Better Safety Must Underpin Prison Reform Says Ombudsman As Suicides, Homicides and Deaths From Natural Causes Reach Record Levels

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The past year saw a 34% rise in prison suicides, more deaths from natural causes and the highest number of homicides in prison for many years, said Prisons and Probation Ombudsman Nigel Newcomen. Today he published his fifth and final annual report and warned that prison reform could stall without a focus on safety and fairness.

The Prisons and Probation Ombudsman (PPO) independently investigates the circumstances of each death in custody and identifies lessons that need to be learned to improve safety. In 2015-16:

  • PPO investigations were started into 304 deaths, 21% more than the year before;
  • the PPO began 10% more investigations into deaths from natural causes (172 deaths), largely as a consequence of rising numbers of older prisoners (the average age of those who died of natural causes was 61);
  • investigations were started into 103 self-inflicted deaths, the highest number in a single year since the Ombudsman began investigating deaths in custody, and a 34% increase from 2014-15;
  • there were six apparent homicides, compared with four the previous year; and
  • a further 11 deaths were classified as ‘other non-natural’ (usually drug related) and 12 await classification.

Nigel Newcomen said:

“Over the past year, deaths in custody have risen sharply, with a shocking 34% rise in self-inflicted deaths, steadily rising numbers of deaths from natural causes and the highest number of homicides since my office was established.

“Together with rising levels of violence and disorder, these figures are evidence of the urgent need to improve safety and fairness in prison. Progress in prison reform will be limited unless there is a basic underpinning of safety and fairness on which to build.

“Unfortunately, I have been saying many of the same things for much of my time in office. While resources and staffing in prisons are undeniably stretched, it is disappointing how often – after invariably accepting my recommendations – prisons struggle to sustain the improvement I call for. Ensuring real and lasting improvement in safety and fairness needs to be a focus on the new prison reform agenda.”

On suicides, he said:

“It is deeply depressing that suicides in custody have again risen sharply but it is not easy to explain this rising toll of despair. Each death is the tragic culmination of an individual crisis. Some major themes do emerge from my investigations, for example the pervasiveness of mental ill-health and the destructive impact of an epidemic of new psychoactive substances, but no simple explanation suffices.

“In such a complex context, effective and thoughtful efforts at prevention by prison staff are vital. Unfortunately, too often my investigations identify repeated procedural failings. For example, I have frequently identified gaps in the assessment of risk of suicide and self-harm and poor monitoring of those identified as being at risk. More can and should be done to improve suicide and self-harm prevention in prison”

The other principal part of the PPO’s remit is the independent investigation of complaints. In 2015-16:

  • the total number of new complaints received was 4,781, a 4% decrease on the previous year;
  • 2,357 investigations were started, just 23 cases fewer than the year before;
  • overall, 2,290 investigations were completed, a 6% increase on 2014-15;
  • in 40% of the investigations, the PPO found in favour of the complainant, compared with 39% the previous year; and
  • the largest category of complaints was about lost, damaged and confiscated property.

Nigel Newcomen said:

“The ability to complain effectively is integral to a legitimate and civilised prison system. In each of my annual reports, I have listed the raft of challenges facing the prison system, which go some way to explaining the sustained levels of complaints reaching my office. These strains in the system may also be reflected in the increasing proportion of complaints from prisoners that I uphold because prisons got things wrong, often in contravention of their own national policies.

“Avoiding mistakes and ensuring basic fairness will also need to be at the heart of any prison reforms. Greater autonomy for governors must be balanced by clear statements of minimum entitlements for prisoners.”

The recommendations made as a result of PPO investigations are key to making improvements in safety and fairness in custody. The past year also saw the publication of a range of learning lessons publications which look across individual investigations to identify broader themes. In 2015-16, bulletins looked at how to avoid the increase of suicides by prisoners in segregation units, how to address deaths associated with new psychoactive substances and how to manage those at risk of suicide in the early days of custody. A thematic study looked at the issue of mental ill health, and a bulletin looked at how legal mail should be dealt with.

Nigel Newcomen said:

“I pay tribute to my staff who have worked so hard to enable me to deliver the commitments that I made on my appointment five years ago: to develop a new programme of learning lessons publications, to improve the quality and timeliness of fatal incident and complaint investigations and to do more with less. We will have to do still more in 2016-17. I know my staff will rise to the challenge.”

A copy of the report can be found here www.ppo.gov.uk.

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