'Activist scholarship' on prisoner suicide

We are all intrigued by crime. Yet how we view prisoners from a human rights perspective, and the conditions in which they are housed, are both important questions that receive little measured popular attention. Towl and Crighton's Suicide in Prisons is a timely book that draws attention to these issues in relation to one of the most important issues bothering the British criminal justice system: preventable self-inflicted deaths of prisoners in custody.

Throughout their book, Towl and Crighton are keen to distinguish between the number of suicides (as a crude tally of self-inflicted deaths) and the rate of suicide (as a proportion of the [prison] population). This is an important distinction to make, and provides a powerful argument as to why urgent action is needed to address the rates of suicide within prisons. For instance, the low number of female prisoners in comparison to males leads to substantially lower crude figures for female suicides in custody, although the rate a suicide and self-injury among female prisoners is substantially higher than the rate among males.

The book's opening chapters provide theoretical insights into the key risk factors that are associated with suicidal ideation and behaviour. An important theme running through the opening four chapters of the book is the extent to which many of the most pertinent risk factors for suicide are common among prisoners. Indeed, as the authors note, "what is striking about the overall list [of risk and protective factors described in the Prison Service Instruction (PSI) on suicide prevention] is the commonality with the list and that of the characteristics of the prisoner population" (p. 95). In short, prisoners do not represent a random sample of the general population, but instead as a small proportion of an already-disadvantaged subset of citizens.

This leads the reader to begin to think that the extent of self-inflicted deaths in custody may merely be a reflection of a lack of those without such factors being present in this population. That said, this is in itself an important observation, and highlights how those who are disadvantaged through, for example, poor mental wellbeing, substance misuse, volatile family environments, and homelessness, or at risk of aggression directed at both the self and others. This hypothesis is mentioned by Towl and Crighton when they discuss Plutchik's (1993) two-stage model of suicide (pp. 48-49), which suggests that pre-existing vulnerabilities to violence can be triggered in oppressive environments, leading to outward (attacks on fellow prisoners) or inward (self-injury or suicide) responses.

Arguably, though, the book's key strength is in its perhaps counter-intuitive call for a pausing of research into suicide in prisons. Towl and Crighton's argument here is that decades of sociological and epidemiological research have all identified common themes, and that new studies are unlikely to yield significantly new information. Instead, they call for action in the form of enacting policies based on what is already known. This is an important argument to consider, and something that clearly has great potential in addressing the suicide problem in British prisons.

The final chapter of the book introduces some suggestions for sweeping changes to the criminal justice system, particularly in relation to how we view punishment at a societal or cultural level. These are important observations that echo those of several leading criminologists and pressure groups in recent years. They include calls for reducing the prison population, redeploying funds from underperforming programmes to suicide prevention schemes, and the treatment of prisoners as humans first, and criminals second. While these are all vital recommendations, it is unclear at times how these necessarily fit within the remit of the book, or the arguments that Towl and Crighton make earlier. This is simultaneously the key strength of the text in terms of providing clear avenues for policy development, but also a weakness of the book from a readability perspective that could be improved by including more explicit depictions as to why issues like overcrowding are important to suicide prevention earlier in the book.

What is clear from Suicide in Prisons is the authors' experience within the system, and their passion for evidence-led reform. This is a fantastic piece of activist scholarship, which grounds the process of custody-based suicide prevention within a clear and established evidence from. In short, it highlights how these schemes can only flourish when we decide at a societal level that prisoners lives really do matter.

- Towl, G. J., & Crighton, D. A. (2017). Suicide in prisons: Prisoners' lives matter. Hook: Waterside Press. 

- Reviewed by Craig A Harper, Lecturer in Psychology, Nottingham Trent University (UK)

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