Contrary to the Ontario data shown in Table 2 of Wendy Wobeser and colleagues' article,1 the suicide rate in provincial prisons in Quebec seems higher than that in federal penitentiaries. In fact, a special Quebec coroner's inquiry2 showed that the suicide rate in provincial institutions in Quebec was 339.8 per 100 000 between 1992 and 1996. For the same period, provincial institutions in Ontario had a much lower rate (44.3 per 100 000), and for all provincial institutions in Canada, the mean was 101.2 (range 0 to 339.8).2 For a comparable period (fiscal year 1993/94), the rate in Canadian penitentiaries was 185 per 100 000, but again, the range has been large (the extremes being 246 in 1982/83 and 88 in 1989/90).2 This range of data shows that we must be cautious in analyzing these relatively small numbers of events, which must effectively be estimated on a population basis (per 100 000).
It is true that the rate of violent deaths is high among incarcerated people, particularly men. Ideally, these rates should be compared with rates in equivalent populations, for example, men from 24 to 49 years of age, as Wobeser and associates1 did. But we should go one step further and compare rates among incarcerated delinquents and non-incarcerated delinquents. This is not easy to do, but Pritchard and colleagues,3 for example, showed that the rate of violent deaths among people on probation was 10 times higher than in the general population. For those aged 35 to 54, the rate was 35 times higher. Other researchers4,5 have shown that characteristics such as these reflect the delinquent population, rather than the correctional system. This is not to say that institutions have no responsibilities in addressing the problem. On the contrary, we should take full advantage of the opportunity to help these people while they are available for care in a correctional institution.
In closing, let me reiterate that correctional facilities are not necessarily the best places to treat people. Diversion programs, such as the ones being implemented now in Quebec6 and elsewhere, are much better alternatives, at least for those with serious mental health problems.
Marc Daigle Centre for Research and Intervention on Suicide and Euthanasia Philippe-Pinel Research Centre Université de Québec à Trois-Rivières Trois-Rivières, Que.
References
- 1.Wobeser WL, Datema J, Bechard B, Ford P. Causes of death among people in custody in Ontario, 1990-1999. CMAJ 2002;167(10):1109-13. [PMC free article] [PubMed]
- 2.David AM. Rapport d'enquête de la Coroner sur la mort de 12 détenus du SCQ. Québec: Bureau du Coroner en chef; 1997.
- 3.Pritchard C, Cox M, Dawson A. Suicide and “violent” death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability. J R Soc Health 1997; 117(3):180-5. [DOI] [PubMed]
- 4.Lidberg L, Wiklund N, Jakobsson SW. Mortality among criminals with suspected mental disturbance. Scand J Soc Med 1989;17(1):59-65. [DOI] [PubMed]
- 5.Forsman A, Holmberg G. Interaction between criminality and psychiatric disorder sharply increases risk of early death [abstract]. In: 23rd International Congress on Law and Mental Health; 1998 Jul; Paris, France.
- 6.PECH: Programme d'encadrement clinique et d'hébergement. Rapport annuel 2001–2002. Québec: Programme d'encadrement clinique et d'hébergement; 2000.