Prisons systematically generate suffering and death: thinking beyond reform

HMP Woodhill, Buckingham, England: Source: BBC

Perhaps one of the most disturbing feature of imprisonment today is the tragically high number of self-inflicted deaths [SIDs].  At 120 SIDs per 100,000 people, prisoners are 10 times more likely to take their own lives than those living in the wider community.  On 18^th November 2016 the one hundredth (100) prisoner killed themselves this calendar year.  This equates to one prisoner taking their own life every 3 days in prisons in England and Wales.  The official data also indicates that a prisoner attempts to kill themselves every 5 hours and that a prisoner is recorded as self-harming every 20 minutes. By the 24h November 306 people had died in prison in England and Wales in 2016 (on average of nearly one person a day).  All this evidence points to the fact that prisons are places of terrible harm and death.

A history of death

Whilst current explanations of the high number of SIDs have been reduced to prisoner mental health problems and reduced numbers of staffing, deaths in prison cannot be restricted solely to prisoner vulnerabilities and regressive policy changes in the last six years.  The officially recorded figure indicates that self-inflicted deaths in prison have risen substantially for the last four decades.  In 1986 there were 21 recorded ‘suicides’ in prison. This number, however, leapt by over 100% in 1987 to 46 recorded suicides. Official data show that there was another major incline of recorded deaths only seven years later, in 1994 when, for the first time, more than 60 SIDs were recorded; and yet again, four years after that in 1998, when more than 80 people took their own lives.  The highest number of prisoner SIDs prior to this year was in 2004, when 96 prisoner SIDs were recorded for that year.  Yet though less people died, because of the lower prisoner population at that time, at 127.2 per 100,000 prisoners, the ratio of death was actually higher in 2004 than in 2016.  What is important to note is that there have been large number of prisoner deaths since the prisons were ‘reformed’ in the early nineteenth century, indicating how deeply entrenched death is in the everyday workings of prisons.

Alongside the sheer number of SIDs, in recent day’s concern has quite rightly focused on the clustering of six SID’s from 2015 – 2016 at HMP Woodhill, a high security male prison in Milton Keynes, Buckinghamshire.  Yet sadly this is not an aberration – cluster deaths have plagued prisons for years.   For example, from 1987-89 11 SIDs were recorded at Risley Remand Centre. Five young men aged from 17 and 19 died while on remand at HMP Armley from May 1988 and February 1989, whilst from August 1991 to March 1992 four young offenders, including a 15 year old, took their own lives at Feltham YOI. Six women hanged themselves in a three-year period from 2002 to 2005 at HMP Durham H wing, whilst from August 2002 to September 2003 six women took their lives at HMP Styal. Previous cluster deaths at adult male prisoners include the five prisoners who killed themselves at HMP Whitemoor from 19 November 2006 and 10 December 2007.

To understand, then, why so many people die in prisons, we need to think beyond the immediate humanitarian crisis confronting prisons.  This means challenging assumption propagated by the media, politicians, prison reformers and the POA that staffing levels and prisoner mental health lie at the heart of the problem.

Prison staff

Among traditional prison officer cultures the prisoner is often considered as “inferior” or “lesser”, and so rather the being treated with respect, care and decency, prisoner relationships with prison officers have often been based on indifference and neglect.  According to one study, the legitimate terms for prison officers who adhere to a traditional working personality when referring to prisoners can include:  Nick Names (Smithy, Jonesy); Second Names (Smith, Jones); 1^st names; Prison Number; “Dicks”, “dickheads”, “cunts”, “bollocks”,  and “wanker”.  The legitimate terms for prisoners when referring to staff were “Boss”, “Officer”, “Mr”, and “Sir”.  These forms of address by disciplinarian officers become a means of institutionalising lesser eligibility and informally maintaining a psychic divide.   In this same study of prison officers it was found that prisoners were described by officers as:

“Selfish”, “pathetic”, “childlike”, “untrustworthy”, “ill-disciplined”, “irresponsible”, “bad bastards”, “overly demanding”, “inadequate”, “dangerous”, “layabouts”, “toe-rags”, “needy”, “druggies”, “contagious”, “scum”, “poor copers”, “manipulators”, “wasters”, “users”.

Negative categorisations justify neglect and lead to the blaming of prisoners for their own dreadful predicament.  Those who harm themselves or attempt to take their own lives are labelled by some prison officers as childish and pathetic manipulators whose harming act is part of a ‘general display of attention-seeking behaviour’.  Controversy has arisen in the past regarding the apparent complacency of staff and the neglect of prisoners who are experiencing serious emotional difficulties On March 11 2004 Arif Hussain took his own life at HMP Full Sutton whilst in the jails segregation unit.  Eye witness testimonies described how Arif’s “screams of agony were ignored by staff for hours”.  When he later repeatedly rang his alarm bell for attention, rather than respond to him the night staff switched it off.

Prison Officers, HMP Risey.  Source: BBC

This negative attitude to the lesser prisoner is not restricted to prison officers alone.  A prison operational manager in a recently published book by a prison governor is quoted as saying:

Sometimes I think, ‘oh fuck, if the guy wants to kill himself, fucking get on with it’ but when I’m on the shop floor I can’t demonstrate it can I? These guys on dirty protest, I’d like to throw my own bucket of piss over them myself, but you can’t do that because it’s not humane.  Doesn’t stop you thinking it though does it? I have to make sure that the staff hold that moral ground.

The current focus on prison officer numbers is predicated on the assumption that there is now less care for prisoners by staff.  But the evidence above indicates that prison officer numbers and prisoner care cannot be easily quantified.  Neither is it obvious that close prisoner-prison officer relationships mitigate the harms of imprisonment.  A study of self-harm and SID’s of women prisoners in England and Wales in 2007 found, perhaps counter-intuitively, that “feeling closer to correctional staff increases a woman’s risk of self-harm and suicide ideation only in England”. This might help explain why the data appears to indicate there is no obvious correlation between historical rates of self-inflicted deaths and in prison officers staffing levels.   Certainly, if we explore the data over the last hundred and fifty years in terms of prisoner self-inflicted deaths and prison officer- prisoner staffing ratios we find that in the last four decades there are record rates of recorded self-inflicted deaths at the same time as there have been record high levels of prison officer – prisoner ratios.

Individual pathologies?

The other main reason proposed for the high number of deaths is prisoner mental health problems. ‘Suicide’ risk has for a long time been connected to ‘abnormal’ people with serious mental health problems. The suicidal prisoner is considered to suffer from fear, depression, despondency and hopelessness and a general inability to adapt to prison life. They simply do not have the personal resources to cope with the deprivations of imprisonment. Whilst this argument around mental ill-health is clearly of significance, as an explanation of the actual deaths of prisoners it has proved remarkably limited. The problem is that even if a person who takes their life has mental health problems this alone cannot tell us why they took their life at that specific time or indeed provide any insight into the distinct set of interpersonal dynamics leading up to the act.

It has proved exceptionally difficult to identify the manner in which mental health problems actually relate to suicidal attempts or to differentiate the ‘suicidal’ from the rest of the prison population. One of the key revelations is the evidence of the prevalence of suicidal thoughts among prisoners, with a number of recent studies identifying exceptionally high levels of suicidal ideation (i.e. thoughts about taking own life): 46% of male remand prisoners have thought of ‘suicide’ in their lifetime, and 40% of male prisoners and 55% of female prisoners experience suicidal thoughts in their lifetime, compared with 14% of men and 4% of women living in the wider community.

Whilst many people in prison do have mental health problems, those who commit ‘suicide’ are less likely to have a psychiatric history than those on the outside who take their own lives.  There has in fact been a systematic failure of identification by the Prison Service of those who are likely to attempt to take their own lives.  Under the current Assessment, Care in Custody and Teamwork [ACCT] policy only around 1 in 4 prisoners who successfully end their lives are identified as a risk of ‘suicide’.

Sarah Reed, who died in HMP Holloway in February 2016. Source: dailymail.co.uk

The pains of imprisonment

There is one further explanation of SID’s that has not been fully explored in the media or in contemporary policy but one which appears to fit much better with historical and contemporary evidence: prison through its daily workings systematically generates death.  Life in the prison place should be seen as a humiliating and unsafe experience perpetuating fear and loathing on a daily basis. Dividing prisoners between ‘copers’ and ‘non-copers’ provides only false assumptions about who may be suicide prone. Most prisoners only just about cope.  The real pains of imprisonment are not to be found in the given quality of living conditions, relationships with staff or levels of crowding, but in the denial of personal autonomy, feelings of time consciousness, and the lack of an effective vocabulary to express the hardship of watching life waste away.  Deaths in prison should not be considered as aberrations or malfunctions of the system but rather located in the daily processes of imprisonment itself.

Adaptations to imprisonment are not a permanent state of affairs but open to erosion, meaning that even small changes in the prison world may reignite underlying difficulties a person has in coping with life inside. Coping mechanisms for everyone, irrespective of the numbers of prison officers or the extent of prisoner mental health problems, are tenuous. Coping and non-coping with prison life are matters of degree that fluctuate over time and all prisoners are vulnerable to suicidal ideation.  There is no let-up in the deadly harms generated by the prison place, but at certain points some prisoners (perhaps virtually all) feel they can no longer face them.

A suicide attempt may then be a frantic and desperate attempt to ‘solve problems of living’. If the response to this situation is hopeless and there is an explicit or implicit expectation that the individual will take their life, this negative communication may erode any sense of hope and facilitate a suicide attempt. SIDs then should be conceived as a social problem where those who take their own lives are responding to given temporal, spatial and emotional contexts of the prison place.

Beyond reform

We will not find a solution to the current problems of SID’s by employing more staff or updating failed policies of the past that focus on risk.  Indeed, the large number of different policies and procedures over the last 50 years indicate just how badly the Prison Service is failing to protect people in prison.

Interventions should be directed at helping people vulnerable to suicidal ideation to develop new meanings and alternative strategies that can help them take their lives forward. Central is the nurturing of hope and the prison is the very last place to try and do this.

The most rational solution then seems to be for the adoption of social policies that can provide immediate humanitarian support to people who are suicidal and the diversion away from prison for wrongdoers who are especially vulnerable to the development of suicidal ideation. Given the high numbers of both SIDs and prisoners with suicidal thoughts, this raises key questions regarding the use of imprisonment at all.

David Scott, The Open University