Christine Tartaro and David Lester,Suicide and Self-Harm in Prisons and Jails

Christine Tartaro and David Lester, Suicide and Self-Harm in Prisons and Jails, Lexington Books (a division of Rowman & Littlefield Publishers Inc): Lanham, MD, 2009; 227 pp.: 0739124641/9780739124642, $68.50 (cloth), 073912465X/9780739124659, $32.95 (pbk)

Christine Tartaro and David Lester, both accomplished suicide researchers, offer an extremely thorough review of the existing literature on suicide and self-harm in various correctional settings including prisons, jails and police lockups. The authors draw on international literature – predominantly from the United States, Canada, the United Kingdom and Australia – and from the disciplines of critical criminology, criminal justice, sociology, medicine and psychology. This book will be particularly useful for correctional administrators and governing bodies that need to evaluate correctional practices, policies, and programs related to mental health evaluation and care in carceral environments in general, and those associated with suicide and self-harm more specifically.

The book is organized into 10 chapters. Chapters 1 through 4 summarize demographic data to contextualize who is most likely to self-harm or to attempt or complete suicide, along with when, where, and how these individuals are likely to do so. The authors emphasize that these data vary greatly study to study, but these initial four chapters provide a solid foundation for Chapters 5 through 8, which focus on correctional interventions for suicidal and self-harming behaviour, including screening and assessment, crisis intervention counselling, institutional design, prevention efforts and diversion and transition planning.

Chapter 9 provides a unique analysis of key litigation issues for both sides: individual correctional staff members and correctional administrations, and prisoners and their families. The authors discuss a number of different cases to showcase the legal options available for plaintiffs (prisoners and their families) who typically litigate with the hopes of changing correctional policies and practices relating to the care and treatment of suicidal and self-harming prisoners and/or to secure compensation for harm to prisoners caused by correctional negligence or deliberate indifference. These examples also help to illustrate possible defences available for correctional agencies if a plaintiff files an intentional or negligence tort claim, or a section 1983 (title 42 of the US Code) claim of a constitutional violation, which is one way for a plaintiff to obtain an injunction for the correctional agency to end a certain practice. The final chapter reviews some of the book’s main findings and identifies important areas for future research.

Tartaro and Lester frame their analysis around what they claim is the most important reason for trying to prevent suicidal or self-harming behaviours: ‘corrections staff have a moral [and legal] obligation to assist people who are troubled and unable to leave the institution to seek help themselves’ (p. 181). They argue that frontline staff must recognize that while some prisoners may self-harm for manipulative or attention-seeking purposes (reasons commonly identified in the psychological literature), it is unwise and unhelpful to discipline them for self-harming. Correctional staff will never really know what is going on in the minds of prisoners or why they behave the way they do. The assumption that an act of self-harm is a strategic attempt to manipulate staff members reinforces the inherent division and tension between prison staff and prisoners, and likely contributes to the disciplining or punishment of prisoners who genuinely require mental health support. Although the book does not refer to the 2007 death of 19-year-old Ashley Smith while she was in a Canadian federal prison, this case is an excellent example. Smith chronically self-injured and repeatedly tied ligatures around her neck, which needed to be cut off by correctional staff. Staff portrayed Smith as manipulative, attention seeking and dangerous; eventually correctional administrators instructed frontline staff not to intervene until she was unconscious. The result was that correctional staff stood in the hall and watched Smith commit suicide, intervening only after it was too late (Sapers, 2008).

The book provides a comprehensive review of the literature on suicide (and to a lesser extent, self-harm) in carceral settings, but its analysis is lacking in two main ways. First, the authors do not situate their arguments theoretically or offer much of a theoretical analysis at all. The result is a pragmatic discussion of suicide and self-harm in prisons and jails, which will likely be advantageous for correctional administrators seeking to improve their suicide and self-harm screening, assessment, prevention and treatment options. Unfortunately, the lack of theoretical analysis will be a detriment to critical scholars seeking a more in-depth and experiential discussion of suicidal and self-harming behaviours. For example, the authors heavily reference Alison Liebling’s research about suicide in prisons and detention centres in the United Kingdom, but they do not incorporate Liebling’s rich critical and theoretical analysis, which included a deeper exploration of how incarceration and prisoner–staff relations affect prisoners and their decision to self-harm or to attempt or complete suicide while incarcerated. The authors open the book with a reference to Sykes’ classic 1958 study about the pains of imprisonment, so they certainly acknowledge the often-toxic nature of the prison environment. However, while they claim the book focuses on prisoners who are unable to find productive ways to adapt and cope once incarcerated, it is really more of review of existing research – mostly quantitative and demographic. The book does not expand on previous research about what self-harm means to prisoners who injure themselves, or the rationalizations they use to justify their own self-harming and suicidal behaviour.

The second deficiency is that the book focuses disproportionately on suicide, to the disadvantage of researchers studying self-harm and correctional staff members who may be confronted with these often-chronic behaviours more frequently than suicide attempts or ideation. This is particularly true for staff members working in women’s prisons, because women self-harm more frequently than men and more frequently than they attempt or complete suicide. The authors acknowledge that self-harming behaviours range over a continuum, and that frontline staff and mental health practitioners should not assume that prisoners who self-harm are necessarily suicidal. They also note that it is impossible to develop a typical profile of self-harming or suicidal prisoners, and that it would be a mistake to rely on the inconsistent demographic information provided by various studies, because this would generate many false positive and false negative cases. This is an important point for correctional administrators and frontline staff members who assess prisoners at intake and throughout their sentence to determine their security level and mental health status.

Despite these limitations, Suicide and Self-Harm in Prisons and Jails is a useful and important book for both correctional administrators and scholars. It is quite comprehensive within its own areas of focus, reviewing decades of literature from a variety of disciplines. Its style and accessibility will likely make it a key resource for anyone working in the field – particularly those striving to develop better screening, assessment, treatment, and prevention efforts.