Advertisement

International Journal of Legal Medicine

, Volume 132, Issue 4, pp 1225–1230 | Cite as

Suicide of isolated inmates suffering from psychiatric disorders: when a preventive measure becomes punitive

  • S. Grassi
  • G. Mandarelli
  • M. Polacco
  • G. Vetrugno
  • A. G. Spagnolo
  • Fabio De-Giorgio
Case Report

Abstract

We performed external autopsies and examinations on two inmates who had committed suicide by hanging themselves with their underwear and using the window bars of their cells as ligature points after they had been placed in solitary confinement. In one case, the inmate had even been deprived of her clothing (with the exception to her underwear). Underwear has been rarely described as a means for self-harm and, to the best of our knowledge, no previous study has focused on cases of prison suicides committed using this garment, even though it is available to every inmate. The two cases were very similar; both inmates were young, physically aggressive and in their first week at a new facility; both had been affected by mental disorders, had been prescribed psychotropic medications and had histories of psychiatric hospitalisation. In each case, the psychiatric evaluations had highlighted significant suicidal risk. We discuss these two cases in an attempt to describe the complexity of and contradictions within the management of suicidal inmates at correctional facilities. We aim to propose new strategies and emphasise the need to introduce evidence-based standardised protocols over inhumane, ineffective and simplistic punitive measures in the management of these individuals.

Keywords

Prison suicide Hanging Underwear Solitary confinement 

References

  1. 1.
    National Bioethics Committee, Presidency of the Council of Ministers, Italy (2010) Suicides in prison. Bioethical indications. Italy, 25 June 2010Google Scholar
  2. 2.
    Konda S, Reichard AA, Tiesman HM (2012) Occupational Injuries among U.S. Correctional Officers 1999–2008. J Saf Res 43(3):181–186CrossRefGoogle Scholar
  3. 3.
    Duthé G, Hazard A, Kensey A, Shon JL (2013) Suicide among male prisoners in France: a prospective population-based study. Forensic Sci Int 233(1–3):273–277CrossRefPubMedGoogle Scholar
  4. 4.
    Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R (2016) Mental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry 3(9):871–881CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gooding P, Tarrier N, Dunn G, Shaw J, Awenat Y, Ulph F, Pratt D (2015) The moderating effects of coping and self-esteem on the relationship between defeat, entrapment and suicidality in a sample of prisoners at high risk of suicide. Eur Psychiatry 30(8):988–994CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Zlodre J, Fazel S (2012) All-cause and external mortality in released prisoners: systematic review and meta-analysis. Am J Public Health 102(12):e67–e75CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rivlin A, Hawton K, Marzano L, Fazel S (2013) Psychosocial characteristics and social networks of suicidal prisoners: towards a model of suicidal behaviour in detention. PLoS ONE 8(7):e68944CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Department of Penitentiary Administration, Ministry of Justice, Italy (2016) Critical events in prison facilities: 1992–2016. Italy, 31 December 2016Google Scholar
  9. 9.
    Ministry of Justice, United Kingdom (2017) Safety in custody statistics bulletin, England and Wales, deaths in prison custody to December 2016, assaults and self-harm to September 2016. United Kingdom, 26 January 2017Google Scholar
  10. 10.
    Shaw J, Baker D, Hunt IM, Moloney A, Appleby L (2004) Suicide by prisoners. National clinical survey. Br J Psychiatry 184:263–267CrossRefPubMedGoogle Scholar
  11. 11.
    Fruehwald S, Matschnig T, Koenig F, Bauer P, Frottier P (2004) Suicide in custody: case-control study. Br J Psychiatry 185:494–498CrossRefPubMedGoogle Scholar
  12. 12.
    Roma P, Pompili M, Lester D, Girardi P, Ferracuti S (2013) Incremental conditions of isolation as a predictor of suicide in prisoners. Forensic Sci Int 233(1–3):e1–e2CrossRefPubMedGoogle Scholar
  13. 13.
    Zoccali R, Muscatello MR, Bruno A, Cambria R, Cavallaro L, D’Amico G, Isgrò S, Romeo V, Meduri M (2008) Mental disorders and request for psychiatric intervention in an Italian local jail. Int J Law Psychiatry 31(5):447–450CrossRefPubMedGoogle Scholar
  14. 14.
    Martin MS, Colman I, Simpson AIF, McKenzie K (2013) Mental health screening tools in correctional institutions: a systematic review. BMC Psychiatry 13:275CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N (2005) The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol 34(2):433–442CrossRefPubMedGoogle Scholar
  16. 16.
    Sarchiapone M, Mandelli L, Iosue M, Andrisano C, Roy A (2011) Controlling access to suicide means. Int J Environ Res Public Health 8(12):4550–4562CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kapur N, Hunt IM, Windfuhr K, Rodway C, Webb R, Rahman MS, Shaw J, Appleby L (2013) Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study. Psychol Med 43(1):61–71CrossRefPubMedGoogle Scholar
  18. 18.
    Gauthier S, Reisch T, Bartsch C (2015) Swiss prison suicides between 2000 and 2010. Crisis 23:1–7Google Scholar
  19. 19.
    Hawton K, Linsell L, Adeniji T, Sariaslan A, Fazel S (2014) Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet 383(9923):1147–1154CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Saukko P, Knight B (2004) Knight’s forensic pathology. Hodder Arnold, LondonGoogle Scholar
  21. 21.
    Law No. 354, Italy (1975) Norme sull'ordinamento penitenziario e sull'esecuzione delle misure privative e limitative della libertà. Italy, 26 July 1975Google Scholar
  22. 22.
    Decree of the President of the Republic No. 230, Italy (2000) Regulations - Containing provisions on the Penitentiary act and on measures entailing restrictions on, and deprivation of, personal liberty. Italy, 30 June 2000Google Scholar
  23. 23.
    Bardale RV, Dixit PG (2015) Suicide behind bars: a 10-year retrospective study. Indian J Psychiatry 57(1):81–84CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tumram NK, Ambade VN, Bardale RV, Dixit PG (2014) Injuries over neck in hanging deaths and its relation with ligature material: is it vital? J Forensic Legal Med 22:80–83CrossRefGoogle Scholar
  25. 25.
    Khokhlov VD (2015) Trauma to the hyoid bone and laryngeal cartilages in hanging: review of forensic research series since 1856. Legal Med 17:17–23CrossRefPubMedGoogle Scholar
  26. 26.
    Marzano L, Hawton K, Rivlin A, Fazel S (2011) Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners. Soc Sci Med 72(6):874–883CrossRefPubMedGoogle Scholar
  27. 27.
    Chapman SCE, Horne R (2013) Medication nonadherence and psychiatry. Current Opinion in Psychiatry 26(5):446–452CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Arboleda-Flòrez J (2009) Mental patients in prisons. World Psychiatry 8:187–189CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    World Health Organization (2007) Preventing suicide in jails and prisons. WHO Document Production Services, GenevaGoogle Scholar
  30. 30.
    Copeland AR (1989) Fatal suicidal hangings among prisoners in jail. Med Sci Law 29(4):341–345CrossRefPubMedGoogle Scholar
  31. 31.
    Clément R, Redpath M, Sauvageau A (2010) Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. J Forensic Sci 55(5):1268–1271CrossRefPubMedGoogle Scholar
  32. 32.
    Sauvageau A, Laharpe R, King D, Dowling G, Andrews S, Kelly S, Ambrosi C, Guay JP, Geberth VJ (2011) Agonal sequences in 14 filmed hangings with comments on the role of the type of suspension, ischemic habituation, and ethanol intoxication on the timing of agonal responses. Am J Forensic Med Pathol 32(2):104–107CrossRefPubMedGoogle Scholar
  33. 33.
    Agonal SA (2009) Sequences in four filmed hangings: analysis of respiratory and movement responses to asphyxia by hanging. J Forensic Sci 54(1):192–194CrossRefGoogle Scholar
  34. 34.
    Sauvageau A, LaHarpe R, Geberth VJ (2010) Agonal sequences in eight filmed hangings: analysis of respiratory and movement responses to asphyxia by hanging. J Forensic Sci 55(5):1278–1281CrossRefPubMedGoogle Scholar
  35. 35.
    Ministry of Justice, Italy (2017) Detenuti presenti italiani e stranieri- anni 1991-2017. Italy, 30 June 2017Google Scholar
  36. 36.
    Criminal Procedure Code art. 275, Italy (1988) Criteri di scelta delle misure. Italy, 22 September 1988Google Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • S. Grassi
    • 1
  • G. Mandarelli
    • 2
  • M. Polacco
    • 1
  • G. Vetrugno
    • 3
  • A. G. Spagnolo
    • 4
  • Fabio De-Giorgio
    • 1
  1. 1.Institute of Public Health, Section of Legal MedicineUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Department of Neurology and PsychiatryUniversity of Rome, SapienzaRomeItaly
  3. 3.Unit of Risk Management, Policlinico A. GemelliRomeItaly
  4. 4.Institute of BioethicsUniversità Cattolica del Sacro CuoreRomeItaly

Personalised recommendations