The high rate of prison suicides experienced in recent years could indicate an upward trend or it could merely be an aberration. In this paper I will try to analyze the problem of suicide in jails and discuss how we can prevent such actions.National studies of prison suicide rates have been conducted; therefore, this paper is limited to research on individual state prison systems reporting widely disparate finding.
The limited research available on national prison suicide rates is both somewhat dated and plagued by inconsistent reporting problems. Lester (1982, 1987) cited previous calculations of national prison suicide rates for two periods: 1978 to 1979 and 1980 to 1983. The rate of suicide for male inmates was 24.6 and 24.3, respectively, for these two periods. Unfortunately, the above calculations were based on nationally reported Bureau of Justice Statistics (BJS) data that were underreported. For example, the most recent data available on prison suicide from the BJS reported a total of 89 Prison suicides throughout the united States in 1991. This total, however, does not include data from six "nonreporting" jurisdictions, as well as an unknown number of possible suicides contained within inmate death data listed by BJS as "unspecified causes." excluding nonreporting jurisdictions, the national prison suicide rate based on BJS data would be 13.9 suicides per 100,000 inmates. This rate is low, however, compared to other data. For example, analyzing annual national survey data from both the Criminal Justice Institute (1992) and Corrections Compendium (1992) as well as from telephone follow-up with several jurisdictions, NCIA was able to verify 127 prison suicides for all state and federal prison during 1991. Thus, a more accurate national prison suicide rate for 1991 would be 16.4 suicides per 100,000 inmates.
In an effort to collect the most recent national data on prison suicides, NCIA surveyed all 50 state departments of correction (DOC), plus the District of Columbia and the Federal Bureau of Prisons and inquired as to the number of inmate suicides each prison system had during 1999. In addition, to review historical trends in the rate of prison suicide throughout the country, I gathered and analyzed data from the 1984 through 1992 annual surveys of both the criminal justice Institute and Corrections Compendium. Table 1 presents the aggregate nine year (1984-1992) total of prison suicides and rates combined with NCIA's 1993 data. As indicated, there were 1,339 suicides in state and federal prisons throughout die United States between 1984 and 1993, resulting in a 10-year suicide rate of 20.6. California led all states with 176 prison suicides, with New Mexico reporting only two suicides during the 10-year period. New Mexico also had the lowest suicide rate (7.1), while North Dakota had the highest (101.7) - perhaps a misleading statistic since this prison system has not experienced an inmate suicide since 1988. In addition, 10 large jurisdictions (Arizona, California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, Texas and the Federal Bureau of Prisons) accounted for almost 50 percent of all suicides yet had a combined suicide rate below the national rate (17.8 versus versus 20.6).
Dual system of both pretrial and sentenced inmates Table 1 also indicates that 31 jurisdictions had suicide rates above the national rate (including extremely high rates in Alaska, Minnesota, Montana and North Dakota). At first glance it would appear that the seven jurisdictions operating dual systems of confining both pre-trial and sentenced inmates, excluding the Federal Bureau of Prisons, had suicide rates that far exceeded the national average. From a low of 15.6 in the District of Columbia to a high of 87.3 in Alaska, these seven dual-system jurisdictions had a combined suicide rate of 34.4 Given that pre-trial inmates appear more vulnerable to suicide and the suicide rate in local jails is estimated to be more than nine times greater than in the community (Hayes 1989 p.27), the rate of suicide within dual-prison systems is not surprising. However, it would appear that the uniqueness of jurisdictions with dual systems is not die sole cause of high suicide rates in prison systems throughout the United States. The analysis found that the seven smallest prison systems (excluding dual systems) of Maine, Montana, New Hampshire, North Dakota, South Dakota, West Virginia and Wyoming had a combined suicide rate of 53.8 - more than two and a half times greater than the national average.
Further, although it might be assumed that prison systems with high rates of suicide would mirror the suicide rate in their respective communities, the data do not support this proposition. According to National Center for Health Statistics (1999) data, the exceptions of Montana and Wyoming, all of the seven smallest and dual-system jurisdictions with high prison suicide rates had general population suicide rates comparable to the national average of 12.2. Perhaps a better explanation for the high prison suicide rates in these states is that, even though all prison systems are plagued by limited resources, the strain may be more acute within smaller jurisdictions.
The most encouraging finding from NCIA's survey is the gradual decrease in the rate of prison suicide throughout the country during the past 10 years. As shown in Table 2, following a high of 27.2 in 1985, the prison suicide rate in subsequent years declined steadily, settling to a low of 16.1 in 1992. Although the rate of prison suicide rose nationally to 17.8 in 1999, the increase could be indicative of either an upward trend or merely an aberration. In addition, the declining prison suicide rate nationwide during the past 10 years is punctuated by a dramatic drop from 21.7 in 1989 to 16.2 in 1990. In fact, from 1984 through 1989, the rate of prison suicide throughout the United States was 24.5. From 1990 through 1999, however, the rate dropped to 16.6. Although the reason behind this noticeable reduction is unknown, there were several jurisdictions that were primarily responsible for this national decline -- 14 state prison systems experienced suicide rate reductions of 50 percent or more from the period of 1984-1989 to 1990-1999. During 1990-1999, these 14 states had a combined suicide rate of 13.5 -- a decline of more than 60 percent from the 1984-1989 rate of 34.6.
What significance can be derived from these findings? While the current data do not allow for a comparative analysis of prison suicide rates and prevention programs, they do provide several interesting findings. First, the rate of suicide in prisons throughout the United States during the past 10 years was calculated to be 20.6 deaths per 100,000 inmates -- a rate more than one and a half times greater than that of the general population, yet far below the rate of jail suicides. Second, states with small prison populations appear to have exceedingly high rates of suicide -- often more than two and a half times greater than the national average. Third, apart from 1993, there has been a gradual yet steady decline in the rate of prison suicides throughout the country since 1984, punctuated by a dramatic decline after 1989. In fact, more than 14 state prison systems have experienced rate reductions of 50 percent or more since 1989.
Fifteen states experienced higher rates of prison suicide during 1999 as compared to their nine-year (1984-1992) averages. Haycock (1991 p. 53) has written that several recent developing characteristics of prisons are suggestive of higher suicide rates in the future, resulting in a significant public health problem. Recent mandatory sentencing laws and dramatic increases in life sentences have not only put a strain on crowded prison systems, but coupled with increased cases of AIDS and "graying" of inmate populations (in which inmates 55 years and older represent the fastest growing age group), they have instilled despair and hopelessness in inmates. Observers also argue that prison crowding has paralyzed correctional budgets, straining both medical and mental health services.
Historically, national correctional standards have been viewed with some skepticism. They have been referred to as too general or vague, lacking in enforcement power and often politically influenced. As one observer noted in reviewing the historical record of national standards for correctional health care, "Courts and correctional administrators seeking specific guidelines as to what constituted `adequate' provisions for health care were not likely to derive much satisfaction from the early standards" (Anno 1991 p.71). Further, with regard to current standards, formal adoption of correctional standards by a prison system does not necessarily ensure that individual facilities have put these procedures into operation. Unfortunately, there are numerous examples of "accredited" prison facilities that are under court order for inadequate conditions of confinement.
Most of the national standards were developed as recommended procedures rather than regulations that measure outcome. For example, ACA standard 3-4364 requires a "written suicide prevention and intervention program" in all prison facilities, but offers no guidance as to which components should be included in such a program. The potential result, of course, is that two prison systems could be in compliance with this standard yet have dramatically different procedures. However, despite this problem, the relationship between suicide prevention and national correctional standards has progressed significantly in recent years. Several national organizations, including the ACA, the National Commission on Correctional Health Care (NCCHC) and other influential bodies have recognized that, because suicide remains a leading cause of death in prisons, standards need to be promulgated and revised to address the specific area of suicide prevention. Once a footnote in medical care standards, suicide prevention is now addressed separately and distinctly in most national standards. These standards now provide the opportunity and framework for departments of correction to create and build upon their policies and procedures for the prevention of suicides.
Recently, observers have noted that several developing trends suggest higher suicide rates in die future. Large-scale, prospective studies of prison suicide and empirical studies on the process of custodial suicide are needed. As the awareness of inmate suicide as a serious health problem within prisons continues to grow, resources must follow. Some encouraging signs are apparent. For example, the National Institute of Corrections currently provides technical assistance to departments of correction in various specialized areas of correctional health care, including the development of comprehensive plans for suicide prevention.
Finally, future success in reducing prison suicides throughout the country will rely not only on developing comprehensive and operational policies, but also on the attitude displayed by prison administrators toward whether to treat the recent increase in prison suicides as an aberration or as a signal of an upward trend.
