The Suicide prevention in England: 5-year cross-sector strategy has just been published1. For hospital inpatients, the good news is that, based on National Confidential Inquiry2 figures, ‘collective efforts to improve patient safety led to a 35% fall in suicides in mental health inpatient settings in England between 2010 and 2020’. Much of this improvement has been attributed to reducing ligature points in hospitals. Suicide rates had been falling across the general population too, although subsequently rising3. These figures, however, have not been reflected in prisons, where the death rate generally and the suicide rate specifically have continued to rise4. In the government’s action plan5, companion to the 5-year strategy document, specific action for prisons is specified:
- Commit £625,000 per year to maintain delivery of the Samaritans Listener scheme and postvention service (although only committed until March 2025)
- Continue to roll out suicide and self-harm prevention training among prison staff
- Develop new suicide prevention training to be rolled out among probation practitioners and approved premises staff
- Install new ligature-resistant cells
- Continue to consider advice from the Independent Advisory Panel on Deaths in Custody
There is also recognition of the elevated risk of suicide or self-harm just after leaving prison and reference to Reconnect services.
In most respects, this is a shadow of HM Prisons Inspectorate safeguarding expectations, last updated in 20216, which includes a recommendation that ‘Detainees at risk of self-harm or suicide can telephone the Samaritans 24 hours a day, seven days a week.’ The latter is feasible, given funding, and implemented in some prisons. Training, perhaps improved training for prison staff may be helpful too, but only if there are sufficient prison staff to allow for its full implementation. After the devastating prison staff cuts of 2013/2014, there has been some evidence of improvement in staff: prisoner ratios7, but prison officer numbers have now plateaued8 while prisoner numbers, with the exception of the COVID-19 years have continued to increase and are projected to continue doing so9.
In order to argue powerfully for more funding to ensure that HM Prisons Inspectorate guidance is fully implemented it is arguable that we need more evidence on some outcomes, but it is at least humane guidance. The important addition made by the Suicide Prevention Strategy is the call to install new ligature-resistant cells. The latter makes sense because of evidence that over 90% of prison suicides are by hanging however, as this evidence was published in 200310, an important question must be why the call for ligature-resistant cells is still necessary? Twenty years have passed since this evidence was published.
How can we ensure not only that practice is, as far as possible, evidence based but also that when there is evidence for a life-saving intervention that it is implemented at the earliest possible? For sure there may be financial implications in rendering prison cells ligature resistant, but then the last published estimate of the cost of a single suicide to the British economy was £1.67 million in 200911 – close to £3 million today. Even on economic evidence it makes sense to speed up appropriate action.
Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.
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References:
2 https://documents.manchester.ac.uk/display.aspx?DocID=66829
3 www.samaritans.org/about-samaritans/research-policy/suicide-facts-and-figures/latest-suicide-data/
4 www.gov.uk/government/statistics/safety-in-custody-quarterly-update-to-march-2023
7 https://questions-statements.parliament.uk/written-questions/detail/2020-02-12/1220
8 Prison officer figures England and Wales 2023 | Statista
9. https://researchbriefings.files.parliament.uk/documents/SN04334/SN04334.pdf
10. Shaw J, Appleby L, Baker D. (2003) Safer Prisons: A National Study of Prison Studies 1999–2000 by the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness. NCISH: Manchester.
11. https://committees.parliament.uk/writtenevidence/70998/html/