Canadian Criminal Justice Association 32nd Annual Congress on Criminal Justice Deaths in Custody Plenary October 31st, 2009 Halifax, Nova Scotia Deaths in Correctional Custody: A Review of the Literature

Outline of Presentation

There is no commonly accepted definition for 'in-custody deaths'.
- Refers to a variety of custodial situations in a singular definition (police lock-ups, youth detention centres, prisons, pre-trial and remand custody, immigration detainment centres, etc.)
- Others include pre-arrest, apprehension, and post-release in the definition of 'custody'.
- Suggest that Canadian Roundtable establishes its own working definition

The natural / unnatural typology is a preferred typology as it is broad enough to encompass a variety of custodial situations.
- Other typologies refer to causes of death in custody in terms of levels of violence, degree of predictability, and internal/external causality.

Data Limitations
- Missing data
- Changes in legislation / reporting practices over time
- Focus on suicide
- Underlying assumptions of offender behaviour
Statistical Limitations
- Small sample sizes, increased likelihood of finding 'statistically significant' results

Most Common Medical Causes of Death in Custody
- Cardiovascular illnesses
- Cancers
- Respiratory illness/ diseases
- Infectious diseases
Comparisons to the Population as a Whole
- In Canada, natural death rates appear to be higher in federal corrections than in the population as whole
- The Canadian experience appears contrary to that of international experiences
Age
- There is some evidence to suggest that offenders are dying younger than would be expected in the population as a whole
Ethnic Background & Gender
- Do not appear to impact rates of natural deaths
Sentence Length
- Does not specifically impact, however, longer sentences would increase the likelihood of an individual staying in prison until an older age and many diseases are more prominent in older populations
Other Considerations
- Underlying assumptions that offenders are "harder on their bodies"
- Literature accepts that natural deaths cannot be prevented and are an inevitable part of the prison experience

Most Common
- Suicides
- Overdoses
- Homicides
- Accidents
Comparisons to the Population as a whole
- Rates of unnatural death are higher in custody than in the population as a whole, particularly in the case of suicide (3 to 9 times the national average)
Background
- Tend to be young (under 40 years of age), male, Caucasian, and in a medium-security facility
- In Canada, trends in ethnicity and suicide is consistent with the ethnicity's representation in the prison population
Gender
- Women offenders are much more likely to engage in self-harming behaviours that do not result in suicide than men
- Suicide rates amongst women offenders are lower than would have been expected in the Canadian context
Sentence Length
- Longer sentences are associated with a stronger likelihood of committing suicide in Canada
- Suicides are more likely to occur in earlier stages of incarceration, particularly following stressful events such as: institutional transfers, negative appeal or parole decisions, and/or the cancellation of visits

Personal History
- Criminal history, family / friends, socio-economic background, education, personal relationships, history of abuse, etc.
Mental Health Issues
Substance Abuse / Addictions
- Drugs (incl. prescriptions) and alcohol
Previous Self-Harming/ Self-Injurious Behaviour
- There is a relationship between self-harm and suicide, though not necessarily one of 'cause and effect'

Prison Environment
- Lack of control of surroundings
- Segregation / isolation
- Physical infrastructure and deficiencies in design
Health Care / Mental Health Care Availability
- Often particularly problematic during after hours coverage (e.g. midnight shift)
- Mental health care is a concern across institutions
Staff Response
- Monitoring and response to medical emergencies is critical
Preventative Programming
- Availability and limited use of programs can contribute to deaths in custody

Natural deaths in custody
- Are inmates harder on their bodies and therefore more likely to die younger?
- Assessments of health care quality and monitoring in Canadian prisons
- Comparisons of natural death rates in custody across countries
- Effect of 'prisonization' on physical and mental health
Canadian vs. international context
- Further evidence to support / refute higher deaths in federal custody than in provincial custody
- Comparisons of mean morbidity rates of custodial populations versus the general population
- How Canada compares to other countries?
Differences in deaths in custody across custodial groups
- Different security levels
- Different sentence lengths
- Remanded, pre-trial, and sentenced individuals

Staff Activities
- Regular and active interaction with offenders (dynamic security)
- Verification of "Live" body counts
Health Care
- Improvements in the provision of care (incl. capacity, staffing, and response to emergencies)
- Increased emphasis on the role of physical and mental health care in the prevention of deaths in custody
- In the case of suicides, avoiding involuntary transfers
Preventative Programming
- Increase access and availability
Communication
- Improved communication between all staff (incl. health staff and correctional staff, as well as with other institutions)
Training
- Improved staff training in the recognition of and response to at-risk individuals and/or emergency situations
Supports
- Increased offender access to supports (including volunteer organizations) to build relationships outside of the institution
Surveillance
- Increased and improved surveillance by staff
- Alterations of the physical environment (i.e. reduce blind spots and remove/reduce potential suicide ligature points)

Date modified
2013-09-16