The suicidal process in male prisoners making near-lethal suicide attempts.

Most investigations of factors contributing to prisoner suicide have focused on suicidal behaviour as a discrete event and used official records or Ôpsychological autopsyÕ methodology. A potentially more informative approach is to study survivors of near-lethal suicide attempts about their suicidal process. We have investigated the suicidal process in male prisoners through semi-structured interviews with 60 prisoners who made near-lethal suicide attempts. The suicide attempts often followed adverse life events (especially broken relationships or bereavement), criminal justice/prison-related factors (e.g. concerns about sentencing) and psychiatric or psychological factors (e.g. drug/alcohol withdrawal, depression/anxiety and hearing voices). The majority of prisoners said they intended to die (73%), although many acts had been impulsive (40%). Most described visual images about their suicidal acts (82%). Limited access to methods of suicide had clearly influenced method choice (most commonly hanging/ligaturing 67%), along with expectations about the anticipated speed, painfulness and lethality. Half the prisoners believed their acts could have been prevented, often with relatively simple solutions. The suicidal process in prisoners is a complex interplay of background factors, adverse life events, mental health and psychological problems and cognitive processes. Understanding and recognising these various aspects of the process is likely to improve suicide prevention in prisons.