Quality Assurance of Suicide Prevention in Jails and Prisons

The incidence of suicides in jails and prisons exceeds the frequency in the general population all over the world. Suicide prevention is one of the most important tasks of psychiatric and psychological staff within the penitentiary system (Marcus & Alcabes, 1993; DuRand et al., 1995; Hayes, 1994; Dooley 1990). In Austria, suicide rates are traditionally high, both in the general population and in the penitentiary system (Etzersdorfer et al., 1992; Frühwald et al, 1998, Frühwald et al., 2000a&b). Sluga (1977) was the first to investigate the phenomenon of suicide in custody, but it was only a very short remark within his survey of forensic psychiatry in Austria. Our research group (Fruehwald, Frottier et al.) has investigated suicidal behavior in correctional institutions in Austria for several years. After the first step (literature search, documentation of all suicides since 1947 and evaluation of personal data of suicides) we got a grant for the next phase (Jubilaeumsfonds of the Oesterreichische Nationalbank): all personal files of suicides were taken from each prison`s archive, and all available personal information was studied. From the very beginning, a case-control study of prison suicides had been planned in cooperation with the Institute of Medical Statistics of the University of Vienna. As we were granted only 50 % of the applied fund, we were not able to get the controls. A case-control study, however, would have higher scientific value, as protective factors seem to play an important role in the context of suicides in custody. In the international scientific literature, no case-control study has been published yet. During the years 2001/2002 we will get two controls for each suicide case having occurred in the Austrian correctional system between January 1st, 1975 and December 31st, 1999 (n=220), which will be matched for sex, age, nationality, legal status and place of incarceration. The influence of relevant parameters on suicidality will be analysed, e.g. duration of custody, preconvictions, previous and last offense(s), occupation before incarceration, psychiatric diagnosis, substance abuse, signs of suicidality, social problems and characteristics of the inmate`s social network, marital status etc. After the descriptive presentation of data for cases and controls, univariate comparisons of factors influencing the suicide risk will be done (t-test, chi-square-test, u-test). Correlation analyses and factor analyses will show the relation and interdependences of risk factors. Furthermore, discrimination analyses between cases and controls and a stepwise logistic regression for the relevant suicide risk factors will be done. The results of our investigations can be the basis of guidelines, which help to identify high-risk groups for suicide within the prison system. A program for prison officers for early identification of persons on risk for suicide will be developed on the basis of our research results.

Background: Few risk factors and indicators of vulnerability for suicide in custody are known so far. Aims: A case- control-study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration for suicide in prison. Methods: For every suicide which occurred in Austrian correctional institutions between 1975 and 1999, two controls matched for correctional institution, sex, nationality, age, custodial status, and time of admission were selected. Psychiatric characteristics, previous suicidal behaviour, criminal history, and indicators of social integration were compared. Results: Of 250 recorded suicides, 220 personal files were available and matched to 440 controls. The most important predictors for suicide in custody were a history of suicidality (status post attempted suicide and suicide threat), a psychiatric diagnosis, psychotropic medication, a high violent index offence and single cell accommodation. Conclusions: A significant finding is the importance of suicidal behaviour for suicides in correctional institutions, which had been contradictorily discussed so far. This CCS demonstrates the necessity for mental health professionals to take suicidal behaviour as seriously in custodial settings as in any other circumstances.