It is time to end this wilful, harmful gender blindness on prison suicides


Prisons need a profound culture change if they are to address the appalling escalation in suicides, two charities have claimed this week.

The arguments put forward by the Howard League and the Centre for Mental Health are compelling and correct. Prison suicides have soared in recent years and last year a record 119 prisoners took their own lives. In an era of chronic overcrowding and staff shortages, prisoners’ mental health needs are going unacknowledged and unaddressed; acts of self-harm and even suicide attempts are commonly considered to be manipulative rather than symptoms of distress and emotional crisis; a ‘toxic’ and violent prison culture sees staff struggling to maintain their own psychological health, never mind that of the prisoners.  

Unfortunately the release of the report was rather overshadowed on the news agenda by coverage of BBC Panorama’s horrifying undercover exposé of life inside the privately-run HMP Northumberland. Hidden cameras demonstrated the horrendous spice epidemic that is running rampant, with officers willingly admitting that they lose all control of the prison for hours every day. It’s perhaps a measure of how bad things have got that stories about catastrophic failures in the prison system have been pushed off the agenda by other stories about catastrophic failures in the prison system.

The report on suicide does still deserve consideration though, partly for what it says – which is important and useful, but I would argue also for what it misses. First, however, the plaudits. The report raises highly pertinent concerns, many of which are on well-trodden ground. Staff shortages and overcrowding are literally killing people; officers are themselves stressed and struggling to cope; the huge rise in suicide runs parallel to (and quite possibly consequent to) huge rises in violence and self-harm; and the flooding of prisons with spice and other drugs is having appalling effects on prisoners’ mental and physical health. With all of this going on it would be frankly remarkable if the suicide rate was not going through the roof.

A more subtle but no less important point is raised about the culture in prisons, where incidents of evident distress and self-harm are likely to be interpreted as manipulative, and where prisoners with complex multiple social and mental health needs fail to meet thresholds for therapeutic intervention and are left to cope alone as best they can with the stress through isolation or self-medication.

All of this should be heeded urgently by the Department of Justice as they continue their own internal inquiry into horrific rise in prison suicides.

In another respect, however, the new report is deeply disappointing. To explain why, let us step back a moment, outside the prison walls.

Suicide, socially and psychological speaking, is a highly-gendered phenomenon. It is well-known that men are three to four times as likely to take their own lives as women. There is a large and expanding shelf of academic and clinical literature explaining that men and women typically think of suicide differently, approach it for different reasons, use different methods and benefit from different methods of prevention and protection.

Many of the most important and effective developments in suicide prevention in recent years have adopted an explicitly gender-based approach. In the UK recently, national campaigning by the likes of CALM may help to explain why male suicide rates have recently levelled off after a decade of rises – bucking the international trends which see male rates continuing to rise.

More easily quantifiable are short and specific interventions. In Queensland,  Australia suicides amongst construction workers were six times national average in 2008. In response, the charity MATES In Construction began taking an explicitly gender-conscious approach to suicide prevention in the industry, encouraging workmates to protect each other, in old-school manly fashion. In the first five years of the scheme suicides in construction fell 7.8% while rates were rising among other men locally.

I’m only scraping at the surface of the suicide prevention work here. It is an incredibly difficult and complex field, and there is no magic wand or formula that can instantly solve the tragedy of suicide. What we do have is a broad clinical and academic consensus emerging that we cannot begin to understand the social tragedy of suicide, we cannot begin to address the social tragedy of suicide, without considering all the gendered processes that feed it. I cannot recommend enough the detailed papers published by Samaritans a couple of years ago. Over a hundred pages of analysis of the gendered processes of suicide from a variety of different academic angles, packed full of wisdom and insight and immediately applicable to real world interventions. If you want to understand the suicide of men, start here.

It is scarcely an exaggeration to say that trying to address male suicide without considering gender issues is like trying to cure tuberculosis without acknowledging that people have lungs.

Unfortunately, there is one exception to this consensus. Our consideration of male suicide as a gender-based issue suddenly evaporates when it is prison suicide we are talking about.

This wilful blindness to male gender considerations means that our approach to the issue is going to be incomplete and intellectually flimsy at best. If suicide is a profoundly gendered phenomenon, so too is prison. We’re on a slightly different tack here and I’ll try not to digress, but we cannot overlook that everything about our use of prison is gendered. Men are more likely to commit most  offences and more likely to be sentenced to prison when they do. They will be sentenced for longer and to harsher conditions for the same offences, they are more likely to be alienated from their children and other family. They are also more likely to have lived through all the conditions that vastly increase risks of ending up in prison – they are more likely to have been institutionalised as children, more likely to have been subjected to violent socialisation, more likely to be addicted to drugs or alcohol, more likely to be homeless, more likely to be unemployed.

For good measure, once in prison, many of the factors that greatly increase suicide risk are heavily gender-relevant. Bullying, interpersonal violence, rape and sexual coercion; separation from children; cultures of machismo that discourage help-seeking behaviour, all tied up in how gender is expressed and performed outside but especially inside prison.

None of this is to suggest that women in prison are safe or in less need of help and attention. As the new report is keen to tell us, last year 12 women took their own lives in prison, the worst year ever. Last year women made up less than six percent of prisoners but almost 10 percent of suicides. The report does not bother to tell us that for the previous ten years the opposite had been the case. In the decade to 2015 no fewer than 708 men took their lives in prison, accounting for 96% of all prison suicides.

And crucially, there may be a reason for that. Back in 2004/5, six women killed themselves in Styal prison in the space of 13 months. This shocked the nation and the government of the day, leading directly to Baroness Corston’s report into conditions for women in prison. In contrast to our approach to male suicide, this was an explicitly gender-based report. Taking in everything from motherhood considerations to access to sanitary towels, the inquiry took evidence from specialists in women’s mental health, from feminist academics and criminologists. The subtitle to the Corston report was “The need for a distinct, radically different, visibly-led, strategic, proportionate, holistic, woman-centred, integrated approach.”

Not everything that Corston called for was granted. In particular the proposal that women’s prisons be closed altogether was barely given house-room. There remain huge humanitarian and gender-specific issues with women’s prisons. Nonetheless in the years after Corston it is undeniable that there were significant improvements to policies in women’s prisons, and they appear to have lasted up until 2016 when we can presume that the impacts of the barbaric incompetence of Grayling, Gove and Truss finally took grip. In the years between the publication of the Corston Report and 2016, the numbers of suicides in the women’s estate across England and Wales were as follows: 1, 3, 1, 2, 1, 2, 3, 5.

I have been arguing for years that we need a Corston report for men. If that is too much of an ask, I would at least plead that those involved with the management and administration of prisons begin to listen to the experts on suicide prevention and begin to re-think their approach to how they can begin to save lives.

At the same time I can only repeat regular pleas to the prison reform charities to end this wilful, conscious and actively damaging insistence that there are ‘prisoners’ and that there are ‘women prisoners’ – in other words that women in prisons have gender-issues but men do not. Until we actually engage with prison as an overwhelmingly gendered issue we are fighting battles for reform with our ankles tied together and one hand behind our back. It is intellectually lazy, politically inept and it breaks my heart that we still do this while prisoners are literally dying by the dozen.

Comments

  1. David S says

    @Ally

    There is a large and expanding shelf of academic and clinical literature explaining that men and women typically think of suicide differently, approach it for different reasons, use different methods and benefit from different methods of prevention and protection.

    Obviously you’re writing a blogpost here not a systematic review. But the paper that you linked to in that paragraph does need to be viewed with quite a few caveats, particularly if you are going to treat as relevant to prison suicide.The first caveat is that it measures a “surrogate outcome”. That is to say that they don’t count how many suicides took place in their sample (you would need a much bigger sample for that). What they measure is the prevalence of suicidal ideation, and various factors that might be linked to it, such as perceived burdensomeness. Statisticians are rightly cautious about drawing inferences from surrogate outcomes, because they often fail to behave in the same way as real outcomes.

    The second caveat is that their sample is derived from male and female volunteers for an Australian study. I doubt that many of them were prisoners, and the differences between male prisoners and unicarcerated men may well be greater than the differences between unincarcerated men and unincarcerated women.

    The final caveat is that the predictive value of any piece of data always depends on what other pieces of data you know. So gender may be predictive of a particular outcome, or the effectiveness of a particular intervention, if gender is the only thing you know about the subject, but the predictive value of gender may completely disappear if you know other things about the subject beside their gender.

    I am aware that you have linked to other bits of research in the post, but there are caveats you could raise about them as well. I am not trying to disagree with your general conclusion about the need to consider gender when thinking about suicide either, just suggesting that it’s important to be pedantic and pick those nits.

  2. says

    Along with overcrowding, there’s also (in the US) arbitrary use of solitary confinement. According to “solitarywatch” (probably biased) 70% of prison suicides were in solitary. It may be a matter of opportunity or inattention, but that’s significant. It may also be an inverse causality – more people who are potentially suicidal wind up in solitary. The obvious answer is to stop use of solitary confinement without due process.

  3. Ally Fogg says

    Perfectly reasonable David [1]

    If anyone feels inclined to challenge the truth, accuracy or validity of any point I make, feel free to challenge & I’ll dig out some evidence.

    But as I hint at in the piece, it is incredibly difficult to quantify & evaluate the epidemiology of suicide and suicide prevention methods. I’m not saying there is a single study anywhere that proves X Y or Z is the specific best approach to take to prevent suicides. What you can say is that if you look at the body of literature and talk about an emerging consensus.

  4. secondtofirstworld says

    @Ally Fogg #3:

    The way I see it, prison or not, the following things need statistical corroboration (as they are independent of culture): men make fewer attempts, and succeed more violently, women take more attempts. The emotional nurturing of men depends on family dynamics, peer pressure, and how the culture of society views men expressing emotion and distress. It’s no surprise most of us don’t open up and talk about it, when many around us claim only pussies whine, real men don’t.

    The difference doesn’t seem to be between genders, rather gender stereotypes. In a dominantly female environment, women are far from the silent, homely nurturing type, they too have hierarchy, so when a women does decide to seek help, a more gender balanced group runs to rescue either out of genuine concern, or because of the perception of gender stereotypes. Men on the other hand feel abandoned in this apartment even without abuse, and thus, seek little to no help. I should have been more clear before: large organizations within a company or the state are de facto their own state, so even if society in itself is socially liberal, a more conservative prison system still can and does mistreat them.

    Lastly, yes, certain types of mental illnesses, like borderline personality disorder really does involve self harm for manipulation. The problem is, generally prison staffs are ill-equipped to deal with it, lacking experience and knowledge, so such inmates should rather be institutions. One caveat however: there’s a different form of manipulation, self harm or self mutilation to earn transportation into a less guarded place to escape. From the outside looking in, the only thing we can do is to support such investigations, and demand deeper and further ones.

    Even if we can bring about shift change in culture, that’s not the terminal, it also needs how we men act with the world and with each other. It should go without saying, that it requires the halt of mocking fun of safe spaces, triggers and PTSD in general.

  5. Marduk says

    “there are ‘prisoners’ and that there are ‘women prisoners’”

    This is very much the case. I’m not sure its meant to say men have no gender (or gender-specific needs), I think its more about the political exposure game that Nusrat Ghani was playing two blog posts ago. If you can make it about women specifically, you can hide from most of the exposure.

    Its a method of breaking down the issue and accessing the ‘overton window’. We haven’t had a government in my lifetime that was prepared to be ‘soft on prisoners’ but we’ve never not had a government in my lifetime that didn’t want to address sexism wherever it is found. So there is way through, but only for women. I think when people talk about the various patterns that exist in male prisoners they instinctively know this to be honest. So again, no government will be soft on criminals, but it might be persuaded to show compassion for the mentally ill say, everyone is playing the same game whether they know it or not.

    I think if you want to go full bore advocate for this you actually have to drop any reference to those patterns, widely manifest as they are. It has to apply the most unapologetic swaggering arrogant scumbag as much as anyone else or it means nothing. But I concede, chances of success are virtually nothing.

  6. Groan says

    I cannot thank you enough for this I sincerely hope you have success in your modest request that some concerted effort is made to look into suicide in prisons. The Bradley report and its follow ups really sets out the way our prisons are progressively becoming the institutions for care of those for which there isn’t any other “home”. From my perspective the development of community care in mental health as effectively reduced MH services ability to treat really troublesome (“challenging”) people safely (and size makes the challenge that much greater if the challenger is a male) while the development of new offenses of being “offensive” or “conspiring” on the internet is hoovering up individuals with all sorts of conditions that once would have labelled them “socially inadequate” “eccentric” or just obnoxious. Having research from the 1950s onwards at how damaging large institutions can be we are collecting ever more vulnerable men (including now an unprecedented cohort of old men) into large and overcrowded institutions. Men are more likely to take definitive action to die because they are absolutely convinced a “cry for help” will be unheard. In prison increasingly this is a fact not a perception.

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