Book review: Suicide in Prisons: Prisoners’ Lives Matter

OPEN IN VIEWER The increase in suicides is surely the worst consequence of the recent deterioration in safety in prisons, confirmed by the latest statistics (Ministry of Justice, 2017). Given the context, this book makes for difficult and necessary reading. Graham Towl and David Crighton provide a comprehensive overview of most that is known about suicide in prison, balancing pragmatic analysis with a humane appeal for this issue to be given the attention and resources it deserves and needs. They temper their outrage with a scrupulous attention to detail, making their final statement all the more powerful:

Suicide prevention is, above all, about people. It is about the values that people hold. It is fundamentally about accepting and acting on the basis that prisoners’ lives matter. (p. 177)

Their criticism is not focused on prison staff, but on governmental decisions that have cut resources, demonstrating all too literally that prisoners’ lives are not worth what they should be. And the ripple effect of this political neglect is a prison system that does not make training around suicide obligatory for staff, emblematic of skewed priorities with real and avoidable consequences.

The chapters range from the theoretical (how suicide is understood) to the data-driven (the statistics around suicide, and what they tell us) and the practical (how suicide is and should be managed in custody). All of these are relevant, and it is the way they speak to each other that lends the text its weight. The interface of theories with data is always presented with a view to what they tell us about what needs to be further understood, or done; this is a practical book that contains real and grounded guidance and direction for the prison service and the politicians who resource it.

Echoing recent recommendations of the Harris Review and Howard League, Towl and Crighton place emphasis on increasing staff awareness, skill and compassion. All too often such recommendations can take the tone of a moralistic dictum, blind to how difficult this work is in reality. The authors’ position is much more nuanced, and they end by stating:

Training alone is not sufficient and will be of limited value if staff cannot access specialist support and provision when needed, both in prison and in the community. (p. 177)

Here we find acknowledgement of the toll that this work is likely to take on staff. So often it is inadequate performance that is scrutinized in the wake of a death in custody – appropriately so, since staff are acting on behalf of the state, and it is the state to whom each prisoner’s life has been entrusted. But staff are also people, and what remains relatively underwritten is the emotionally vexed nature of their work. Towl and Crighton draw repeated attention to the complex psychosocial needs of the prison population, and the impossibility of these being met in an overcrowded and poorly resourced system. It is not to accept suicide in prison, but to also acknowledge that staff are being placed in a situation in which failure seems endemic. That this might be manifest in poor practice and behaviours that dehumanize prisoners may best be understood as a defensive response, as opposed to wilful neglect.

The details around what staff training and support could look like are thin. Towl and Crighton explain that emotional disclosure to staff, such as through psychologists, who are primarily tasked with risk assessment and management, is a tall order, both for the prisoner and the professional. Their suggestion is that this complexity can be managed, given support to staff and institutional backing. Certainly their ambition is correct, but one of the consequences of this book could be a real consideration of what it is to ask staff – whether in prison, probation or psychological services – to know, and hold in mind simultaneously, risk and vulnerability.

With this in mind, perhaps one of the most important hypotheses raised is that suicide and violence towards others can be best understood as part of the same behavioural system. What this gets at is that whether violence is directed towards self or other, it contains some of the same emotional underpinning. Here we move past overt risk factors to the complex psychosocial processes that can result in suicide and violence. This is where psychologically informed practice may emerge: when it becomes possible to understand why distress is communicated in this way, as opposed to just who is most likely to do it. And in getting past the risk factors, the authors also encourage a shift from a managerial focus to a relational one:

A focus upon the managerial administration of a process to reduce suicides rather than a focus perhaps upon working with prisoners who are feeling suicidal may well be problematic. (p. 23)

Such a stance is bound to resonate with criminal justice practitioners who seek to place primacy upon building a working alliance, as opposed to an exclusive emphasis on the procedural aspects of risk management.

Towl and Crighton are clear: the quantitative data has been gathered and sufficiently analysed – indeed it seems to be them who have done much of this invaluable legwork. What now needs to happen is for this knowledge to be translated into a model of prison practice that is psychologically informed, appropriately resourced and humane, to both staff and prisoners. For such conditions to emerge the prison population must reduce. At present, there is little sign of the political courage necessary for such a change of direction, but in its absence Towl and Crighton have offered an accessible and irrefutable case for how prisons themselves might start to do things differently.