Death in our prisons

The recent article on causes of death among people in custody in Ontario, 1990-1999,1 raises a variety of issues. In comparing rates of suicide in custody with rates in the community, the authors examined only suicide by strangulation. However, because many more means of suicide are available to people in the community (e.g., firearms, poisoning, drowning), a more appropriate analysis would have been to compare total suicide rates between prison inmates and the community.

The 1991 Canadian suicide rate for men 25 to 44 years of age was 28.8 per 100 000; in 1996, the rate was 24.7 per 100 000.2 Using an average of these rates and the prisoner-years at risk in federal inmate populations provided in Table 2 of Wendy Wobeser and associates' article,1 we might have expected 8.6 suicide deaths in federal institutions in Ontario over the 9-year period for which exposure data were provided (1990–1998), but there were in fact 32.4 deaths in that period (based on the 36 deaths that occurred in the 10 years for which data were available). It would therefore have been more appropriate to state that suicide rates among federal inmates were about 3.8 times higher than in the community, rather than the 10-fold difference mentioned in the article.

The inmate population is dramatically different from the typical community population with respect to prevalence of mental disorders, history of substance abuse and other important factors. It would be interesting to compare the suicide rates of prison inmates with those of more comparable community populations, but such data are not available.

The higher rates of inmate suicide remain a priority concern for Correctional Service of Canada (CSC). The suicide rate in federal prisons varies from year to year but is showing an overall downward trend (Fig. 1). CSC has recently adopted a new policy to ensure a comprehensive strategy for prevention, management and response regarding suicides. In addition, an awareness and prevention workshop is being made available to all inmates.

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Fig. 1: Number and rate of suicides in federal prisons, 1991/92 to 2000/01.

The authors did not contact our office for information or to discuss the interpretation of their findings. If they had, we would have informed them of these activities.

Françoise Bouchard Director General Jane Laishes Senior Manager, Mental Health Health Services Correctional Service of Canada Ottawa, Ont. Brent Moloughney Public Health Consultant Newmarket, Ont.