An important article in the latest edition of the Probation Quarterly published last week (8 June 2023) looks at how we can learn from the deaths of people under probation supervision to try to reduce them in the future. Written by Karen Slade, Thom Baguley and Lucy Justice, the article is based on research using secondary analysis of nDelius information relating to people who died between April 2019 and March 2021.
In their introduction the authors make it clear that it is important to recognise the differing responsibilities across the justice sector. Unlike custody, where there is a duty of care in the preservation of life as the person is in the custody of the state, this is not reflected in the community other than, to an extent, within Approved Premises. Probation practitioners in the community are not the lead partner in preventing death. That said, they can encourage and support those being supervised to address issues affecting health and wellbeing, management of these needs relies on other partners.
Nonetheless, the research team point out that many of the risk factors for nonnatural deaths align with those for offending behaviour including physical and mental health needs, poverty and family breakdown and substance misuse which reinforces probation’s role in the pathway to prevention.
Pattern of deaths
The study identified an extremely high proportion of non-natural deaths within this population. Within classified deaths, over one quarter are drug overdose (25.9%), a minimum of 10% are suspected suicides, 7.9% are accidental death and 4.8% are homicide. This equates to nearly 50% of cases reported as non-natural deaths. This is far more than the general population where according to ONS, natural causes (e.g., cancer or heart disease) account for over 90% of deaths.
Remarkably, although researchers found the expected rise in drug-related deaths after custody release, this rise was also present after community sentencing, which may have implications for how we explain why drug deaths occur, risk management and wider service provision.
Drugs and suicide risks
Across post-custody and community sentences, there are strong and unique contributions for both drug misuse and suicide risk for all types of non-natural deaths. For example, a history or
current suicide or self-harm risk was present in a third (33%) of suspected suicides but also a
quarter (23%) of drug-related deaths. In line with patients in contact with mental health services, only a small proportion of cases had current concerns reported in the weeks leading to the death.
Focussing on improving the identification and follow-on management of suicide and self harm concerns could be a leading avenue for both justice and health services in ambitions to prevent suicide and drug-related deaths.
Enforcement and recall
Relevant to probation, the initiation of enforcement action or recall within 28 days of the death, was more likely across all non-natural deaths. Concerns that lead to action by probation may function as an imminent risk marker for suicide or drug-related deaths.
Unsurprisingly, the relationship with these actions was greatest for those on post-custody supervision and facing a potential return to custody, although it was also present amongst people on community sentences.
The research team conclude that it is likely that rather than being causal, this marker is an indicator of wider social, psychological, or mental health issues, common in this population,
which are culminating in the violation of the terms or conditions of their sentence.
It is also possible that recall actions in the community trigger the same impacts as reported in custody and so raise the risk of harm (owing to such powerful emotions as: a sense of unfairness, acute loss, hopelessness, or loss of control with a return to custody).
The graphic below (taken from the original research) shows the presence of range of factors relating to the cause of people dying on probation and both protected characteristics and known risks and vulnerabilities.
Researchers found significant disproportionalities for minority groups alongside the broader factors discussed above. These included women displaying a higher rate of drug overdose than
men (although not of drug use) with greater prominence in mental health issues, suicide or self-harm risk and domestic abuse (both as perpetrator and victim).
Furthermore, homicide rates were striking amongst people from ethnic minority backgrounds (accounting for 35% of homicides) or of Muslim faith (accounting for 19%). Other factors may have a mediating effect, and the small numbers mean caution should be applied.
Nevertheless, this pattern of disproportionately is present in official MoJ statistics across multiple years and the general population e.g., ONS identified a 4-time risk of homicide within Black and ethnic minority populations accounting for 29% of all homicides.
This suggests the need for further strategic direction to consider the diverse nature of risk along with gender and cultural needs in the prevention of non-natural deaths.
This research has identified some of the prominent factors linked to non-natural deaths amongst people in the community who are being supervised by the CJS, especially at transition points.
The raised risk of drug-related death after community sentencing as well as post-custody; confirming enforcement actions or recall as risk markers; the need to reflect diversity in probation strategies; to the relationships between risk-to-others and fatal risk-to-self should all be the focus of future strategic and policy development.
Acknowledging the heightened risk in this population is the first step but the research findings indicate that effective management of offending-related needs alongside health needs can support death prevention.