The suicidal process in male prisoners making near-lethal suicide attempts

Abstract

Most investigations of factors contributing to prisoner suicide have focused on suicidal behaviour as a discrete event and used official records or ‘psychological autopsy’ methodology. A potentially more informative approach is to study survivors of near-lethal suicide attempts about their suicidal process. We have investigated the suicidal process in male prisoners through semi-structured interviews with 60 prisoners who made near-lethal suicide attempts. The suicide attempts often followed adverse life events (especially broken relationships or bereavement), criminal justice/prison-related factors (e.g. concerns about sentencing) and psychiatric or psychological factors (e.g. drug/alcohol withdrawal, depression/anxiety and hearing voices). The majority of prisoners said they intended to die (73%), although many acts had been impulsive (40%). Most described visual images about their suicidal acts (82%). Limited access to methods of suicide had clearly influenced method choice (most commonly hanging/ligaturing 67%), along with expectations about the anticipated speed, painfulness and lethality. Half the prisoners believed their acts could have been prevented, often with relatively simple solutions. The suicidal process in prisoners is a complex interplay of background factors, adverse life events, mental health and psychological problems and cognitive processes. Understanding and recognising these various aspects of the process is likely to improve suicide prevention in prisons.

Keywords:

• suicide
• near-lethal suicide attempts
• prison
• qualitative methods
• prevention

Acknowledgements

The study was funded by the NHS Forensic Mental Health R&D Programme. KH is also supported by Oxford Health NHS Foundation Trust and is a National Institute for Health Research Senior Investigator. The funders had no role in the design and conduct of the study, collection, management, analysis and interpretation of data, or preparation, review and approval of the manuscript. We are grateful to Tunde Adeniji, Jenny Rees, Debra Baldwin and Pat Baskerville of the Ministry of Justice Safer Custody and Offender Policy Group for their support and advice, Mary Piper of the Department of Health, Jo Borrill and Jo Paton for their assistance with the study, Adam Spriggs of the Ministry of Justice for providing control data, and all Area and Local Suicide Prevention Coordinators who helped with recruitment for the study. We thank Dr Emily Holmes for her advice on the visual imagery part of the study. Lastly, we thank all the prisoners who participated in this study.