There are approximately 655 people incarcerated for every 100,000 Americans – the highest rate by far out of all developed countries. In total, that adds up to more than 2 million Americans currently in U.S. prisons and jails. About one quarter of these imprisoned people have not be convicted or sentenced; they are incarcerated because they cannot afford to pay bail.
Incarceration comes with a broad range of physical and mental health consequences. People in prisons and jails are more likely to have chronic health problems including diabetes, high blood pressure and HIV. They are more likely to experience depression, anxiety, substance abuse and other mental health problems.
In addition, they are much more likely to commit suicide. In a study of prisoners in 24 high-income countries, incarcerated men were three times more likely to commit suicide compared with those not incarcerated, and incarcerated women were nine times more likely to commit suicide.
A systematic review published last month in the British journal The Lancet looks at the factors related to this increased risk in order to create interventions that prevent suicides. The authors combined the data from 77 studies on prisoners in high-income countries to better understand what factors of incarceration lead to suicide risk. In total, the review included data on more than 35,000 suicides of people in prisons in 27 countries.
The authors were able to identify the factors most strongly associated with committing suicide while incarcerated. People who had reported thinking about suicide while in prison, those with a history of self-harm and those with a current psychiatric diagnosis were more likely to commit suicide. Those accused or convicted of homicide and sexual offenses were more likely to commit suicide.
In addition, there were several modifiable factors that contributed to suicide risk among those imprisoned. For example, those without social visits were significantly more likely to commit suicide. There is a broad range of possible contributing causes for this problem. It could be that incarcerated people who commit suicide have poor social support outside of prison. Prison policies may contribute to a lack of social visits, such as strict restrictions for visitors or moving prisoners to facilities far from their homes. In either case, evidence suggests that promoting visits from families and friends would reduce the suicide risk for people in prisons.
Single-cell occupancy also led to an increased risk of suicide among prisoners. The authors note that inmates with a serious mental health problem or those prone to exhibit violent behavior may be more likely to be placed in a cell alone.
The authors’ most sweeping recommendation is to make mental health services universally available to people in prisons, and to screen people for mental health problems when they arrive. They make the case that access to mental health services for those in prison should be similar to the general population.
The take home message: Unmet mental health and social? needs likely contribute to significantly higher suicide rates among people in prison compared with the general population. There are concrete steps public officials could take to help remedy this problem, including encouraging social visits and providing prisoners access to mental health services.
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