Worldwide, there are more than 11 million people in prison on any given day, with over 30 million entering and being released per year. People in prison are more likely to die by suicide than those in the community, with a recent meta-analysis of the international evidence finding rates up to 10 times higher among women and up to 5 times as high among men compared to people of similar ages living in the community. This represents a high risk population, where prevention can focus on the prison environment and culture, in addition to targeting individual factors, such as mental illness and self-harm.
Most suicide deaths in prison involve hanging with a ligature (any object that can be used for the purpose of hanging or strangulation). As around 70% of hangings are fatal, preventing these attempts before they happen is more effective than trying to revive someone afterward. Drawing on long-term data on prison deaths in England and Wales, a recent research report by the Independent Advisory Panel on Deaths in Custody found windows to be the most common attachment point and bedding the most common ligature. This report highlights that while these deaths are preventable, a lack of coordinated, national strategy to remove ligature points and reduce access to potential ligatures leaves prisons with often unsafe cell conditions–a challenge faced by many correctional systems globally.
Moreover, when assessing risk, prison operational and healthcare staff typically rely on personal judgment or focus on immediate needs, which misses important markers for suicide risk. A meta-analysis has identified several risk factors for suicide in prison, including previous self-harm, having suicidal thoughts while in prison, psychiatric disorders such as depression and psychosis, and being housed in a single-person cell. These risk factors can be used when combined to develop structured evidence-based risk assessments, which can assist prison staff to identify those at higher risk and ensure limited preventive resources are directed to where they are most needed. An example of structured assessment is the Risk Assessment for people in Prison at risk of Self-harm and Suicide (RAPSS) tool. The RAPSS tool was developed to provide prison staff a transparent, objective and evidence-based way to identify individuals who remain at risk of self-harm or suicide after standard suicide risk monitoring ends, filling a key gap during this high risk period.
Improving suicide prevention in prison involves a whole systems approach, from targeting support to individuals at the highest risk, including those with a history of suicidal behaviour, mental illness, or single-cell housing. It also involves national strategies to remove the access to means of suicide by ligature, implement structured assessments, and prioritise resources for prisons with the highest suicide rates. Facilitating information sharing between facilities and supporting research can further maximise the impact of suicide prevention efforts.
References
- Mundt, A. P., Cifuentes-Gramajo, P. A., Baranyi, G., & Fazel, S. (2024). Worldwide incidence of suicides in prison: a systematic review with meta-regression analyses. The lancet. Psychiatry, 11(7), 536–544. https://doi.org/10.1016/S2215-0366(24)00134-2
- Independent Advisory Panel on Deaths in Custody. (2025). Ligature deaths in prisons in England and Wales: trends and reduction strategies. https://iapdeathsincustody.independent.gov.uk/document/ligature-deaths-in-prisons-in-england-and-wales-trends-and-reduction-strategies/
- Zhong, S., Senior, M., Yu, R., Perry, A., Hawton, K., Shaw, J., & Fazel, S. (2021). Risk factors for suicide in prisons: a systematic review and meta-analysis. The Lancet. Public health, 6(3), e164–e174. https://doi.org/10.1016/S2468-2667(20)30233-4
- Fazel, S., Heathcote, L., Farouki, L., Senior, J., Perry, A., Fanshawe, T. R., & Shaw, J. (2025). Bridging assessment and treatment for repeat suicidality in prisons: Development and validation of a risk model. BMJ Mental Health, 28, e301280. https://doi.org/10.1136/bmjment-2024-301280
Professor of forensic psychiatry and Director of the Centre for Suicide Research at the University of Oxford.
Doctoral researcher at the University of Oxford with research interests in psychosis, substance use, and forensic psychiatry.