Suicide prevention in the prison system
The prison system is a complex, paradoxical, and highly bureaucratized ecosystem, but, like all systems, it survives through the daily relationships of those who are part of it.
Suicidal behavior is a major public health problem due to the large number of people affected worldwide each year. Suicide is considered a multidimensional disorder resulting from a complex interaction of biological, genetic, psychological, sociological, and environmental factors.
Suicidal behavior represents one of the most serious problems in the context of penitentiary institutions, frequently being the main individual cause of death in these environments.
The risk of suicide among the general population and the prison population presents significant differences in terms of rates, risk factors, and specific contexts. Studies on this topic reveal that suicide rates are generally considerably higher in prisons than in the general population (Görgülü & Tutarel-Kişlak, 2012).
Mental health in the prison ecosystem
Regarding suicide rates:
- General population. Suicide rates in the general population vary by country, region, and other demographic factors. For example, in many countries, the annual suicide rate ranges from 10 to 15 per 100,000 people.
- Prison population. The suicide rate in prisons is significantly higher than in the general population: 8 times higher in the pretrial detention population and 6 times higher in the incarcerated population (Bedoya et al. 2009). In some contexts, studies reveal suicide rates exceeding 100 per 100,000 inmates, depending on the country and the specific prison (Garés Calabuig et al., 2024) (INE, 2020).
According to data from the Catalan Department of Justice and reports on the state of prisons, the suicide rate in prisons is considerably higher than that of the general population. In 2021, the suicide rate in Catalan prisons was 3.8 suicides per 1,000 inmates, reflecting a very high prevalence within the prison population.
Multiple factors that impact the suicide rate
It is essential to recognize that prison settings vary depending on the characteristics of the inmate population and the specific conditions of the environment. Factors such as short- or long-term detention, the presence of individuals awaiting trial, overcrowding, recidivism, and sentencing policies, among others, are determining factors that can impact suicide rates in diverse ways.
Prisons often house groups traditionally considered vulnerable to high suicide rates. Furthermore, it is crucial to recognize that incarceration involves much more than the loss of physical freedom.
Isolation significantly increases the risk of suicide. People in isolation experience heightened psychological stress due to the lack of social interaction, reduced stimulation, and a perception of extreme loneliness. These factors can trigger symptoms of anxiety, depression, and hopelessness, which are common precursors to suicidal thoughts. Isolation can accelerate self-destructive thinking, especially in situations of prolonged confinement.
Youth represents a significant risk factor in prison settings due to their developmental stage. They often enter prison without having developed strong coping skills and under a high degree of impulsivity and social pressure, which can contribute to self-harm.
Separation from family and the loss of emotional bonds significantly affect this population, which is forced to live with people facing diverse and severe problems. This context is accompanied by rules of discipline and supervision, which contributes to a loss of privacy and, sometimes, of identity.
Suicidal behavior is considered by the World Health Organization (WHO) to be a preventable cause of death, since risk factors and warning signs can often be detected early. Therefore, it is the duty of the prison administration to ensure the highest possible detection rate and the subsequent implementation of preventive measures. Given that the prison population is under the direct custody of the administration, the administration has the obligation to:
- To watch over their lives.
- To ensure their safety.
- Look after their health.
It is important to emphasize that the impact of what has been termed "institutionalism" extends beyond the time spent in prison. The consequences of this experience can accompany individuals for long periods, even after their release. Recent studies have revealed that the incidence of suicide after release is higher than that recorded in the general population, suggesting that the transition back to life in freedom can be a critical time when many inmates face a heightened risk of suicidal behavior.
In 2023, a total of 6 suicides were recorded in the Catalan prison system, broken down into 4 cisgender men and 2 cisgender women, with no cases involving transgender individuals. So far in 2024, up to the end of October, the figure has risen to 11 suicides, of which 9 were cisgender men and 2 cisgender women, with no cases among transgender individuals.
The higher rate of suicide among men may reflect several factors, including stigmas related to emotional vulnerability and fear of seeking help, which are common in male-dominated cultures. It is important to consider the methods used and gender differences in this regard. In general, men tend to employ more lethal methods when attempting suicide, which contributes to the higher suicide rates in this group.
Female prisoners face more risk factors linked to their social roles
On the other hand, women also face unique challenges in the prison environment, such as gender-based violence, trauma, and stigma, which can affect their mental health and increase their vulnerability. While women experience fewer completed suicides, they tend to make more suicide attempts, depending on the methods they use. This may be related to a greater predisposition to express their emotional distress. The literature shows that women incarcerated in prisons are 20 times more likely to commit suicide than women who are not incarcerated (Marzano et al., 2010).
Incarcerated women face a range of specific risk factors closely linked to their social roles. Many of them, as mothers or primary caregivers in their families, experience profound guilt and anxiety about being separated from their children and loved ones. As their release date approaches, they experience a combination of fear, uncertainty, and pressure due to the family and societal expectations placed upon them, which poses a significant risk.
The absence of suicides among trans people in the last two years could be interpreted in various ways, from the lack of accurate records to the possibility that this group is being made invisible in the data.
Suicidal behavior in Catalan prisons presents a significant challenge that requires attention and appropriate prevention, intervention, and postvention strategies. Understanding the factors that contribute to this problem is essential not only to raise awareness but also to reduce suicide rates and improve the emotional and psychological well-being of the prison population.
A crash plan to address the rising suicide rate in prisons
In response to the alarming increase in suicides within the prison system during 2024, an emergency plan has been implemented to address this problem urgently and effectively. This emergency plan for suicide prevention in the Catalan prison system comes from the Department of Justice of the Government of Catalonia as a response to growing concern about suicide rates in prisons.
The initiative is based on these measures;
Establishment of working groups in each prison.
This committee will be composed of all relevant stakeholders (Welfare team, Internal Affairs, Primary Health Care, and Mental Health) and will meet monthly to review data on the detection, activation, and deactivation of cases, as well as their evolution. It will also propose recommendations to the center's management and develop immediate solutions to any problems that arise.
Awareness and training.
Implementation of training programs (learning modules) aimed at all prison officers and professionals involved in the care of inmates. This includes training on suicide prevention and crisis management.
Dissemination and training in suicide prevention guidelines, aimed at professionals, entities, volunteers, families, the close environment and people deprived of liberty.
Alert system for critical events.
Creation of an alert system that activates protection protocols in critical situations.
Internal notification and support mailbox.
Implementation of a mailbox so that inmates can report risk situations or request support.
- Installation of the NOTICE FOR LIFE mailbox in all areas of the center, accessible to all residents.
- Implementation of the figure of the support inmate, in order to accompany, from a perspective of support and coexistence, people at risk of suicide.
Protocol activation control.
Establishment of a monitoring system for activations of the suicide prevention protocol, as well as for primary care actions.
- Intensify the monitoring by Primary Care of people at low and moderate risk of suicide.
- PPSs with a high risk of suicide will not be deactivated; instead, follow-up will be arranged through a gradual decrease in risk (being considered medium or low risk), according to the psychiatric clinical justification.
- The Wellbeing team will conduct bimonthly follow-ups with individuals exhibiting higher-risk factors, such as self-harm, suicide attempts, pending legal proceedings, and other relevant factors. They will also monitor detections/activations and issue recommendations to the center's management teams regarding the Suicide Prevention Plan (SPP).
Restriction of access to lethal means or implements.
A list of tools that can be used as hazardous methods will be drawn up, along with specific measures to mitigate these risks.
Enable alternative spaces.
Create more pleasant video surveillance monitoring spaces, with an environmental layout suitable for people at risk of suicide.
To enable more flexible and less restrictive spaces in the Department of Specialized Care for people with intellectual disabilities and in the Compensatory Intervention Units, where alternatives can be offered to resolve conflicts.
Intensive intervention in a closed setting.
Development of intensive intervention programs aimed at inmates in closed regimes, who often present a higher risk of suicide due to the lack of social interaction and emotional support.
Connectivity and accessibility.
Ensure the registration of information in the shared repository by all professionals (healthcare and prison) regarding detections, activations and interventions, respecting confidentiality and legal regulations.
Risk study with a gender perspective.
Conducting risk studies that consider gender differences in the prison population, recognizing that different genders may present different risk factors and needs.
The implementation of the emergency plan for suicide prevention in the prison setting marks a significant step towards improving the mental health of inmates.
The working group assigned for the comprehensive analysis of the emergency plan and the implementation of the corresponding adjustments and recommendations will be responsible for the continuous monitoring of each component of the plan, evaluating its effectiveness and proposing the necessary modifications to ensure its success.
Suicide prevention, especially in prisons, must be understood as a collective task in which all stakeholders play a crucial role. By actively participating in the detection and prevention of suicide risk, we can create safer and more humane environments.
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