England's secret 'death penalty'

By Jon Silverman

As a new report highlights the worrying extent of self-harm in Britain the situation in prisons is particularly disturbing. But in jails in Scotland and New York, simple measures seem to have made a big impact.

Almost two people every week kill themselves in prison in England and Wales. Were it not for the alertness and prompt action of cellmates and prison staff, that figure would be higher.

Last year, 211 prisoners who made "serious" attempts at self-harm were resuscitated. The litany of casualties has become so familiar that it might be thought an inevitable part of custody.

So why is it that some countries have made progress in reducing the suicide rate, putting us to shame?

Take Scotland. The average prison suicide rate in Scotland rose from 72 per 100,000 people in 1976 to 233 per 100,000 in 1999. This was a consistently higher figure than the rate for England and Wales. After an evaluation of a prevention strategy which was clearly failing, the Scottish prison service introduced a new process of risk management in 1998.

The impact has been dramatic. The number of suicides went down from 17 in 1999 to five last year and the rate per 100,000 was slashed by three-quarters. Given that the Scots have spent less on their system than has the prison service of England and Wales, there must be reasons other than money for this progress.

PRISON SUICIDES IN 2003 94 prisoners killed themselves 14 of them were women 13 were under 25 years Source: Howard League for Penal Reform

One of the keys appears to be that buzz phrase, "multi-agency working". The suicide prevention strategy for England and Wales was devised by the Department of Health, with no other agencies actively involved.

The Scottish version, called Choose Life, had input from the prison service, the police, the courts and mental health services. As a result, and as a response to the spate of suicides at Cornton Vale prison, in Stirling, there is now an alternative to jail for drug-addicted female prisoners - a treatment unit in Glasgow.

As a member of the Safer Custody Group of the prison service for England and Wales puts it: "Our government has talked about such an alternative but not done it."

The Scots put more resources into training prison staff in suicide awareness and they evaluate what they do more frequently.

But, perhaps even more important is the leadership and commitment shown north of the border. "The pride and energy that came from the Scottish folk was palpable," was the verdict of the Safer Custody Group member.

75% of male inmates suffer two or more mental health problems

The other model which has impressed senior figures from both the prison service of England and Wales and health officials is New York State. When a British team visited New York earlier this year they found concern that the number of suicides in prison had gone up by almost a third last year- from six to eight.

That's in a prison population of 67,000 - not far short of the total for England and Wales (about 75,000).

One of the delegation, Paul Fallon, a senior Department of Health official, said: "We were astonished at the low figure. The lesson is that reducing the suicide rate has to be embedded from the very top, and not seen as an adjunct. It is very distressing that despite all the improvements being made by the Safer Custody Group, our suicide rate is so high."

In New York, self-harm is taken as evidence of mental illness and the inmate is usually transferred within 24 hours to a specialist facility.

Neglect or poor care by the prison is often met by legal action because, unlike any other US citizen, the prisoner is entitled under the constitution to a reasonable standard of healthcare. Paying other prisoners as observers has also improved the supervision of the vulnerable inside.

Recognising that the critical period for many prisoners is their first 48 hours behind bars, the prison service here is running a pilot in the south-west in which six courts are showing videos telling the newly sentenced what awaits them when the cell door shuts behind them.

The death penalty in Britain was abolished 40 years ago. But for too many, it still exists.