Shredding Human Beings: Death and Self-Harm in Prisons

Joe Sim is Professor of Criminology, Liverpool John Moores University

The latest figures from the Ministry of Justice (MoJ), concerning deaths and self-harm in prison, indicate that the institution remains lethal for those to whom the state supposedly owes a duty of care. The figures are scandalous and are a scathing indictment of the abject failure of penal policy in England and Wales, particularly around the health and safety of prisoners.

Between December 2017 and December 2018, there were 325 deaths, a rise of 10%. Ninety two of these deaths were self-inflicted, up from 70. Three involved women, up from 2. There were 162 deaths from ‘natural causes’, compared with 191 the previous year. The figures are incomplete. In 2018, 67 deaths were recorded as ‘other’, 54 of which were ‘awaiting further classification’. This means that the number of deaths in particular categories may increase, including ‘natural deaths’.  

In the toxic context of the prison environment, the idea of a ‘natural death’ is highly questionable. For the charity INQUEST, ‘no death in prison is natural’ as the ‘failure to treat prisoners with decency, humanity and compassion is a “consistent feature” of deaths [inside]’, a point supported by the Parliamentary Health and Social Care Committee in a report published at the end of 2018 .

Between September 2017 and September 2018, there were a record number of incidents of self-harm – 52,814, or approximately 145 each day – an increase of 23%. Self-harm is highly gendered. The rate for male prisoners was 540 incidents per 1000 men, also up by 23%. In women’s prisons, the rate was an astonishing 2,465 incidents per 1000 women, a rise of 20%

The Official Response: Abject and Complacent

The government has no answer to the deaths and self-harm occurring in prisons except to introduce new, repressive measures such as arming staff with pepper spray, at a cost of 2 million pounds. It is an insidious development which will only further militarize prisons. According to a former prison governor, it will not work, and could make the problems inside worse.  

INQUEST’s casework reveals that many deaths are eminently preventable. However, endlessly repeated institutionalized failures – the management of self-harm and suicide, drug prescribing processes, poor communications and record keeping, inadequate healthcare and systemic, procedural failures and delays[i] ensure that the death rates remain high.

For the state, the deplorable number of deaths is easily explained: it is about the pathology of the individuals involved, the risk they pose to themselves or bureaucratic inefficiency. These stock phrases are uncritically and endlessly rolled out. However, they are too simplistic and distract attention away from the pathological and harm-inducing nature of the prison regime itself which makes all prisoners vulnerable, a point made by Lord Harris in his review of deaths in custody involving 18-24 year olds.

This bleak, and entirely avoidable, situation is compounded by the systemic indifference towards prisoners, particularly towards those who might be in distress. Basic, humane procedures such as answering cell bells are not followed. In 2018, this was highlighted by the Prison Inspectorate in a devastating report on Liverpool prison. Liverpool was not understaffed. Therefore, low staffing levels, contrary to the line propagated by the Prison Officers Association, and an uncritical, ill-informed mass media, had nothing to do with officers not attending to the prisoners. Rather, the report was an indictment of this prison’s immoral treatment, and systemic, uncaring attitude towards those to whom they owed a duty of care.

The MoJ figures illustrate, in the starkest possible terms, the government’s lamentable failure to fulfil this duty of care towards the health, safety and welfare of prisoners[ii]. Additionally, the ongoing failure to implement recommendations from the Prison Inspectorate, the Prisons and Probation Ombudsman and coroners, designed to ensure prisoner safety, and some measure of accountability, has intensified the problem still further and has engendered a culture of immunity and impunity which leaves state servants, and the institutions themselves, effectively beyond reproach. If prisoners are supposed to be responsible for their actions, and are to be held accountable for them, why is the same criterion not used when state servants fail in their duty of care towards prisoners and ignore the majority of official recommendations designed to ensure that prisoners are protected?

Ministers have simply ignored these points. The ‘imminent and foreseeable harm’[iii] the prison generates on a daily basis has been marginalised. Instead, the government has steadfastly focused on the issue of drugs and violence inside, particularly the alleged rise in violence towards prison staff which has also dominated the media debate. However, this is a highly complex issue which the MoJ itself has recognized in noting that the process of recording assaults on staff changed in April 2017, meaning that it was ‘possible this has increased the reporting of incidents’. 

Even if assaults on staff were increasing, the numbers of days lost at work through violence is miniscule compared with the number of days lost through other health and safety issues such as musculoskeletal problems, depression, sickness, stress, bullying by managers, anxiety and nervous debility. If the government is serious about violence towards staff, ministers should consider the overall harms the prison regime generates for staff, of which violence is one aspect. They might also consider the issue of violence by staff against prisoners which both groups have identified as an issue which has a long history.

Additionally, Rory Stewart, the Prisons Minister, has said that he will resign if the levels of drug use and violence do not improve in 10 prisons targeted by the government. This ‘politically irrelevant’ stunt will make no difference. His ‘threat will only distort the issue further’[iv]. It reduces the complex problems in prisons to a superficial discussion about the actions and personality of the individual who holds political office while leaving in place, undisturbed and unaccountable, the corrosive structures of penal power and the discretionary exercise of this power by prison officers on the landings. It is a power structure which induces feelings of helplessness, hopelessness, terror and trauma in the lives of prisoners, with often-catastrophic results for them and their families. That is the issue the minister should be addressing.

A Deeply Embedded Crisis

The MoJ statistics provide a stark and brutal illustration of a system in deep crisis. Death and self-harm are at the sharp end of a continuum of penal violence which labels and relegates prisoners to an animalistic status and legitimates an uncaring, often-unforgiving, punitive response towards them.

The statistics were published in the same week it was announced that a prisoner in Wormwood Scrubs, (who was serving a short sentence for a benefits offence for which he insisted he was wrongly convicted), was suing the prison service for post-traumatic stress disorder due to the constant presence of rats in his cell which ran across his body and which induced nightmares, depression and a skin rash. In 2015, this was identified by the Inspectorate as a significant problem. By 2019, nothing had changed, the rodents were not only in the cells but also in the servery area where prisoners received their meals.

At the same time, the Inspectorate, following the publication of devastating reports on the desperate state of Liverpool, Nottingham, Exeter and Birmingham prisons, published another damning report, this time on Bedford. Here too there was a rodent problem. During the inspection, a prisoner in segregation ‘caught and killed a number of rats in his cell…’.

In their previous inspection, the Inspectorate made 68 recommendations for improving Bedford. In the latest report, they noted that nineteen recommendations were achieved, five were partially achieved and 44 – 68% – were not achieved. Astonishingly, out of 10 recommendations they made about purposeful activity, where prisoners ‘are expected to engage in activity that is likely to benefit them’ one was achieved while nine – 90% – were not achieved. In other words, the mechanisms designed to ensure some form of accountability, and to improve the lives of prisoners, were simply ignored by prison managers and staff, a situation not unique to Bedford but which is intrinsic to how many prisons are operating.

According to the Inspectorate, one of the four tests of a healthy prison is to ensure that ‘prisoners, particularly the most vulnerable, are held safely’. However, out of the 19 recommendations made about safety after their previous inspection, 5 were achieved, 2 were partially achieved while 12 – 63% – were not achieved. The Inspectorate noted that there had been five self-inflicted deaths since 2016 while the rate of self-harm incidents ‘had increased substantially’. In the previous six months, there were 163 incidents which was higher than comparable prisons. The report noted that ‘most prisoners in crisis said that they did not feel well cared for. They faced living in grimy conditions with little time unlocked and hardly anything to do’. 

The lack of safety was compounded by poor living conditions. One prisoner was found in a cell with a bed, a broken window and no other furniture. There was a huge backlog of repairs, some stretching back to 2017. Towels and sheets were changed every four weeks. Poignantly, and contrary to political and popular perceptions that those inside selfishly and violently look after themselves, disabled prisoners:

….relied on the goodwill and friendship of other prisoners to get their basic needs met. Two prisoners who were amputees were unable to shower regularly as they didn’t have the necessary adaptations. One said he had only five showers this year [2018] and to wash himself he had to sit on the floor of his cell and try to splash water on himself from the sink.


The modern prison is a warehousing wasteland. Prisoners are transformed into abstract statistics where the poverty and pain involved in daily survival undermines hope for the future, a point brilliantly made in Lisa Stevenson’s study of self-inflicted deaths amongst the Inuit people. Her insights can be applied to the system-induced degradation experienced by prisoners and the ‘dissolution of the self’ the prison generates.  

Politicians from both the major parties should be deeply ashamed of the latest safety statistics and the existence of corrosive institutions like Bedford. However, whether they are willing to listen to those who advocate radical alternatives, rather than simply hear the repetitive echoes of their own, tired voices, is a moot point. Freeing themselves from the tribal shackles of political opportunism, and the unprincipled, law and order race to the bottom which they have evangelically pursued for decades, would be a good place to start.  Radical action – stopping building prisons, changing the harsh sentencing culture that currently prevails, developing well-funded alternatives to custody operated by well-trained staff, visualizing a prison system based on an ethics of care, social justice and democratic accountability, placing questions of social harm, protection and safety at the centre of criminal justice policy and doing something meaningful about the rampant criminality of the powerful – needs to be taken if the mistakes of the past are not to be endlessly and mindlessly repeated. Anything less, and prisons will continue to be places of ‘punishment for misery’. As the safety statistics indicated, this means living with the dire consequences that flow from this brutal state of affairs. 

Thanks to Katie Tucker for her comments on an earlier draft of this blog.

i.These points are taken from a letter to the Guardian co-written with Deborah Coles from INQUEST and Steve Tombs from the Open University.
ii. See point 1 above.
iii. This was a phrase used by Tessa Kahn on Channel 4 News on 7th August 2018 which seemed highly applicable to prisons.
iv. Thanks to Steve Tombs and Katie Tucker for strengthening the argument here.

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