So many individual tragedies
This is a grim, but important post which shares information of the recent analysis of all deaths in custody for the three years between 2016 and 2019 conducted by the Independent Advisory Panel on Deaths in Custody (IAPDC). The report underscores the high mortality rate for those detained in custody compared with the general population. It reveals that one in five deaths in custody are self-inflicted. While most deaths in custody occur in prisons, when rates are considered people detained under the Mental Health Act have the highest mortality rate. The Panel rightly laments the fact that in very many cases secure health services did not record the ethnicity of the people that died.
Inevitably, data analysis leads to dry text, table and charts; but we try never to forget that each death is a tragedy for the individual person and their family.
Deaths by places of detention
The report reveals that the rates of deaths in detention were considerably higher than in the comparator community group. The majority of deaths in custody between 2016 and 2019 occurred in prisons (57% of all deaths in custody and 1,274 of the 2,269 in total). The average all-cause mortality rate for 30-34 year olds in England and Wales between 2016 and 2019 was 64 deaths per 100,000 people. The comparable figures for people in prison ranged from 344 to 415 deaths (approximately six times the frequency) and are even worse for those detained under the Mental Health Act which ranged from 1,103 to 1,334 (approximately 20 times the rate of the general population).
Cause of death
Between 2016 and 2019 the majority of deaths were due to natural causes (1336, 59% of all deaths in custody), followed by self-inflicted deaths (457, 20% of all deaths). Self-inflicted deaths include deaths by suicide, along with other self-inflicted deaths where the intent may not have been to cause death, or where the intent was not clear.
Over the same period there were 195 deaths (9%) for other natural causes, a category which includes accidental overdoses, and 53 deaths as a result of restraint (2% of all deaths). Deaths due to restraint were recorded by prisons and hospitals only. In addition, there were 13 deaths (less than 1%) due to homicide, all occurring in prisons. The remainder of deaths were not categorised, mainly due to insufficient information.
Deaths by age
More natural deaths occur in older detainees, with an average of 61% occurring in the over 60s over the four years, and almost 80% occurring in the over 50s. For self-inflicted deaths, on average, 63% occur in those 40 and under, and 97% of deaths occurring in those under 60.
Deaths by ethnicity
The majority of deaths occur in people of white ethnicity across all settings, for both males and females (see the table reproduced below). The completeness of ethnicity data varied by setting. There was a large amount of missing data on ethnicity in people detained in hospitals under the MHA. For example, half of females dying in 2019 whilst detained under the Mental Health Act did not have their ethnicity recorded. This large proportion of missing data has the potential to obscure the underlying pattern of deaths by ethnicity, particularly if the data is not missing at random. In contrast, the data collected by prisons is more complete. The numbers of deaths occurring in or following custody or in IRCs are few, with largely complete ethnicity data.
The IAPDC and the Royal College of General Practitioners (RCGP) have been jointly working on the prevention of drug and alcohol-related deaths in prison and immediately following release and are about to publish a report which I will also be covering on the blog.
Thanks to Nikko Macaspac for kind permission to use the header image in this post which was previously published on Unsplash.