Despite advances in understanding the mental health of prisoners, many myths about suicide persist, both in prisons and in the general population. These misconceptions can hinder efforts to develop effective strategies for preventing suicide.

One common myth is that suicide is a predictable event. However, research shows while there are several risk factors, it remains impossible to predict suicide in individual cases, either in prison or outside. One large analysis reported that “predictive ability had not improved across 50 years of research”.

Even suicidal thoughts, which seem like a clear warning sign, are sufficiently common in the general population that they do not reliably predict suicide. Everyone with suicidal thoughts needs care and support, but not all will act on them.

Prisons are places of risk. International data suggest prisoners are four to five times more likely to die by suicide compared to those outside prison. The risk is particularly high in remand prisons, where individuals await trial, and is most acute immediately after incarceration and among those serving life sentences.

Suicide risks

Several factors increase the risk of suicide in prison, including being young, male, on a first remand, imprisoned for violent offences, or having a history of drug misuse, self-harm, or major mental illness. Substance intoxication or withdrawal also heightens the risk.

Contrary to another common myth, not all suicide involves severe mental illness like major depression or schizophrenia. Psychological suffering in prison often stems from situational factors such as isolation from family, legal stress, past trauma, and hostile prison environments.

Although predicting suicide in individual cases is not possible, research highlights several effective strategies to lower the overall risk. One such measure is the removal or minimisation of ligature points in prison cells, which has been shown to substantially reduce suicide rates. This approach is similar to reducing the pack sizes of paracetamol to lower overdose risks. Making prison cells safer through careful design can have a significant impact.

Sharing cells can also help reduce risk, provided this does not lead to overcrowding or force prisoners to sleep on the floor. Thoughtfully designed shared spaces enhance safety.

Maintaining connections with family from the first night in prison can be lifesaving, because this is often the most difficult time. Access to phone calls, support from chaplains and prison staff, and contact with organisations like the Samaritans can provide crucial emotional support. Allowing early and regular social visits helps reduce feelings of isolation.

For prisoners struggling with substance withdrawal, timely access to detoxification services is essential. Those with a history of trauma or self-harm benefit significantly from early and consistent psychological support. Likewise, effective treatment for severe mental illnesses like schizophrenia or major depression can both reduce suicide risk and alleviate suffering.

Respectful relationships between staff and prisoners, along with a fair and accessible complaints system, contribute to safer, more positive prison environments. A culture of respect can help mitigate some of the despair and hopelessness that often lead to suicide.

Creating safer prisons benefits not just prisoners, but also society as a whole and the victims of crime. Preventing suicide in prisons requires a thoughtful, multi-faceted approach that addresses both environmental risks and individual needs. By implementing these strategies, we can build a safer, more effective prison system.

• Gautam Gulati is adjunct professor at the School of Law, University College Cork
• Brendan Kelly is professor of psychiatry at Trinity College, Dublin