Preventing prison suicide

• TheHowardLeagueandCentreforMental Healthareworkingtogetheronajoint programmeaimedatsavinglivesinprison

• Onaverage,aprisonerdiesbysuicideeverythreedays.Theneedforurgentactionisclear

• Prisonsneedtobecomesafer,healthier placestoreducesuiciderisk

• Aprisonregimeshouldbebuiltaround anormallife.Peopleinprisonshouldbe abletogetup,haveashowerandbreakfast,occupythemselvesproductively,socialise andexerciseandgooutdoors

• Allprisonsneedenoughstaffwiththeright mixofskillsandexperiencetobeableto keepprisonerssafefromharm

• TheIncentivesandEarnedPrivileges(IEP) schemeishavingadetrimentalimpactonthewellbeingofprisoners.Itisincompatiblewithahealthy,constructiveregime

• Theuseofsolitaryconfinementisdetrimental toprisoners’healthandwellbeingand increasestheriskofsuicide.Itinherently reducesprotectivefactorsagainstsuicide

• Investigationsintoself-inflicteddeathsinprisonmustleadtoactiontoreducerisk.

Key points

Introduction Thenumberofpeopledyingbysuicideinprisonannuallyhasrisenby53percent,from58peopleinin2011to89peoplein2015.Overthistimeperiodthenumberofprisonplacesreducedbyapproximately5,000,whilsttheprisonpopulationincreasedbyapproximately2,000.Levelsofsuicideinprisonarenowataten-yearhigh.

TheHowardLeagueandtheCentreforMentalHealthareinvestigatingsuicidepreventioninprisons.Thejointworkisfocussingonhowthepolice,thejudiciary,prisonsandhealthcareproviderscanworktogethertopreventsuicidesinprison.Itwillalsolookatwhatlessonscanbelearntfromthewidercommunity.Thisisthethirdinaseriesofbriefingsonprisonsuicide.Thisbriefingwillexploretheimpactofprisononmentalwell-beingandmakerecommendationsforchange.

Aprisonregimeshouldbebuiltaroundanormallife.Peopleinprisonshouldbeabletogetup,haveashowerandbreakfast,occupythemselvesproductively,socialiseandexerciseandgooutdoors.Prisonersshouldbeabletoleadagoodandusefullife.

Prisonlifehasbecomesodivorcedfromthisprinciplethatbothprisonersandstaffareincarceratedinanunreal,filthyandfrighteningworldthat,atitsworst,iskillingpeople.

The need for urgent action to save livesOnaverage,aprisonerdiesbysuicideeverythreedays.ConcernsaboutthehighnumberofpeopledyingbysuicideinprisonhavebeenraisedbyMembersofParliament,inspectors,coronersandthePrisonsandProbationOmbudsman.BetweenthebeginningofApril2015andtheendofMarch2016,100peoplediedbysuicideinprison.Inthesameperiod,thefollowingreportswerepublished:

• CoronersinEnglandpublishedPreventionofFutureDeathsreportsintotheself-inflicteddeathsofeightmenwhohaddiedbysuicideinprison.Thereportsallraisedconcernsandcalledforspecificactiontobetakentopreventfurtherdeaths.

• TheHarrisReviewwaspublishedon1July2015.Itcalledforradicalchangesandstated:‘unless progress is made on the proposals that we have made, young people will continue to die unnecessarily in our prisons’.

• HerMajesty’sInspectorateofPrisonspublisheditsannualreportinJuly2015raisingconcernsaboutthehighnumberofself-inflicteddeathsinprisons.Itstated‘many of our previous

concerns about the care of those at risk [of suicide] continued to be repeated’.

• ThePrisonsandProbationOmbudsman(PPO)publishedfourlearninglessonsreportsand86fatalincidentreportsintotheself-inflicteddeathsofprisoners.ThelearninglessonsbulletinonearlydaysincustodypublishedinFebruary2016stated:‘It is a sadness to me that this bulletin repeats learning that I have frequently published elsewhere, about staff not spotting or using essential information about risk of suicide’.

• FollowingthepublicationofdatainOctober2015whichshowedanongoingdeclineinprisonsafetyandariseinself-inflicteddeaths,theHouseofCommonsJusticeCommitteeheardevidencefromtheministerforprisonsandtheNationalOffenderManagementService(NOMS).

On16May2016,theJusticeSelectCommitteepublishedareportonprisonsafetywhichstated:

‘Notwithstanding the considerable efforts of the Ministry of Justice, National Offender Management Service and staff in prisons striving to keep prisoners and themselves secure and unharmed, overall levels of safety in prisons are not stabilising as the Ministry of Justice and the National Offender Management Service had hoped, let alone improving. This is a matter of great concern, and improvement is urgently needed.’

ItrecommendedthattheMinistryofJusticeandNOMS‘produce an action plan for improving prison safety, addressing the factors underlying the rises in violence, self-harm and suicide’.

BetweenthepublicationofthereportinMayandtheendofSeptember2016,afurther47prisonersdiedbysuicide.Urgentactionisneedednowtostoppeopledyingbysuicideinprison.Thisbriefingpaperexamineswhatchangesareneededinsideprisonstomakethemsaferplacesforall,ratherthanplacesofdespairandsuffering.

Why the rise in suicides? Theriseinprisonsuicideshascoincidedwithcutstoprisonstaffingandbudgetsandariseinthenumberofpeopleinprison,resultinginovercrowding(HowardLeague,2014).Therehasbeenanincreaseinprisonviolenceandadeteriorationinprisonsafety.Prisonersarespendinghourslockedintheircellseachday.Theuseofprisonpunishmentshasincreasedandamorepunitivedailyregimewasintroducedatthesametimeasdeathsbegantorise.

Theprisonsuiciderate,at120deathsper100,000prisonpopulation(MinistryofJustice,2016),remainsmuchhigherthantherateinthegeneralpopulation.Itismisleadingtoattributetheriseinprisonsuicidestoanincreaseinthesuiciderateinthegeneralpopulation,whichwas10deathsper100,000peoplein2014(OfficeforNationalStatistics,2016).

Preventing prison suicides: Promoting healthy prisonsItisclearfrominspectionreportsandfromdatasuppliedbytheMinistryofJusticethatmanyprisonsareunhealthyplaceswhicharehavingadetrimentalimpactonprisoners’mentalandphysicalwellbeing.

Manyprisonsaredangerous,violentplaces.Therewereeighthomicidesinprisonin2015.Inthe12monthstoMarch2016,therewere22,195recordedassaults,upby5,310(31percent)fromthesameperiodin2015.Thenumberofseriousassaultsincreasedby26percentinthesameperiod(MoJ,2016).

Anincreasingnumberofprisonersarereportingfeelingunsafeinprison.In2016HMIPreportedprisonersinSodexorunForestBankprisonwerefoundtobeself-isolatingastheyweretoofrightenedtocomeoutoftheircells.

Theprisonpopulationhasalmostdoubledsince1990,whenitstoodat44,975.InSeptember2016,therewere85,321peopleinprison.Thenumberoffirstreceptionswasevenhigher,with93,722firstreceptionsintoprisonin2015.Acustodialremandoraprisonsentencehassuchseriousconsequencesthatitshouldonlybeconsideredbythecourtsasalastresortforthemostseriousoffences.Thenumberofpeoplebeingsenttoprisonmustfallasovercrowdingisintrinsicallylinkedwithprisonsafety.

Thestatehasaprimaryobligationtoensurethatallprisonersareheldhumanelyandsafely.Themajorityofprisonerswillbereleased.Prisonshouldnotresultinthedeathofanindividual.

Prisonsneedtobecomesafer,healthierplacesiftheyaretohalttheriseinprisonsuicides.Fundamentalchangesareneededtoensureprisonspromotementalandphysicalhealthandmitigatetheharmfuleffectsofimprisonmentonmentalwellbeing.

Theconceptofahealthyprisonisnotanewone.ItwasfirstsetoutbytheWorldHealthOrganisation(WHO)in1995andhasbeenadoptedbyHerMajesty’sInspectorateofPrisonsaspartofthecriteriaforinspection.

Therearefourkeytestsforahealthyprison;

• safety:prisoners,eventhemostvulnerableareheldsafely

• respect:prisonersaretreatedwithrespectfortheirhumandignity

• purposefulactivity:prisonersareable,andexpected,toengageinactivitythatislikelytobenefitthem

• resettlement:prisonersarepreparedforreleaseintothecommunity,andhelpedtoreducethelikelihoodofreoffending

Ahealthyprisonisnotjustaprisonwithahealthcaredepartment.Itisaplacewherethewholeregimeisgearedtowardspromotingthephysicalandmentalhealthofprisonersandstaff.Prisonsshouldasfaraspossiblereplicatetheenvironmentandservicesofthecommunitybutinasecuresetting.

Prison safetyResearchsubmittedtotheHarrisReviewbyNOMSin2015showedthatfeelingsofsafetyinprisonhadanotableassociationwithlevelsofpsychologicalandemotionalwellbeingordistress.Therecordedriseinlevelsofviolenceandassaultshasundoubtedlyimpactedonlevelsofdistressinprison,resultinginhighlevelsofself-harmandsuicide.

Allprisonsneedenoughstaff,withtherightmixofskillsandexperience,tobeabletokeepprisonerssafefromharm.Inaddition,staffneedtheeducationalbackground,training,skillsandtimetobeabletobuildpositiverelationshipswithprisonerswhohavecomplexandvariedneeds.Staffwillstruggletodothisinovercrowdedprisonswithahighratioofprisonerstofrontlineprisonofficers.

ResearchconductedbyLudlowetal(2015)fortheHarrisReviewfoundthatprisoner/staffrelationshipswerekeytomanagingsuicideriskinprison.Theresearchersfoundthatmanyprisonstaffuse‘jailcraft’—theknowledgeandexpertisegainedthroughtheirownexperience—toidentifyandmanageatriskprisoners.

‘There was strong agreement that staff capacity to form and sustain high-quality staff–prisoner relationships supported SID [self-inflicted death] prevention. Staff reported that this had been adversely affected by Benchmarking and New Ways of Working. However, the problem was not just too few staff on wings but that the staff who were present were less effective than they could be because of inconsistent detailing, the use of agency and detached duty staff and low staff morale.’

Theproblemsofstaffrecruitmentandretentionwithintheprisonservicearewelldocumented(HowardLeague,2016).In2016theJusticeCommitteeraisedconcernsaboutthe‘seriousanddeep-rootedissueofstaffretention’.WhilsteffortshavebeenmadebytheMinistryofJusticetoamelioratetheeffectsofstaffshortages,suchastheintroductionof‘restrictedregimes’withfewerstafftooverseegreaternumbersofprisoners,ortheuseofstaffondetacheddutyfromotherprisonstofillgapsinstaffingnumbers,theydonotaddressthefundamentallyimportantissueofpositivestaff/prisonerrelationships.

Prisonsneedastablecohortoftrained,experiencedandcommittedstaffinordertoruneffectively.Staffneedtogettoknowprisonerstobeabletorecogniseminutechangesinaprisoner’sdemeanourwhichmightindicaterisk.Theeffectivedeploymentofstaffiskeytobuildingrelationships.

Suicidepreventionmeasures,includingthesuicideandself-injuryriskassessmentprocessACCT(Assessment,CareinCustodyandTeamwork)aredependentuponpositivestaff/prisonerrelationshipsaswellaseffectivecommunicationbetweenstaff.

ConcernsabouttheimplementationofACCThavebeenraisedbytheMinistryofJustice(2011),thePrisonsandProbationOmbudsman(2014a)andtheHarrisReview(2015)amongothers.CoronershavealsorepeatedlyraisedconcernsabouttheimplementationofACCTinRegulation28PreventionofFutureDeathsreports.

However,theprisonserviceshouldnotrelyonACCTtoflagupandsupportallprisonersatriskofsuicide.Ofthe89prisonerswhodiedbysuicidein2015,lessthanhalf(35)wereonanACCTatthetimeoftheirdeath.TheWorldHealthOrganisation(2007)foundthatmanyofthecharacteristicsofsuicidalinmatesmaybesharedbyallotherinmatesandfewstudieshadidentifiedcharacteristicsthatdistinguishprisonerswhodiebysuicidefromotherprisoners.

‘What is particularly confusing, when trying to screen at risk prisoners, is that the profile of those who will eventually die from suicide looks more “normal” than the profile of those who will attempt suicide’.

Inordertoreducetheriskofsuicide,thewholeprisonenvironmentshouldbefocussedonpromotingthementalandphysicalhealthofallprisonerswithinasupportiveenvironment.

Certaingroupsofprisoners,includingnewarrivals,prisonersonremandorrecallandlifesentence

prisoners,areknowntobeatheightenedriskofsuicide(PPO,2014b)andpoliciesareinplacetosafeguardprisonersmostatrisk.However,alackofresourcesisimpactingontheimplementationofpolicies.ThegovernorofGlenParvaprison,speakingattheinquestintotheself-inflicteddeathofLiamLambert,statedthatalackofresourcesfromtheMinistryofJusticepreventedstafffrombeingabletoprotectprisonersatriskofsuicideandself-harm(theGuardian,2016).

Newarrivalsinprisonshouldbe‘allocated initially to dedicated first night accommodation, if available’orplacedinanotherlocationwhichissuitablefornewprisoners,accordingtoPrisonServiceInstruction52/2010.HerMajesty’sInspectorateofPrisonshasrepeatedlyfoundthatfirstnightorreceptioncentresdidnothaveenoughplacesfornewprisoners.AtLewesprisonHMIP(2016a)found,

‘new arrivals were placed wherever a space could be found in the prison. Some were even placed in the segregation unit, which is a particularly inappropriate location for someone new to prison. Most staff on other units were unaware of who the new arrivals were and could not therefore provide first night support and monitoring’

StokeHeathIMB(2016)raisedconcernsaboutthetransferofprisonersidentifiedasatriskofsuicide.‘Prisoners are removed from other prisons to Stoke Heath the day or two after an ACCT document has been closed, we state and feel this is a very dangerous practice’.

Thesafetyofprisonersmustalwaysbetheparamountconsideration.Overcrowdingandalackofresourcesarecompromisingprisonerandstaffsafety.TheMinistryofJusticemustensureprisongovernorshaveadequateresourcestosupporteveryprisonertheyreceiveintotheircare.

Respect for human dignity Allprisonersshouldbetreatedhumanely.Yetapunitiveregimeandinhumanepracticessuchastheuseofsolitaryconfinement,whichcontravenesinternationalhumanrightsstandards,continuetobewidelyusedinprisonsinEnglandandWales.

InNovember2013,theMinistryofJusticeintroducedamorepunitiveregime,therevisedIncentivesandEarnedPrivileges(IEP)scheme.

HMIP(2016b)found‘the very restricted regime and limited time unlocked rendered much of the scheme ineffective as there was too little offered to encourage good behaviour’.

Prisoners‘who have demonstrated insufficient commitment to rehabilitation and purposeful activity, or behaved badly and/or who have not engaged sufficiently with the regime’canbeplacedonbasicregime.Theymustwearprisonissueclothing,arenotallowedin-celltelevision,havelimitedtimeoutofcellandlimitedvisitscomparedtothoseonstandardorenhancedlevel.Theyareonlyallowed£4aweekoftheirownmoneytospendonnecessitiessuchasfood,stamps,toiletriesorphonecalls.

ThePPO(2013)foundthatadisproportionatenumberofprisonerswhotooktheirownliveswereonthebasicregime.Between2007and2012,eightpercentofself-inflicteddeathsinvestigatedbythePPOwereofprisonersonthebasicregime.Thiswasconsiderablyhigherthanthenationalaveragepercentageofprisonersonthebasicregime(twopercent).ThePPOfoundthatprisonerswithahistoryofmentalhealthproblemswerebeingplacedonthelowestlevelofprivileges.Placingaprisoneronbasicregimeseverelyrestrictsaccesstocopingmechanisms.

TherevisedIEPschemeintroducedentrylevelforallnewlyconvictedprisonersduringtheirfirsttwoweeksinprison.Prisonershavelimitsplacedonfamilycontact,physicalactivityandaccesstotheirmoneyandpossessions.

TheIEPschemeishavingadetrimentalimpactonthewellbeingofprisoners.Itplaceslimitsonfactorswhichareknowntoreducetheriskofsuicideincluding‘regular participation in regime activities, positive family and peer relationships’ (MoJ,2013).

Prisonersonentryandbasiclevelarebeingdeprivedofvaluablecopingmechanismsatatimewhentheymostneedit.TheIEPscheme,asitcurrentlyoperates,isincompatiblewithahealthy,constructiveregime.

Anewincentiveschemeshouldrewardpositivebehaviour,encourageparticipationandrecognisetheneedsofthemostvulnerable.Maintainingfamilyrelationships,physicalexerciseandsocialisingwithothersshouldberegardedaspartofanormal,healthylife,notasprivilegesthathavetobeearned.TheScottishPrisonServicedoesnothaveanationalincentivesandearnedprivilegesschemeora‘basic’regimetomanageprisoners’behaviour.TheNorwegianprisonservicehasa‘principleofnormality’andlifeinsideprisonshouldresemblelifeoutsideasmuchaspossible.

Solitary confinementPrisonerswhoarestrugglingtocopeandmostatriskofsuicidearelikelytobethemostchallengingandthemostlikelytobepunishedorplacedinsolitaryconfinement.

ThePPO(2015)foundthatin2013/14,eightprisonerskilledthemselvesinprisonsegregationunits,fourofwhomhadbeenassessedasatriskofsuicideandself-harm.Thiswasthehighestnumberofdeathsinsegregationsince2004/5andaccountedforninepercentofallself-inflicteddeathsinprisonthatyear.NOMSdoesnotkeepcentralisedrecordsofthenumberofprisonerssegregatedatanyonetimeacrosstheprisonestate.

ThePPOnotedthatsegregation‘inherently reduces protective factors against suicide and self-harm, such as activity and interaction with others, and should only be used in exceptional circumstances for those known to be at risk of taking their own life.’

TheEuropeanCommitteeforthePreventionofTortureandInhumanorDegradingTreatmentorPunishment(CPT)hasreferredtoevidencethatsolitaryconfinement“canhaveanextremelydamagingeffectonthemental,somaticandsocialhealthofthoseconcerned”.

Prisonersarebeingheldundersegregatedconditionsforweeks,monthsandevenyears.Therearenolimitsonhowlongaprisonermaybesegregatednoristhereanyrequirementfortheprisonertobeinformedofhowlongheorshewillremaininsegregation.Thisengendersasenseofhopelessness.

InevidencetotheSupremeCourt,theHowardLeague(2015)statedthatprisonersinsegregation“oftentendtobethemostdisturbedandvulnerableprisoners,characterisedbybeingyoung,institutionalised,withmentalhealthdifficultiesorhistoriesofselfharmorattemptedsuicide”.

Prisonerswithmentalhealthproblemsandthoseidentifiedasatriskofsuicideareregularlyplacedinsolitaryconfinement,incontraventionoftheUnitedNationsMandelaRules(2015)andprisonservicepolicy.AnHMIP(2016c)inspectionofLeedsprisonfound ‘too many prisoners on ACCT documents were held in segregation’.

Segregationhasaserious,adversepsychologicalimpactonprisonersandcancauseirreversibledamage;theriskofsuicideincreasesevenbeyondtheperiodofsolitaryconfinement.Asignificantnumberofprisonerswhodiebysuicideinprisonhavehadsomeexperienceofsegregationpriortotheirdeath.

Prisonerswithmentalhealthproblemsorknowntobeatriskofsuicideshouldneverbeplacedinsolitaryconfinement.

PunishmentPrisonersexhibitingchallengingbehaviourareroutinelypunished,yetthebehaviourisoftenasignoftheirmentaldistresswithinanimpoverishedenvironment.

Therehasbeenariseintheuseofdisciplinaryhearingsinprisons,knownasadjudications.Therewere148,023adjudicationsoutcomesin2015,ariseof16percentcomparedto2014.Therehasalsobeenanincreaseintheuseofexternaladjudicationsandtheimpositionofextradaysinprison.

Theriseinthenumberofadjudicationshascoincidedwithstaffingcutsandovercrowding.Deterioratingprisonconditionsandlimitedaccesstoactivity,exerciseorhumancompanyhaveledtoincreasedlevelsoffrustrationinprison(HowardLeague,2016).Thisisadownwardspiralofanger,resentmentandincreasedpunishmentthatinitselffeedstheovercrowdingproblem.

ThePPO(2016)found:

‘When prison staff do not have the skills and knowledge to recognise and manage symptoms of mental health problems, unusual or difficult behaviour of a prisoner can easily be misinterpreted as a behavioural problem or a side-effect of taking prohibited drugs, such as new psychoactive substances (NPS). This can lead to a prisoner being punished, perhaps by removal to the segregation unit or a reduction in their IEP level’.

TheHowardLeagueforPenalReformlegalteamhasactedforchildren,disabledandmentallyillpeoplewhohavebeenwronglyadjudicated.

Prisonpunishmentscauseadditionalstressforprisonerswhoarealreadystrugglingtocope.LukeMyersdiedbysuicideinLiverpoolprisoninFebruary2013.ThecoronerreportedthatLuke’sconcernoveranadjudicationhewasfacingwas‘more than likely a relevant factor in Luke putting himself in a potentially fatal position’ (Liverpool Echo, 2015).

Inahealthyprison,staffshouldlookholisticallyataprisoner’sbehaviourtodeterminetheunderlyingcauses.Challengingorpoorbehaviourisoftenanindicatorofpoorcopingskillsordistress.

Prisonstaffshouldinvestigateandaddresstheunderlyingcausesofpoorbehaviour,ratherthanjustimposingapunishment.Thisislikelytobemoreeffectiveintermsofmanagingaprisoner’sbehaviourandinreducingtheriskofsuicide.

Purposeful activity Allprisonersshouldbeoutoftheircellsduringtheworkingdaytakingpartinhealthy,constructiveandmeaningfulactivities.Aprisoner’sriskofsuicideislikelytoincreasesignificantlyiftheyareisolatedintheircellforhoursonendwithlittletokeeptheirmindoccupied.

Someprisonsarenearertoachievingafullandpurposefulday.AninspectionofSendprisonbyHMIP(2014)found‘time out of cell, which was rarely cancelled, was good. Prisoners could move about the site fairly freely during the working day and access to the pleasant outside areas was generally good.’Womenattheprisonreportedfeelingsafeandincidentsofself-injurywerelow.

NoprisonerhaddiedbysuicideinSendprisonsince2011.

However,toomanyprisonersarespendingtimelockedintheircellswithlimitedaccesstowork,education,recreationandphysicalexercise.HMIP(2016b)foundthatinlocalprisons,athirdofprisonerswerelockedupduringtheday.38percentofyoungadultprisonerswerelockedintheircellsforover22hoursaday.

TheMinistryofJusticeneedstotakeurgentactiontoensureeveryprisonerisoutoftheircelleverydaytakingpartinworkoreducationandhasaccesstofreshair,sports,andotheractivitiesbeneficialtomentalhealth.

Keepingphysicallyactiveisimportantformentalwellbeing.NHSguidancerecommendsthatadultsshouldbeactiveeverydayanddoatleast150minutesofmoderatephysicalactivityeachweektomaintainahealthylifestyle.TheUnitedNationsMandelaRules(2015).

‘Every prisoner who is not employed in outdoor work shall have at least one hour of suitable exercise in the open air daily if the weather permits. (Rule 33)

Manyprisonersarebeingdeprivedofbasicwaystoimprovetheirphysicalandmentalhealthandreducetheirriskofdepressionandsuicide.Giventhatprisonersareathighriskofsuicidecomparedtothegeneralpopulation(WHO,2007),theprisonregimemustfocusonreducingtheenvironmentalrisksofsuicideandimprovingwellbeing.

ThePrisonServiceshouldenableandencourageprisongovernorstoinvestinaprisonenvironmentwhichwillbebeneficialtomentalwellbeing.Allprisonersshouldbephysicallyactiveandbeabletohavedailyaccesstotheoutdoors,inlinewiththeMandelaRules.

Prisons that encourage communicationAhealthyprisonmustfostereffectivecommunicationbetweenstaff,prisonersandtheirfamiliesandencourageandenableprisonerstotalk.Prisonersmustbegiventhetime,spaceandopportunitytotalktoothersinconfidenceabouttheirmentalwell-being.

The Listener SchemeThe Listener scheme is a peer support service in prison which aims to reduce suicide and self-harm. The scheme was established by the Samaritans and has been running since 1991 when the first Listener scheme was set up in Swansea prison following an increase in prison suicides in the 1980s. Nearly every prison in England, Scotland and Wales now has a Listener Scheme.

Samaritans volunteers select, train and support prisoners to become Listeners. Listeners provide confidential, emotional support to their fellow inmates who are struggling to cope. Listeners have undoubtedly saved countless prisoners’ lives.

AccordingtotheannualIMBreport(2016)onStaffordprison,theprisonhadabovetherecommendedlevelofListenersperpopulation.However,anHMIPreport(2015)onWoodhillprisonfoundtherewerenotenoughListenerstosupportprisoners,despitethefacttherehadbeenahighnumberofsuicides.TheannualIMBreportonBristolprisonnoted ‘The Board regrets that the prison has seemed to allow the place of listeners to decline over the last year’.

SchemessuchastheListenersrelyonthecooperationandsupportofprisonmanagersandstafftoruneffectively.Prisonerscannotcontacthelplinesortalktotrainedsupportersiftheyarelockedintheircellswithnoaccesstoaphone.

Overcrowding,prison‘churn’andstaffshortagesareimpactingontheprovisionofsupportservicesforprisoners,includingListenerschemes.TheMinistryofJusticemustensurethatallprisonersareabletospeaktosuicidepreventionservices,includingListeners,whenevertheyneedto.

Familymembersshouldbeabletospeakdirectlywithaseniormemberofstaffiftheyhaveconcernsaboutthewellbeingofsomeoneinprison.Familiesareoftenbestplacedtoknowiftherehasbeenachangeindemeanourandtheirconcernsshouldbetakenseriouslyandfollowedup.InvolvingfamiliesinACCTreviews,withtheconsentoftheprisoner,isanexampleofgoodpractice.

Prisons which learn lessons Thereiscertainlynolackofinformationaboutpreventativemeasuresregardingprisonsuicides.Eachself-inflicteddeathinprisonisthoroughlyinvestigated,bythePrisonsandProbationOmbudsmanandtheCoroner’sCourt.Regulation28PreventionofFutureDeathsreportsraiseconcernsandmakerecommendations.Responsestoconcernsarealsopubliclyavailable.Yetoftenthesameconcernsandrecommendationsforactionarerepeatedtimeandtimeagain.

TheseniorcoronerforMiltonKeynes,inaRegulation28PreventionofFutureDeathsreportfollowingtheself-inflicteddeathofaprisoneratWoodhillprisoninJanuary2015,stated:

‘I have concerns that the recommendations [made by HMIP, the PPO and the chief coroner] will not be implemented and that past recommendations have been ignored’.

Despitepreviouspreventingfuturedeathsreports,thecoronernotedthatthenumberofsuicidesatWoodhillprisoncontinuedtorise.Therewerefiveself-inflicteddeathsinWoodhillprisonin2015.

Theairlineindustryhasadoptedaconsistentapproach,followingfatalitiesornearmisses,toimprovesafetyandsavelives.Airlinestaffareencouragedtocooperateintoindependentinvestigationsastheyknowtheyareaboutlearninglessonsandpreventingfatalities,notfindingscapegoats.Protocolshavebeenintroducedacrosstheindustryfollowingaccidentsornearmisses,forexampletoimprovecommunicationandlimitrisksateverystage(FlightSafetyFoundation,2016).

TheDepartmentofHealth(2016)hasmodelledtheapproachoftheairlineindustryandsetuptheHealthcareSafetyInvestigationBranch(HSIB)tocarryoutlearningorientedsafetyinvestigationstounderstandthecausesofharmanddeliverpracticalsolutionstoremoverisks.Thishasnothappenedinprisons.

Suicideisnotinevitable.WhencoronersorthePrisonsandProbationOmbudsmanraiseconcernsabouttheriskoffurtherself-inflicteddeaths,theNationalOffenderManagementServicemustensureittakesactiontoreducerisksacrossthewholeprisonestate,orisabletojustifywhynoactionisnecessary.

02072497373info@howardleague.orgwww.howardleague.org@TheHowardLeague

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Hospitaldepartmentscanbeplacedunderclosesupervisionorevenclosedifthereareconcernsaboutpatientsafety(Telegraph,2016).Noprisonhaseverbeenshutdownbecauseofconcernsaboutahighnumberofsuicides.However,ahighnumberofdeathsbysuicideinaprisonisanindicatorofunderlyingissuesthatneedaddressing,whetherbytheprisonserviceorbyotherbodies.

TheMinistryofJusticemusttakeactiontoaddresstheissuesaffectingprisonersafetyaswellasensuringchangesarefullyresourced.

Conclusions Oneoftheprimaryobligationsofthestatemustbetoensurethatallthoseheldinstatecustodyareheldsafely.Thereisnoexcuseforalackofactionwhenitcomestoprisonersafety.Urgentactionisneededtopreventprisonsuicidesandensurethatbothprisonersandstaffarekeptsafefromharm.Prisonstaffshouldnotbeexpectedtoworkinanenvironmentwheredeath,violenceandself-harmarecommonplace.TheMinistryofJusticemustinvestinstaffingandensurethattheroleofaprisonofficerisarewardingandfulfillingoccupation,wherestaffarehelpingprisonerstoturntheirlivesaround.Allstaffshouldbeabletoworkinahealthyenvironmentwherestaffandprisonerwellbeingisaprimaryconsideration.Increasingthenumberofstaffworkinginprisonswilltaketimetohaveanimpactandwillrequireadditionalresources.Itmustgohandinhandwithareductionintheprisonpopulationtobeeffective.

TheHowardLeaguesubmissiontothegovernmentspendingreviewin2015outlinedhow

theprisonpopulationcouldbehalved,resultinginasmaller,cheaperandbetterjusticesystem.AbolishingthecurrentIEPschemeandendingtheroutineuseofsegregationinprisonshavefewcostimplicationsbutwouldhaveanimmediateeffectonprisonerwellbeing.Anewincentivesschememustallowprisonerstoflourish.

Culturalchangeinsideprisons,includingashiftawayfrompunitivepractices,requiresleadershipfromabovebuthasfewcostimplications.Thereisnobenefittoconductingrepeatedinquiriesandinvestigationsintoself-inflicteddeathsinprisonifthefindingsarenotusedtochangepracticesandremoverisks.

About the Howard League for Penal ReformTheHowardLeagueisanationalcharityworkingforlesscrime,safercommunitiesandfewerpeopleinprison.

Wecampaign,researchandtakelegalactiononawiderangeofissues.Weworkwithparliament,themedia,criminaljusticeprofessionals,studentsandmembersofthepublic,influencingdebateandforcingthroughmeaningfulchange.

About Centre for Mental Health CentreforMentalHealthisanindependentnationalmentalhealthcharity.Weaimtoinspirehope,opportunityandafairchanceinlifeforpeopleofallageslivingwithoratriskofmentalillhealth.

Weidentifyeffectivemethodsofsupportinganddivertingpeoplewithmentalhealthproblemsinthecriminaljusticesystem.

Afulllistofreferencesisavailableonourwebsiteathttp://www.howardleague.org/publications-prisons/

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2016