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72 Medico-Legal J. 1 (2004)

handle is hein.journals/medlgjr72 and id is 1 raw text is: Medico-Legal Journal (2004) Vol. 72 Part 1, 1-2 © Medico-Legal Society 2004 Editorial: Suicides in UK Prisons Diana Brahams Barrister The prison population in the UK - and especially the proportionate number of women - has increased substantially in recent years. Why should this be? There will be many likely causes including the breakdown of family life with increasing numbers of children habitually truanting from school and/or left unsupervised and to their own devices at weekends and during the holidays. Such children and particu- larly teenagers involved in gangs are likely to get into trouble and will be on the way to becoming hardened reoffenders. With the sell-off of school playing fields and lack of organised local sports and other activities, children will end up on the streets. However, a likely major factor has been the systematic running down and closure of most of the large mental hospitals over two decades with all but the hardest of the hard core patients released into the community. Community is a nice cosy word, but the reality for a large number of patients with mental illness or vulnerability will be hostility, neglect or indifference. Some finish by dossing down in the street, city car parks, shop doorways or move from hostels to lonely bedsits and then on again. It is more than mere coincidence that during the period when mental hospitals were closed that the number of prisoners with mental illness (which may be aggravated by substance addiction) has increased so significantly. An expensive illegal drug habit is a trigger for thefts and robberies which are a great cost to society both in terms of losses, distress, policing, the courts and prison. Others with untreated or inad- equately treated mental illness who engage in substance abuse (and I include alcohol) aggravate their mental symptoms which can lead to anti-social or violent criminal behaviour. A sizeable number of prisoners have a history of depression, with or without serious attempts at self-harm. These often inadequate, unhappy, unfulfilled, vulnerable people will be increasingly vulnerable to feelings of hope- lessness and at the greatest risk of a suicide attempt in the first weeks or months of incarceration in a prison, even when on remand. Even before this, they may have regarded the future as bleak; after arrest and confinement, the future is likely to appear far worse - and matters can be yet more complicated if they are at this time experiencing withdrawal symp- toms from drugs or alcohol. It is thus entirely foreseeable that some prisoners may become very depressed and/or disturbed and difficult to manage; they are likely to have an adverse impact on other inmates and may become potentially suicidal or encourage others to become so. The question must be asked - is prison the right place for these people? Particularly if they spend most daylight hours locked in a cell? Will this regime be conducive to reform and rehabilitation on release? Are part time prisons the answer? They are about to be tried in the UK. Meantime, should there not be more specialist psychiatric, medical and educational input with the stick being more hours of detention confined in a cell for those prisoners who refuse to cooperate or attend and to progress? Should there not be greater emphasis on literacy and the acquisition of useful and practical skills that would raise prisoners' expec- tations of themselves, make their lives more enriched and make them more employable and more likely to remain out of trouble when they are released? There will be a small number of prisoners who will never be released, of course. Some are dangerous serial rapists and others serial killers - real lifers with no expectation of being let out of

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