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Rivista di Medicina Legale
Minerva Medicolegale 2015 June;135(1-2):17-33
Suicides in prison: trends and prevention programs
D’Ovidio C., Sablone S., Carnevale A.
Section of Legal Medicine, Department of Medicine and Aging Sciences, “G. d’Annunzio” University of Chieti‑Pescara, Chieti, Italy
In the present study, we provide some general background on suicide through a comparison of trends in suicide rates of inmates in correctional institutions between Italy, other European countries and the USA. This analysis reveals that suicide rates in Italian prisons are among the highest in Europe, countries and higher than those recorded in the USA. Italy also shows a large “gap” between the suicide rate among prisoners and that of the non-prisoner population, that is a sign of the poor living conditions of the Italian correctional settings. Several strong risk factors facilitate and encourage suicidal behavior in Italian prisons, including: lack of formal policies and procedures to prevent, identify and manage inmate suicide; worrying and continually increasing overcrowding; a lack of correctional, health care, and mental health personnel, who are anyway untrained and overworked, and can thus miss the early warning signs of suicide risk; and lack of adequate mental health treatment programs. To provide recommendations towards comprehensive suicide prevention programming, we have analyzed the major prevention strategies adopted in the USA that have led to a nearly three-fold decrease in their inmate suicide rates over the last twenty years. In this way, we have identified a number of key components that can be used as part of a comprehensive suicide prevention program in Italy. These key components can mainly be recognized in terms of the following strategies: staff training; identification/referral/evaluation; communication; housing, observation/follow-up/treatment planning; interventions; reporting/notification; critical incident staff debriefing/mortality-morbidity review.