When compared to the general population, individuals involved in the criminal justice system are at increased risk of suicide and self-harm. Overall, death by suicide, suicide ideation, and self-harm are rare occurrences within the general population. Research indicates that when examined in the general population in 2014, death by suicide was the 10th leading cause of death in the United States, accounting for 42,773 deaths or 1.6% of all deaths. Worldwide, approximately 800,000 individuals die by suicide each year. Furthermore, 0.6% of individuals in the general population attempt suicide, and 3.3% experience suicide ideation at some point in their lives. Additionally, approximately 1–4% of adults and 13–23% of adolescents in the general population engage in self-harm without the intention to die.
When comparing these data from the general population to the data provided below, it is clear that suicide and suicide-related distress is more common among individuals involved in the criminal justice system. It should be noted that research about suicide-related behaviors suffers from a lack of consistent terminology to help define specific characteristics of these behaviors (e.g., the intent to die from the behavior); therefore, definitions are provided for the purpose of this review. This article discusses the prevalence of suicide ideation, nonsuicidal self-injury (NSSI), suicide attempts, and suicide deaths in corrections.
Suicide Ideation in Corrections
Suicide ideation refers to thoughts of ending one’s own life. Research indicates that approximately 27% of male prisoners report current suicide ideation. Many studies have examined suicide ideation among prisoners in an attempt to examine the association between various psychological phenomena and suicide ideation; however, often times, these studies do not provide a prevalence estimate of suicide ideation. A similar problem exists with research that has examined suicide ideation among jail inmates. Despite this, it is possible to glean information about the prevalence of suicide ideation within correctional facilities from the percentages of inmates who attempt suicide and die by suicide. Within the general population, the majority of individuals who think about suicide do not go on to attempt or die by suicide. If this fact is extended to suicide within correctional facilities, a larger percentage of individuals in correctional facilities experience suicide ideation than the number of those who attempt or die by suicide.
Within community corrections (e.g., parole, probation, work release), 41% of individuals report experiencing suicide ideation sometime during their life. Other data suggest that 12.3% of individuals in community corrections report having serious thoughts about suicide. More specifically, on average, 9.7% of probationers report suicide ideation during their probation term over the last 12 months, which is about 2.7 times that of the general population. On average, 14.3% of female probationers and 7.8% of male probationers report suicide ideation during this time. These gender differences indicate that female probationers are 1.83 times more likely to report suicide ideation than male probationers and 3.76 times more likely to report suicide ideation when compared to nonprobationer females.
Self-harm is a broad term that does not specify intent to die from the behavior, and synonymous terms include self-injury, self-injurious behaviors, parasuicide, and undetermined suicide-related behaviors, among others. NSSI is a more specific term that refers to intentional self-inflicted damage to one’s body (e.g., cutting, burning, hitting) without intent to die. In general prison settings, prisons report that 2% of prisoners engage in self-injurious behaviors (intent to die not specified). Although this percentage may seem small, the majority of prisons indicate that self-injury occurs at least once per week. Other data indicate that 22.5% of adult prisoners in psychiatric units engage in NSSI. Moreover, 41.1% of female Canadian prisoners reported engaging in NSSI while in a federal correctional facility. The discrepancies in these data may indicate differences between what correctional institutions consider to be self-harm or NSSI versus inmates’ selfreported data.
Within the New York jail system, there were 2,514 acts of self-injury between 2007 and 2011. The majority of these acts involved lacerations, followed by overdose, swallowing dangerous objects (e.g., razors), or asphyxiation. Of these self-injuries, 1,129 were not severe enough to necessitate a hospital transfer. In addition, approximately 28% of individuals who engage in selfinjury engaged in this behavior more than one time. These numbers did not differ by age, sex, or criminal history. Among individuals involved in community corrections, approximately 14% had engaged in NSSI during their lifetime; however, there are not clear data to indicate what percentage of individuals involved in community corrections engage in NSSI during their involvement in community corrections.
Suicide Attempts in Corrections
Suicide attempt refers to nonfatal, intentional self-injury with the intent to die as a result. The determination of a suicide attempt can be challenging in many settings, given that inferring intent is not always straightforward. In addition, those in correctional settings may have a variety of reasons for indicating they have attempted suicide, some more genuine than others.
In the general population of the United States, there is an average of 25 suicide attempts prior to a death by suicide. Suicide attempts and other forms of self-injury are known risk factors for death by suicide, with research indicating that a history of multiple suicide attempts is associated with greater risk of eventual death by suicide. Research has indicated that suicide attempts and death by suicide are 2–5 times more frequent in rural jails compared to urban jails. Research examining individuals in the Swedish criminal justice system who were being assessed for drug- or alcohol-related problems (including prison, probation, or remand) found that 21% had attempted suicide in the past. In this sample, 81% of those endorsing a history of suicide attempt were male. Additional research found that previous suicide attempt occurred in 7.7% of those in a community correctional sample who were still living, compared to 20.2% of those who had died of any cause (including, but not limited to suicide). Of the individuals involved in community corrections who report suicide ideation, 63% of them also report a suicide attempt history. Conversely, 37% of individuals within community corrections with a history of suicide ideation do not go on to attempt suicide. This further highlights that not all individuals who think about suicide will later attempt or die by suicide.
Suicide Deaths in Corrections
Suicide/death by suicide refers to death brought about by intentional self-injury with the intent to die as a result. Although suicide within jails and prisons has been declining since the early 1980s, it is still a leading cause of death in prisons and jails. Although it is the 10th leading cause of death in the general population in the United States, it is the third leading cause of death in prisons, and the second leading cause of death in jails. Jail inmates appear to be at increased risk of death by suicide when compared to prison inmates. Research suggests that jail suicides are approximately 3 times the rate of prison suicides (i.e., 47 suicide deaths per 100,000 inmates vs 14 suicide deaths per 100,000 inmates). Other estimates suggest that between 300 and 400 jail inmates die by suicide each year. In general, communities located in rural areas tend to have higher rates of death by suicide, and this is likely true of rural jails as well. More specifically, the suicide rate in the United States’ 50 largest jails was approximately half that of smaller jails. Although risk factors for death by suicide during incarceration are covered in another entry, it is noteworthy that 50% of individuals who die by suicide take their own life during the first week following incarceration. Additionally, there is a greater prevalence of suicide deaths among male prison and jail inmates when compared to female inmates. There is also a greater prevalence of suicide deaths among inmates younger than 18 years old and inmates who identify as White/Caucasian.
Individuals under community supervision or on probation also appear to have higher rates of death by suicide. Estimates have indicated risk up to 9 times that of the local suicide rate, depending on the location. Research conducted with probationers and prisoners in England and Wales found that 22% of probationers and 46% of prisoners who died during a 2-year period died by suicide or self-inflicted injury.
Limitations Regarding Prevalence and Estimates of Suicide Risk and Self-Harm in Corrections
Data on suicide-related statistics have the potential to be biased due to inconsistent reporting. For example, a suicide may be labeled as accidental death or death due to unspecified causes. Further, if an inmate attempts suicide, is rushed to the hospital, and dies there, reports may not show that the prisoner died in prison. Similarly, there is inconsistent terminology within different correctional settings regarding suicide-related behaviors. Some settings may require self-injurious behaviors to be deliberate, a behavior that produces visible injury, injury that requires medical attention, an intent to die, or a lack of an intent to die. Some settings may not require some of these characteristics when defining self-injurious behaviors.
In addition, underreporting of suicide ideation and suicide-related behaviors should be considered among offender samples. Inmates who express suicide ideation to correctional staff may be placed on suicide precautions to increase observation of the inmate by correctional staff and limit access to means for self-harm. For example, inmates may be placed in strip cells, which are special cells where inmates’ clothing and belongings are removed for safety against self-injury and violence. Although these conditions may increase inmate safety, they may also deter inmates from disclosing suicide-related distress.
References:
- Appelbaum, K. L., Savageau, J. A., Trestman, R. L., Metzner, J. L., & Baillargeon, J. (2011). A national survey of self-injurious behavior in American prisons. Psychiatric Services, 62, 285–290. doi:10.1176/appi.ps.62.3.285
- McCullumsmith, C. B., Clark, C. B., Perkins, A., Fife, J., & Cropsey, K. L. (2013). Gender and racial differences for suicide attempters and ideators in a high-risk community corrections population. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34, 50–62. doi:10.1027/0227-5910/ a000160
- Mumola, C. J. (2005). Suicide and homicide in state prisons and local jails. Retrieved from https://www.bjs.gov/content/pub/pdf/shsplj.pdf
- Selling, D., Solimo, A., Lee, D., Horne, K., Panove, E., & Venters, H. (2014). Surveillance of suicidal and nonsuicidal self-injury in the New York City jail system. Journal of Correctional Health Care, 20, 163–167. doi:10.1177/1078345813518637
- Yu, S. V., & Sung, H. (2015). Suicidal ideation of probationers: Gender differences. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36, 424–432. doi:10.1027/0227-5910/a000336