Hopelessness and Suicide in Prison
Tony O'Riordan, SJ
Why do people kill themselves? Because they have lost hope. People who have hope can envisage a future and can see what they are going to do tomorrow, next week and even in the years ahead. This ability to look forward to the future with a degree of confidence is what keeps us going in life.
Sadly it seems as if a growing number of Irish people are lacking in hope. There has been a dramatic increase in the number of suicides in Ireland in recent years, particularly among young males. 359 suicides were recorded in the first 9 months of last year. It is estimated that the figure for the entire year will exceed 500. This will be significantly more than the number of people killed in road accidents in 1998, which is estimated at 460.
Considerable research has been carried out with a view to understanding the factors that lead to suicide. Dr. Patrick McKeon provides a useful overview of three interrelated factors; \'Psychiatric disorders, usually depression or an intoxicant problem, are present in 90% of people who take their own lives. However as not everyone with depression attempts suicide, it is clear that other factors are relevant. Suicide can best be explained by a domino effect of the three components, depression and related disorders, traumatic losses in life and finally the added depressing effect of alcohol abuse or illicit drugs. Depression would appear to be the most commonly experienced first sequence in the domino chain followed by the further demoralising effect of emotional trauma leading in turn to alcohol abuse. In young people it may be that the sequence starts with drug use.\' In other words, what brings people to the brink of suicide is a combination of some form of mental illness, the inability to cope with difficult circumstances and alcohol or drug abuse.
People who commit suicide come from all walks of life. However, particular social factors are associated with suicide. Suicide rates are generally lowest in women, married individuals, and those in higher socio-economic groups. Young men, people living alone or isolated and those who feel alienated from society are more likely to kill themselves.
Prisoners: A Vulnerable Group
The sociological and personal profiles of prisoners puts them in a particular category of person likely to feel hopelessness. Most of the people we send to prison are young men from marginalised urban areas. They are multiply disadvantaged and most suffer from chronic drug addiction. While, in general, women are less likely to commit suicide, women in prison share many of the personal and sociological characteristics found among male prisoners, and as such, female prisoners are equally vulnerable to experience hopelessness.
A recent study shows that prisoners experience high levels of psychological difficulties and significant feelings of hopelessness. It found that one in two prisoners had thought about killing himself at some point in his life and one in three had tried to do so. This study was carried out by a Psychologist in Clinical Training on placement with the Department of Justice Psychology service. It examined psychological distress, thoughts of suicide and self injury among male prisoners in Mountjoy and St. Patrick\'s Institution. Interviews were conducted with inmates during the first days in prison. The majority were from Dublin, one fifth were functionally illiterate, on average they had left school at 14 with no qualification. 15% had never been employed and the majority were unemployed prior to their current imprisonment. Close to three quarters of the sample misused drugs; a habit that, on average, began at the age of 12. The majority abused non prescription drugs, with 45% using heroin and 19% using cannabis. Using more than one drug was a common practice among most of the prisoners interviewed. 45% of the group admitted that they got in trouble with the law after using drugs.
In terms of physical health status, over a quarter stated that they had physical health problems and over a quarter stated that they had spent some time in a psychiatric hospital. Other significant findings about this group include:
52% had experienced suicidal thoughts in the past
8% of prisoners had a member of their immediate family die through suicide
33% had engaged in self injurious behaviour at some point in their lives
70 % of these had self injured on two or more occasions with two thirds of attempters stating that their intent to die in the last attempt was high.
In terms of attaining a measure of hopelessness the study used a scale called the Beck Hopelessness Scale. This categorises hopelessness, in a range from minimal to severe hopelessness. Over 80% of prisoners were in the hopeless range. 70% of the prisoners scored in excess of the mean score for the Irish population. The prisoners experienced high levels of depression, anxiety, and somatic complaints. Over 60% had feelings of personal inadequacy and inferiority
Clearly, there is a significant requirement for physical and mental health care for offenders prior to committal. Once in prison the need for this support increases. From the inmates perspective there are certain unique features of the prison environment which diminish hope and enhance suicidal behaviour:
There were 37 prison suicides in Irish prisons between 1988 and 1998. Official figures are not available but conservative figures suggest that there are approximately 200 reported incidents of attempted suicide and self harm in prison every year. Others put the level of self injury much higher, at 8-10 incidents a week in Mountjoy alone. Even if the lower figure is more accurate, 200 such incidents are a cause for concern. The most common form that such incidents take are attempted hangings and self-mutilation involving sharp objects . It is difficult to assess how many of these incidents of self-harm represent serious attempts by inmates to kill themselves. Wishing to be transferred to a different part of the prison or to another prison might be the reason behind some incidents of self- injury. What can be said is that all acts of self-injury reflect personal breakdowns resulting from crises of self doubt, poor coping skills and hopelessness.
The Official Response
In 1989 the Government, concerned by the rising number of prison suicides, set up an Expert Group to look into the problem. The group reported in 1991 and made 57 recommendations. Many of these were elements of an approach to preventing suicides that relies primarily on a strategy of identifying prisoners considered high-risk. These prisoners, once identified, are monitored closely. As a result some possible deaths have been prevented through the increased vigilance of Prison Officers. However, there has not been any real decrease in the level of prison suicide in recent years.
This may be due to thto prepare them for their release without a planned programme for their management. Such a programme would encompass assessment of the prisoner on arrival; a plan of treatment of any illness or addiction; education and counselling family visits; pre-release arrangements and follow-up on release. This will require attention to the shortcomings of the medical and psychological services outlined in this article but it will also require resources to improve the occupational and educational aspects of our prisons.
Updating Prison Rules. In the Department\'s own words; "The 1947 Prison Rules are, by common consent, hopelessly obsolete and require urgent updating." This was written 5 years ago and no updating has taken place, (at least it gives a sense of what the Department understands by \'urgent\'.) On the principle of \'what is best for the prisoner is ultimately best for society\', there is a clear need to outline the regime that is to operate in our prisons and to ensure that the rights of prisoners are protected.
Prison as a Last Resort. A more radical course of action is to reduce the use of imprisonment as a response to offending behaviour and develop a spectrum of community-based corrective measures. Prison is not be the only way of punishing offenders. In many cases other methods, such as fines, have been found to correct behaviour more effectively than imprisonment. Other measures involving appropriate supervision of convicted offenders in the community, and measures that address the factors of disadvantage that lead so many young people to offend, are more likely to achieve rehabilitative outcomes in the long run. In this context, hopelessness and mental illness are more likely to be successfully treated provided that the appropriate range of such services is provided.
It is not possible to say, with certainty, that any of the suicides in our prisons since 1991 could have been prevented if a different approach was adopted, but more could have been done to reduce the level of risk among the general prison population. This could have been done by improving the standard of medical care. Decisive action to (1) humanise our prisons and (2) change our practice in the way we use imprisonment is required if we are to challenge this sense of hopelessness and help prisoners cope more effectively and reduce the likelihood of suicide.
Currently we are investing up to £200 million to provide more prison places in a prison system that already costs over £150 million to run every year. While emphasis is being placed on building and design aspects of these new institutions, little advance consideration is being devoted to personnel requirements with the exception of Prison Officers.
Investing in bricks and bars may serve the limited purpose of keeping some vulnerable members of our society locked up for periods of time, but rehabilitative regimes require adequate personnel at various levels in the system. Often the poor physical conditions in our prisons are excused by the fact they are Victorian constructions that we have inherited. Will people in the next century excuse the regimes and services in prisons they will inherit, by stating that they are constructions of late twentieth century Irish people? Or will they deplore a system which favoured the easy option of infrastructure over rehabilitation?
Patrick Mc Keon, Suicide in Ireland- A Global Perspective and A National Strategy, Aware publications 1998.
Joseph Duffy, Psychological Distress, Suicidal Ideation and Self-Injurious Behaviour Among Male Remand Prisoners. (Thesis completed in 1998 in Trinity College Dublin )
Prison Officers Association Figures.
These are small windowless stuffy unfurnished rooms which are used for a spell of solitary confinement. Prisoners are confined in these cells without books, radios or other personnel possessions having first to strip to their underpants. Meals are brought in to them and they are checked on a regular basis by officers. In theory these cells should only be used to restrain prisoners and prevent them from injuring themselves or others in practice they appear to play a key role in arbitrary punishment decisions by officers.
· Note: Thanks to Niamh Gaynor and Bill Toner SJ for helpful comments on an earlier draft of this paper.