Death in our prisons

Françoise Bouchard and associates suggest that in our study¹ we should have compared total suicide rates within custody to total suicide rates in the community, rather than comparing strangulation-specific suicide rates. We submit that such a change in comparison groups would not change the message of our paper. By using the strangulation-specific rates, it is likely that we underestimated the suicide rate in prisons, since deaths from poisoning or toxic effects probably included some suicides.

Our observations do not support a decline in rates over the period of observation. We identified several people who committed suicide very soon after the end of a “suicide watch” and others who clearly had a history of suicide attempts for whom no intervention was attempted. The simple fact remains that death by suicide and death by overdose within the incarcerated population is a major health concern. We look forward to observing the impact on prisoners' safety of the recent changes in CSC's suicide-prevention policy, and we would support the adoption of additional policies to address the burden of death by overdose.

Marc Daigle raises some interesting points. It may be difficult to directly compare suicide rates between Ontario and other provinces, because (as we pointed out¹) the Ontario coroner's system may be using a somewhat more restrictive definition of suicide than is used elsewhere. The apparently greater rate of violent death among “non-incarcerated delinquents” than in the general population is interesting, if not entirely surprising. We also endorse Daigle's statement that correctional facilities are not the right place to treat mental illness and would support a wider application of diversion programs for both mentally ill and addicted people.

Wendy L. Wobeser Department of Medicine Faculty of Health Sciences Queen's University Kingston, Ont.