High number of prison deaths are preventable, says damning new report

Eric Allison
Photograph: Murdo MacLeod/The Guardian

The persistently high death toll in prisons is a “national scandal”, with too many deaths avoidable, according to a new report published on Wednesday.

In the year to September 2019, someone killed themselves in jail in England and Wales every four days, Ministry of Justice figures reveal. Self-harm rates are also spiralling up by around a quarter from 2018 figures.

But analysis of 61 coroners’ reports and prevention of future death notices, by Inquest, the charity that supports families of people who have died in the custody or care of the state, finds that significant numbers of fatalities could have been averted and that coroners’ advice on how to avoid further deaths is frequently ignored. The report also concludes that even when deaths were due to “natural causes”, often they were a reflection of serious lapses in prison healthcare.

“This report is a stark illustration of a system in deep crisis: too many deaths are eminently preventable,” says Deborah Coles, Inquest’s executive director and one of the report’s authors. “Official recommendations to prevent future deaths have been systematically ignored, as seen by the depressing repetition of failings. The state is failing in its duty of care to the health and welfare of prisoners, pointing to a serious lack of prison accountability.”

The report’s findings identify a number of serious shortcomings. Inconsistent and insufficient mental health care and assessments are cited as one of the main areas of concern, along with staff having an inadequate understanding of procedures for monitoring the risk of suicide and self-harm. They also highlight “wide-ranging failures” to provide basic medical care, in particular a “lack of provision for people with complex physical and/or mental health needs”, alongside a failure to assess, monitor and review prisoners’ existing health conditions. Problems are exacerbated by poor communication between health, mental health and prison staff; inadequate record keeping; and unacceptable delays in calling for emergency services or enacting basic resuscitation procedures, the report finds.

Prisons minister Lucy Frazer says she is concerned about self-harm and suicide in prisons. “Far too many prisoners are self-harming and it is one of the reasons we introduced the key worker scheme in 2018, supported by the recruitment of 4,400 extra prison officers, so that every offender can get dedicated support and have someone to talk to,” she says. “We’ve also given more than 25,000 staff better training to spot and prevent self-harm, and are investing an extra £2.75bn to modernise prisons, combat drug use and improve the environment in which offenders live. We never completely know what drives someone to suicide but I am determined that the Prison Service does everything it can to avoid contributing to that pressure.”

• In the UK and Ireland, Samaritans can be contacted on 116 123 or email jo@samaritans.org or jo@samaritans.ie. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org.