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The authors reviewed all suicides between 1992 and 2002 in a statewide correctional system. Thirty-seven inmates committed suicide in various prisons during this period. The average suicide rate for the system over the period of study is higher than the suicide rate of the general population, but it is lower than the correctional suicide rates reported in the literature. Inmates who committed suicide were more likely to be young single white males with mental health and substance abuse problems. First-time inmates and those incarcerated for a short period of time presented a higher risk than long term prisoners. Furthermore, transferring an inmate between facilities was signaled as a risk factor. This paper highlights the importance of: 1] systematic screening of offenders and evaluation of suicide risk, 2] obtaining mental health data from community sources and jails, 3] recognizing isolation in administrative segregation, and inter-facility transfer as risk factors, 4] clinical monitoring and 5] tracking of inmate communication of intent to commit suicide. Based on this study the authors discuss certain critical steps as part of a comprehensive suicide prevention program in state prisons.


Suicide is the third leading cause of death in prisons in the United States, following natural deaths and AIDS (Metzner, 2002). Studies of suicide in prison seem to focus on two general areas: a] risk factors that lead to suicide and b] the phenomenology of the suicide act itself although many studies incorporate both aspects.

In prison, inmates who commit suicide are generally young single white males (Liebling, 1993; Green, Kendall, Andre, Looman & Polvi, 1993), are likely to have received long sentences and have high prevalence of mental disorders (Hurley, 1989; Joukamaa, 1997; McHugh, 1995; White, Schimmel & Frickey, 2002). Marcus & Alcabes (1993) reported that in the New York City Department of Corrections 52% of inmates who died by suicide had an Axis I diagnosis. He, Felthous, Holzer, Nathan & Veasey (2001) reported that 88% of their sample received a psychiatric diagnosis.

Another commonly reported risk factor is a history of alcohol and substance abuse (Dole, 1972; Kerkhof & Bernasco, 1990; Liebling, 1993). The majority of substance abusers who commit suicide in prison preferred alcohol as their drug of abuse. While He et al. (2001) found that 68% of inmates who committed suicide abused alcohol, Weitzel & Blount (1982) found that there was no increased risk for any specific group of substance abusers. In their study, nonusers were not more or (surprisingly) less at-risk than heavy substance abusers.

Suicidal inmates are more likely to have committed a violent crime such as murder, rape, felonious assault, or assault and battery (Ivanoff & Jang, 1991; Lester & Danto, 1993). Conversely, Hayes et al. (as cited in Bonner, 2000) found that an inmate who commits suicide is likely a nonviolent offender.

The rate of suicide in prisons has been disputed, primarily because different studies have focused on different prison populations. The suicide rate in federal prisons has been reported to be between 14 and 19 per 100,000 inmates per year (White et al., 2002; Lester & Danto, 1993). The rates for state prisons are higher, ranging between 18 and 40 (Salive, Smith, & Brewer, 1989). Both federal and state prison rates exceed the recognized suicide rate of 12 per 100,000 in the general population, while the jail rate is approximately nine times that of the general population.

Fruehwald, Eher & Frottier (2001) examined the link between previous suicidal behavior and completed suicides and found that 50% of the inmates who committed suicide had made prior attempts. Research suggests that inmates who have a history of suicidal behavior are more likely to commit suicide than their peers who have no history of suicidal behavior.

An inmate's housing assignment may be linked to suicidal behavior, especially if the inmate is isolated from others. Living in a single cell and administrative segregation increases suicide risk due to great deal of isolation and deprivation. In Falkenstein vs. City of Bismarck (1978) the court ruled that the conditions of "the hole" (administrative segregation) did in fact contribute to an inmate's suicide while in Maricopa County v. Cowalt, a later case, the court found that the brick and mortar structure of a correctional facility did not contribute to an inmate's suicide (O'Leary, 1989).

The most common method of suicide in prison is hanging followed by overdose with psychiatric medications, especially tricyclic antidepressants. Hanging is likely preferred because it can be carried out using a variety of materials such as bed sheets, socks, jump ropes, belts, elastic band from a pair of underwear, shoelaces, and bandages (He et al., 2001; Marcus & Alcabes, 1993). In order for a hanging to result in death, the person must succeed in cutting off blood flow to the brain by applying about 2 kg of pressure and the inmate does not have to be fully suspended in the air. Death by hanging usually takes about 5-7 minutes but permanent brain damage can occur in as little as three minutes (Lester & Danto,1993). Although hanging is the most common method of suicide, it only accounts for 7% of all attempted suicides.

In prison, acute and chronic psychosocial stressors may precipitate suicide. The stressor may be due to the stigma, shame or guilt associated with the crime that led to incarceration. Institutional stress due to undesirable unit or housing assignment, and disciplinary action may precipitate suicidal behaviors. Death of a loved one is an acute stressor that can precipitate or aggravate preexisting suicidal feelings (Rieger, 1971; He et al., 2001). Usually, an inmate cannot participate in the common mourning rituals such as the wake, funeral, and burial service. Grieving inmates are not at liberty to express their sorrow overtly which may lead the inmate to suppress his or her feelings of sadness (Schetky, 1998).

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Dr. Anasseril E. Daniel, specializes in Forensic Psychiatry. Dr. Daniel applies his clinical expertise to issues involving civil, criminal, and correctional matters. Board Certified in Adult, Child and Forensic Psychiatry.

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