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Prisons: Suicides

My Lords, I add my gratitude to the noble Lord, Lord Dholakia, for introducing the debate so comprehensively. The figures on suicides in prisons are very worrying. As well as concern about the mental welfare of those who end up in custody, I, like the noble Lord, Lord Elton, who has just spoken, would like to look at the antecedents to them being there, and particularly to being at risk of suicide. The figures suggesting a five-fold excess of suicide mortality in prisons are alarming, but I would suggest that every suicide is a reflection of society as a whole and that society cannot lay all the blame at the doors of the prisons. Sadly, many of your Lordships have first-hand experience of bereavement from suicide and the plethora of ““what if?”” and ““if only”” thoughts which remain unresolved for the rest of their lives. There is a global trend apparently of increased suicide rates over the past 50 years so that by 2020 there will be a projected 1.53 million suicides a year of all types. It may be that prevention measures in some countries have been offset by huge rises in developing countries, such as China and India, but the inaccuracies of classification of deaths makes it difficult to assess. But let us focus on England and Wales. A recent study of prisoners in the past 25 years by Seena Fazel and colleagues is important because it reports a rise across all ages, with a particularly striking excess in young boys aged 15 to 17 years. It is this group that I want to focus on. It is known that severe emotional stressors, including traumatic bereavement in childhood and adolescence, are linked to offending and maladaptive behaviour. A family history of suicidal behaviour, a history of psychiatric hospitalisation and symptoms of anxiety or depression are independent risk factors for suicidal ideation in prisoners, and prisoners with suicidal ideation have a higher risk of self-destructive acts in the long-term after discharge from prison. In 1998, a Cardiff prison medical officer, Dr Nick Jones, and I tried to find out if bereavement was linked to people ending up on remand. With an occupational therapist and four nurses, he tried to discover whether the young offenders on remand in Cardiff had a higher incidence of unresolved grief than others in the population. They had noticed that some of the remand prisoners seemed the most emotionally vulnerable and had a history of traumatic bereavement. The prison authority wanted to be helpful but was very frightened that even asking a question about past bereavements might precipitate a suicide. So it was agreed that only those prisoners who came to the medical services for any reason were given an information leaflet, assured of confidentiality and offered an interview. Those with a history of bereavement were invited to a semi-structured interview, conducted with great sensitivity by these very motivated staff, and were offered a series of support sessions. Among those wishing to attend the support sessions, more had witnessed a violent death, felt that they had not coped well with the loss and had more pointers to depression and suicidal ideas. Many of these young men described traumatic bereavements. For example, three were bereaved through suicide; one was in a car crash that had killed his girlfriend; one prisoner’s baby had died and another’s girlfriend had had a fatal pulmonary embolism, linked to the conception that she was taking, after his imprisonment. Sadly, none of those taking up the offer of support sessions completed them for a variety of reasons, often being moved on by the system. If we live in a society that does not adequately recognise the disastrous effects of loss and bereavement on young people, that does not provide them with any haven of safe support where they can resolve their grief, where can all that anger and chaotic emotion of bereavement go? If all that anger is unfocused, it is hardly surprising that it turns against the society that has not supported them and ends up in criminal activity. When in custody the unresolved grief and the depression that goes with it become high risk factors for suicide. But it is also well known that those presenting to prison medical services with insomnia and pain are traditionally perceived as manipulating to try to obtain hypnotics or analgesics. I suggest that the prisoners who are presenting thus may be particularly emotionally vulnerable, may have a history of unresolved grief and could benefit from support that does not medicalise their presenting complaints. However, the resources of the prison health service are too stretched to take this on, although voluntary sector assistance could well be harnessed to try to provide some support for those who present with unresolved grief. But until the extent of such antecedents to offending behaviour are linked to suicide, then a better way to prevent suicide will not be developed. Suicide prevention and prevention of offending behaviour must be linked to providing support to children and adolescents overall. All those, when bereaved or otherwise traumatised in our society, deserve support. Proper bereavement support to children and adolescents must become a routine part of our health and education provision so that every staff member considers the relationship of the dying or dead patient to young people and feels that it is his or her duty, working in healthcare or education, to ensure that children or adolescents are included as part of the family and are important as secondary patients in the bereavement process. Otherwise we are just waiting until those children exhibit offending behaviour. Some of them will, some will become imprisoned and some will commit suicide. It is far too late, then, to be wringing hands. Perhaps the first step towards would be to adopt fully the United Nations Convention on the Rights of the Child, giving children equal status with adults right across the board.