertaken comprehensive suicide prevention programmes, these are often limited by available resources and, unfortunately, the lack of empathy towards prison suicide compared to other social problems. The Department of Mental Health and Substance Abuse of the WHO recommends certain key components of any suicide prevention program, which include: staff training in suicide prevention, intake screening of inmates, post-intake observation, and sufficient mental health treatment. These measures have been put into place by Correctional Service Canada, under the plan “The National Strategy for the Prevention of Suicide and Reduction of Self-Injury”.

However, according to the John Howard Society of Alberta, a non-profit focused on prison reform, the success of such programs is limited, essentially due to the low priority of the problem for correctional institutions and society generally. In reviewing efforts to reduce prison suicide, the John Howard Society ultimately calls for an interdisciplinary approach whereby inmate suicide will not be viewed strictly as a security matter or entirely as a medical or psychiatric problem. The Society criticizes existing programs’ focus on treatment and prevention as a problem for doctors to solve alone. It calls instead for therapeutic care, in addition to custodial care for inmates, which would focus on self-help and peer group assistance, as well as inmate watch and supervision. Canada’s correctional investigator, Howard Sapers, agrees that it is time to manage self-harm through the lens of both mental health and security

The John Howard Society report ends with an observation which is the crux of the debate on the effects and impacts of incarceration versus rehabilitation of those accused of crimes: “Perhaps the solution to inmate suicide lies in more discriminate and appropriate use of incarceration, keeping less serious offenders in the community and making better use of mental health facilities for inmates with mental health concerns”.