Commentary on: Suicide Screening Tools for Use with Incarcerated Offenders

Publication Summary

Suicide and self-harm among prisoners has risen in the UK over the past decade and affects a substantial proportion of prisoners worldwide (Bergen et al., 2010; Witt, 2017). Many of those who self-harm are based in prisons where rates of self-harm and eventual suicide far exceed the rate within the general population (Fazel et al., 2011). In an international review of suicide in prisons, data from 24 high-income countries in Europe, Australia, and North American showed similar worldwide trends. Elevated risk of suicide amongst prisoners as compared to the general population was found to be five times greater in men and two times greater for women. The study showed a significant association between the prison suicide rate and that of incarceration. (Fazel, Ramesh, & Hawton, 2017). Recent evidence suggests that incidence of self-harm in UK prisons in the 12months to March 2016 have increased by 27% over the previous year. This equates to 405 self-harm incidents compared with 320 incidents per 1,000 prisoners in the previous year (Ministry of Justice, 2016). Self-harm is a major problem in the prison environment because individuals often repeatedly harm themselves, and such repetition has been shown to increase the probable risk of ultimate suicide. Eventual suicides are 5 times higher in male prisoners and 20 times higher in female prisoners than in general population controls (Fazel, Benning, & Danesh, 2005; Fazel & Benning, 2009). Screening for suicide or SH behavior involves the classification of individuals using a classic 2 2 table identifying those who truly are at risk, a/(a/c) (i.e., the sensitivity of the instrument), and those who truly are not at risk, d/(b/d) (i.e., the specificity of the instrument). The evaluation of any screening instrument therefore tends to involve a trade-off between the sensitivity and specificity of the instrument by manipulating the threshold or cut-off score that is used to identify a case. This tradeoff is used to maximize the likelihood that those who score positive have a high probability of being at risk, and those who score negative have a low probability of being at risk. Besides sensitivity and