The invisible condemnation: suicides in the centros penitenciarios

By Jose Sanchez Sanchez, member of the Subcommittee on Penitentiary Law of the Abogacía Española. 

Suicides, in general, are one of those issues that are not addressed calmly in our society, despite being the leading cause of death after natural causes, and twice as frequent as those caused by traffic accidents. Under this immense veil of silence, only inadequate Prevention Plans have been designed, about which nothing is known and which fail to address the social need.

Well, if, as has been pointed out, the issue of suicide is largely invisible from both a social and media perspective, this is even more true of suicides among incarcerated individuals, which constitute one of the most serious and persistent problems within the Spanish prison system and probably prison systems worldwide. It is not only a matter of public health but also of human rights, since incarcerated individuals are under the custody of the State, which has the obligation to guarantee their life and safety. Despite this, suicide rates among incarcerated individuals remain high. centros penitenciarios are much higher than in the general population.

In recent years, efforts have been made to promote the role of an inmate who provides support to those at risk of suicide. However, these monitoring and support functions cannot be left in the hands of another inmate, given that their limited training does not allow them to perform such responsible tasks with the necessary qualifications, in addition to the potential psychological consequences they may experience after a suicide or suicide attempt by the person looking after the life of a fellow inmate.

In this regard, the Ombudsman has already pointed out that “these functions must be carried out by trained personnel and in no case can persons deprived of liberty be required to perform functions that are proper to the Administration and that entail a responsibility.

The Ombudsman, regarding suicides in Centros Penitenciarios, has been noted in various reports;

• The need for the Centros Penitenciarios Facilitating elements should be avoided.
• It has also highlighted the problem that in some Centros Penitenciarios There is no on-site medical service and you have to call the 112 emergency service.
• It is very clear that the Prison Administration is directly obligated to provide, both directly and through prison health doctors, coverage for the medical assistance needs of people deprived of their liberty in the centros penitenciarios that manages.
• He highlighted that restrictions on the living conditions of people deprived of their liberty are agreed upon without prior medical or psychological assessment of the inmate's condition, who are often not visited by doctors or technicians during their time in isolation.
• It also refers to the shortage of doctors and the progressive deterioration of healthcare in the Centros Penitenciariosaggravated by the fact that extra-penitentiary emergency services have to attend to people who are often very far from the urban center.
• Of course, it also points out an outstanding issue, namely the transfer of responsibility for prison healthcare to the regional health services, as mandated by Law 16/2003, on Cohesion and Quality of the National Health System, and the need, while this is not being carried out, to activate agreements with the Autonomous Communities to provide healthcare for people deprived of their liberty.
• Finally, the Ombudsman welcomes the issuance of Instruction 6/18, which establishes a necessary and rapid procedure for issuing medical reports and processing the suspension of the execution of the prison sentence due to very serious illness with incurable conditions.

While it's true that in most cases the most dangerous periods are pretrial detention or the first few days or weeks after entering prison, along with obvious mental health problems, substance abuse, and other risk factors, due to an event that affected me personally, I want to conclude with a reflection on suicides in open prison regimes. In these cases, where theoretically there is a more flexible system with greater freedom, work opportunities, outings, and less isolation—which might be expected to reduce certain prison stressors—the reality is that there are problems that are risk factors for suicide. These include the transition from closed to open prison regimes, which generates anxiety, uncertainty, adjustment difficulties, potential job rejections, and family problems. Furthermore, in open regimes, there is no active psychological support with readily available staff, and the risks of relapse or crisis may go unaddressed. Moreover, there is no protocol for assessing suicide risk.

In open regime situations, it is also necessary to maintain mental health assessments, expand the coverage of specialized personnel (psychologists, psychiatrists, workers, etc.), improve coordination between penitentiary institutions, public health, social services and NGOs, and facilitate the restoration of family and social ties that were broken during the open regime period.