FORUM on Corrections Research

The problem of suicide among female prisoners

by Marc Daigle,¹ Mylène Alarie and Patrick Lefebvre
Université du Québec à Trois-Rivières, Centre de recherche et d’intervention sur le suicide et l’euthanasie

This article summarizes a study conducted among female prisoners incarcerated in institutions for women in Quebec (two prisons and one penitentiary).² To date, there have been few studies of suicidal behaviour among female prisoners. Notwithstanding existing differences between men and women in the community in this regard, those working in prisons for women generally agree that the situation among female prisoners is very different. The purpose of our study was to evaluate the magnitude of the suicide problem among women incarcerated in Quebec in terms of the number of previous suicide attempts, the severity of the attempts and the suicide risk potential. Two tools were used in this study: the Suicide Probability Scale and the Lethality of Suicide Attempt Rating Scale.

Magnitude of the problem

Few studies address the problem of suicide among female prisoners. This is due in part to the small female prison population, but also because it is difficult to measure the magnitude of the phenomenon. The fact remains, however, that the suicide rate among female prisoners is abnormally high.³ It could well be that, as with incarcerated men, the suicide rate is about the same as the rate for female offenders living in the community.⁴

It is estimated that almost half of all female prisoners have made previous suicide attempts.⁵ Among this population, high levels of psychological distress and despair manifest themselves as self-injury and attempted suicide.⁶ In fact, one of the reasons most frequently cited by women for consulting a worker is the need to discuss their desire to harm themselves and die.⁷

In the prison environment in particular, however, clinicians are unable to agree on how to distinguish between attempted suicide and self-injury as a means of relieving stress, anxiety, depersonalization and gaining control of one’s environment.⁸ It is not necessarily any easier to make this distinction at the scientific level, given that we are referring either to intent or to severity.⁹ Intent (intention to die) is not easy to determine, especially in hindsight, mainly because of the suicidal person’s ambivalence, the various levels of conscience, impulsiveness and so on. Evaluating the severity of the act may be easier, namely by identifying the means used. This approach has already been used quite successfully by Smith, Conroy and Ehler¹⁰ with their Lethality of Suicide Attempt Rating Scale (LSARS) which is based on the severity of the method used and the circumstances surrounding the attempt. This scale is one of the two best scales used to measure severity and is supported by a significant amount of empirical data.¹¹ However, in the prison environment, this approach may be biased, given that suicidal prisoners do not have access to the full arsenal of lethal means.¹²

In terms of the suicide risk, Cull and Gill’s¹³ Suicide Probability Scale (SPS) can be used to determine the probability that an individual will commit the act. This instrument has been validated in Quebec by Labelle, Daigle, Pronovost and Marcotte.¹⁴ It has already been used in a study involving female prisoners in Ontario¹⁵ and men incarcerated in Quebec.¹⁶

Methodology

The purpose of our study was to assess the magnitude of the suicide problem among women incarcerated in Quebec in terms of the number of past suicide attempts, the severity of the attempts (measured using the LSARS) and suicide risk potential (measured using the SPS). We approached female inmates in three Quebec facilities (two provincial detention facilities and one federal penitentiary) responsibile for ensuring the custody of female prisoners. At the time of our research, 130 women were being accommodated in the two provincial prisons; 103 were available and 60 agreed to meet with us. In the penitentiary, 67 women were incarcerated: 50 were available and 28 agreed to participate. The participation rates (58% and 56% respectively) were deemed satisfactory and comparable with those obtained in similar studies. We met the women initially in a group; they completed the SPS and anonymously indicated whether they had attempted suicide at least once. At that time, 47 women indicated that they had made at least one attempt. Of these, 34 agreed to meet with us individually to provide additional details on their history, thus enabling us to complete the LSARS.

Most of the women in the total sample were francophones (86.4%). On average, they were 33 years old (SD = 9), with 11 years of education (SD = 2). In the provincial facilities, 28.1% of the women had been charged but not yet sentenced. No one fell into this category in the federal penitentiary, given that it accommodates only women who have been sentenced to two or more years. Taking into consideration the differences in the mandates of the institutions, the average sentence was 37 weeks (SD = 29.6) in the provincial facilities and 345.8 weeks (SD = 281.1) in the federal penitentiary. On average, the provincial clients were serving their fifth period of incarceration (M = 5.02; SD = 6.7), compared with the third (M = 3.3; SD = 7) for federal clients. This is not a significant difference.

Number of women who had already made one suicide attempt

In the provincial prisons, 60% of the women indicated that they had attempted suicide at least once, compared with 39.3% in the federal penitentiary (a barely significant difference (p < 0.1). These results seem to indicate that women incarcerated in provincial facilities had had a more difficult past, even though the federally sentenced women had obviously committed more serious offences and received longer sentences. Overall, 53.4% of the women (47 of the 88 who responded) had already attempted suicide at least once, a result that is comparable with the findings of other studies (see above). This rate is clearly higher than the figures generally reported among their male counterparts; for example, 13% in England,¹⁷ 23% in two Alberta prisons¹⁸ and 30% in Quebec prisons.¹⁹ However, among women, as among men, the situation in prisons and penitentiaries might be quite different. Upon admission to federal penitentiaries in Quebec, only 9.4% of male inmates (some of whom had been incarcerated in the past) admitted that they had attempted suicide. Moreover, for comparison purposes, it has been found that only 5% of adult students have a history of suicide attempts.²⁰ It should also be noted that in our sample of incarcerated women only seven of the 47 recent attempts had taken place in secure custody: two in a prison, three in a police station and two in a juvenile detention centre. To a certain extent, this would confirm the data from other studies that indirectly show that the problem of suicide is associated with a life of delinquency, suffering and disorganization, rather than with life in prison.

During one-on-one interviews, the women with a history of attempted suicide told us that that they had attempted suicide an average of three times (SD = 3.3), two women had attempted suicide up to fifteen times (see Table 1). This figure was higher, but not significantly so, for the women in provincial prisons (M = 3.3; SD = 3.5) than for those incarcerated in the federal penitentiary (M = 1.8; SD = 0.8).

Severity of the attempts

Also during the one-on-one interviews, the researchers evaluated the severity of the most recent self-injury or suicide attempt to attempt to differentiate them. On average, these suicidal behaviours scored 4 (SD = 2.8) on the LSARS, which ranges from 0 to 10. Scores from the two types of custodial facilities were almost identical. This figure is quite high given criteria 3.5 and 5 on the scale (see Table 2). Another way to look at things is to consider the proportion of serious attempts, that is, those that scored higher than 5 on the LSARS. Overall, 29.4% of the attempts (32.1% for provincial prisons) obtained such high scores.

Suicide risk

The average suicide risk, estimated using the SPS, was 63.2 (see Table 3) for all women. Based on test standards, this score was assessed as fairly high; the score for women incarcerated in a provincial prison was even higher (significant difference). Moreover, based on these test standards, 39.1% of the women should have been referred to a clinician, given that a moderate suicide risk was identified among 27.6% of them and a high suicide risk among 11.5%. In the provincial system, 46.7% of the women should have been referred to a clinician (equally significant difference).

Table 1

Frequency of Suicide Attempts
Number of times	Number of women
1 attempt	9 women
2 attempts	13 women
3 attempts	4 women
4 attempts	4 women
5 attempts	2 women
15 attempts	2 women

Table 2

Benchmark Criteria for the Severity of Suicide Attempts (LSARS)

3.5 Death is improbable so long as first aid is administered by victim or other agent. Victim usually makes a communication or commits the act in a public way or takes no measures to hide self or injury.

5.0 Death is a fifty-fifty probability directly or indirectly, or in the opinion of the average person, the chosen method has equivocal outcome.

7.0 Death is the probable outcome unless there is “immediate” and “vigourous” first aid or medical attention by victim or other agent.

Table 3

Level of Suicide Risk — Comparison Between Federal and Provincial Institutions
	Provincial	Federal	TOTAL
Total score	65.2 (7.3)	58.9 (9.2)	63.2 (8.4)*
Risk: *
sub-clinical low moderate high	10.0% 43.3% 35.0% 11.7%	40.7% 37.0% 11.1% 11.1%	19.5% 41.4% 27.6% 11.5%
* p < .01

For comparison purposes, only 16.2% of sentenced males represented a high risk (see Table 4). This figure 6% among male and female students.²¹ Naturally, the suicide incarcerated females who had suicide at least once was 53.2% of them represented a high risk (see Table 5).

Conclusion

The data we collected on women who had already attempted suicide at least once was already an indication of the magnitude of the problem. However, the majority of these attempts took place somewhere other than a penal institution, hence the need to recognize that this problem is not unique to the system. Individuals who end up in prison are already part of a group with a high suicide risk.²² Moreover, several of these women had attempted suicide numerous times, thus supporting the hypothesis that the attempts may be a cry for help. This by no means implies that the behaviour might be self-injury of no significance; in fact, at least 29% of the attempts could have been fatal (that is, they scored between 6 and 10 on the LSARS).

Table 4

Level of Suicide Risk — Comparisons with Other Groups
	Female Inmates	Male Inmates	Female Students	Male Students
Sub-clinical risk	19.5%	31.7%	57.6%	63.6%
Low risk	41.4%	52.2%	36.8%	30.3%
Moderate risk	27.6%	12.4%	4.9%	6.1%
High risk	11.5%	3.8%	0.7%	0.0%

Table 5

Level of Suicide Risk — Comparisons Between Women with and without a History of Attempted Suicide
	History of Attempted Suicide	No History of Attempted Suicide
Sub-clinical risk	4.3%	37.5%
Low risk	42.6%	40.0%
Moderate risk	36.2%	17.5%
High risk	17.0%	5.0%
Note: All values p < .001

Generally speaking, the research also revealed that female inmates, especially those in the provincial system (serving short sentences or awaiting sentencing) are at a higher risk than male inmates and the general population. Based on the benchmarks of the SPS, 39% of the women (and perhaps as high as 48% at the provincial level) should be referred for clinical assessment. However, our research did not allow us to verify whether they had, in fact, eventually been clinically assessed within the framework of the various screening processes in place in federal and provincial institutions. In any case, whether or not screening or intervention took place, the continued existence of the problem seems obvious. This leads us back to our earlier observation: these clients are at risk, whether or not they are incarcerated, as demonstrated by the fact that they have, in many cases, attempted suicide more than once in several different environments. Moreover, one should not ignore the fact that these clients may have personality disorders.

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1. Please address all correspondence to Marc Daigle, Professor, Centre de recherche et d’intervention sur le suicide et l’euthanasie, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec G9A 5H7.

2. The authors wish to thank the female prisoners at Maison Tanguay (Montreal), the Detention Centre for Women (Orsainville) and Joliette Institution who bestowed their trust. They also with to thank managers and workers with the Quebec Department of Public Security and the Correctional Service of Canada for their ongoing cooperation.

3. A. Liebling, Suicides in Prison (London, UK: Routledge, 1992); see also A. Liebling, “Suicides amongst women prisoners,” Howard Journal, 33, 1 (1994): 1–9.

4. C. Pritchard, M. Cox and A. Dawson, “Suicide and ‘violent’ death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability,” Journal of the Royal Society of Health, 117, 3 (1997): 20; see also L. Lidberg, N. Wiklund and S. W. Jakobsson, “Mortality among criminals with suspected mental disturbance,” Scandinavian Journal of Social Medicine, 17, 1 (1989): 59–65; see also G. Holmberg and A. Forsman, “Extent of psychiatric consultations among prison inmates during one year,” 23rd International Congress on Law and Mental Health (Paris, France, 1998); see also D. Biles, R. Harding and J. Walker, The Deaths of Offenders Serving Community Corrections Orders, (Canberra, Australia: Australian Institute of Criminology, 1999); see also M. S. Daigle, “La prévention des comportements suicidaires en milieu carcéral: évaluation de la situation et approche préventive,” Revue de science criminelle et de droit pénal comparé, 2 (1999): 303–311.

5. C. E. Climent, R. Plutchick, F. R. Ervin and A. Rollins, “Parental loss, depression and violence. III: Epidemiological studies of female prisoners,” Acta Psychiatrica Scandinavica, 55, 4 (1977): 261–268; see also J. E. Cullen, “Prediction and treatment of self-injury by female young offenders,” in D. P. Farrington and R. Tarling (eds.) Prediction in Criminology, (Albany, NY: State University of New York Press, 1985): 135–148; see also M. Shaw, “Issues of power and control: women prisons and their defenders,” The British Journal of Criminology, 32, 4 (1992) 438–452; see also K. Blanchette, “Comparing violent and non-violent female offenders on risk and need,” Forum on Corrections Research, 9, 2 (1997).

6. Shaw, “Issues of power and control: women prisons and their defenders.”

7. S. Pollack, “Opening the window on a very dark day: A program evaluation of the Peer Support Team at the Kingston Prison for Women,” Forum on Corrections Research 6, 1 (1994).

8. H. M. Cookson, “A survey of self-injury in a closed prison for women,” British Journal of Criminology, 17, 4 (1977): 332–357; see also K. A. Farmer, A. R. Felthous and C. E. Holzer, “Medically serious suicide attempts in a jail with a suicide-prevention program,” Journal of Forensic Sciences, 41, 2 (1996): 240–246.

9. B. W. Walsh and P. M. Rosen, Self-mutilation: Theory, Research, and Treatment (New York, NY: Guilford Press, 1988).

10. K. Smith, R. W. Conroy and B. D. Ehler, “Lethality of Suicide Attempt Rating Scale,” Suicide and Life-Threatening Behavior, 14, 4 (1984): 215–243.

11. A. A. Leenaars, D. De Leo, R. F. W. Diekstra, R. D. Goldney, M. J. Kelleher, D. Lester and P. Nordstrom, “Consultations for research in suicidology,” Archives of Suicide Research, 3 (1997): 139–151.

12. M. Livingston, “A review of the literature on self-injurious behaviour amongst prisoners”, in G. Towl (ed.), Suicide and Self-injury in Prisons, (Leicester, UK: The division of Criminological and legal psychology of the British Psychological Society, 1997): 21–35.

13. J. G. Cull and W. S. Gill, Suicide Probability Scale (SPS) Manual (Los Angeles, CA: Western Psychological Services, 1988).

14. R. Labelle, M. S. Daigle, J. Pronovost and D. Marcotte, “Étude psychométrique d’une version française du Suicide Probability Scale auprès de trois populations distinctes,” Psychologie et psychométrie, 19, 1 (1998): 5–26.

16. P. M. Valliant, L. L. Maksymchuk and D. Antonowicz, “Attitudes and personality traits of female adult victims of childhood abuse: a comparison of university students and incarcerated women,” Social Behavior and Personality, 23, 2 (1995): 205–216.

17. M. S. Daigle, “Comparaison de deux stratégies de dépistage des détenus suicidaires,” VIIIe Colloque provincial de l’Association québécoise de suicidologie (1996).

17. Liebing, Suicides in Prison.

18. R. C. Bland, S.C. Newman, R. J. Dyck and H. Orn, “Prevalence of psychiatric disorders and suicide attempts in a prison population,” Canadian Journal of Psychiatry, 35 (1990): 407–413.

19. Quebec Department of Public Security, Portrait de la clientèle correctionnelle du Québec (Québec City, PQ: 1994).

20. M. S. Daigle, Dépistage systématique et prise en charge des personnes incarcérées suicidaires (Québec City, PQ: Quebec Department of Public Security conference, 1998).

21. Daigle, Dépistage systématique et prise en charge des personnes incarcérées suicidaires.

22. A. Liebling, “Prison suicide and the nature of environment,” in A. Liebling (ed.) Deaths of Offenders: The Hidden Side of Justice (London, UK: Waterside Press, 1998): 64–74.