Hanging During Incarceration

All manners of death are possible while the victim is in prison (72-78). Inmates of prisons have a higher rate of suicide than the general population (72,74,78-85).

In jail, the risk of suicide is increased because of the transient nature of the population and the fact that jail is a new experience for many of these new inmates (76,78,80). The inmate may be intoxicated when jailed (58,78,80,85,86). Although some studies have shown that jail suicide victims have been incarcerated for nonviolent crimes, others have observed that arrest for crimes against persons (e.g., armed robbery, rape, murder) predominate, and the anticipation of a lengthy prison sentence is a possible

Fig. 4. Reclusive woman found slumped on her side suspended from a bent door key (arrow), which was tied to a shoelace worn around the victim's neck. Postmortem toxicology showed ethanol intoxication.

stressor (73,76,80,82,87). This contradiction could be attributed to the type of facility involved (82). Individuals admitted to lockups (police-run short-term detention facilities) are there usually for minor offenses and sometimes are withdrawing from alcohol and drugs (82). Prison inmates typically have been arrested for more serious charges (82). One review revealed that at least 75% of victims had a psychiatric history (87). Most jail suicides occur within 1 to 2 d of incarceration (58,73,78,80,85,87). Self-inflicted sharp force injuries are common, but hanging is more likely to be lethal (83-85). Bed linen is commonly used as a ligature in prisons (83,87).

Long-term prison inmates who commit suicide have a high frequency of psychiatric disorders diagnosed either prior to or during incarceration (72,76,83,88,89). The prospect of lengthy incarceration is a motive for suicide (81,89). In a Texas study, at least half of imprisoned suicide victims had made a prior suicide attempt, about two-thirds had made at least one attempt during their imprisonment, and about two-thirds had a history of alcohol and substance abuse (88). Other studies have shown a similar high incidence of drug abuse and suicide attempts (76,83). Lack of access to alcohol and drugs may reduce the ability of the inmate to deal with the stresses of prison life (88). The majority (60%) of prisoners in a British study killed themselves within the first 3 mo of incarceration (89). Studies have shown that many hanging suicides tended to happen between midnight and 8:00 am, when supervision was reduced (80-82,87). Some suicides occur during the day with the expectation by the victim that imminent resuscitation by staff is possible (89). An inmate may stage a hanging to stimulate apparent unconsciousness. Consequent hospitalization can provide a means of escape (78). The majority of victims are male

(83.88). Most are younger than 35 yr of age, mirroring the general prison population

(76.89). Various means (e.g., overdose, cutting, jumping, strangulation) are used, but hanging is the most frequent (76-78,80,81,85,87-90). In one study, 95% of suicide victims in a maximum security psychiatric institution hanged themselves (79).

Deaths in jails and prisons require careful scene investigation and a thorough autopsy, particularly because of public allegations of homicide against the authorities or criticism of their failure to recognize a potential suicide (74-78,80,90).

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