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Studies of prison suicides have consistently reported higher numbers of deaths for men than women. However it is not clear whether male or female prisoners have higher rates of self‐inflicted deaths proportionate to their population. This paper explores the number, rate and patterns of self‐inflicted deaths of women in prison over the last ten years (1992‐2001) compared with death rates for male prisoners and identifies from 13 case studies possible precipitating factors and implications for prevention.The female prison population increased by 237% over the period 1992 to 2001, from an average annual figure of 1,577 to 3,739. During the same period there were 33 self‐inflicted deaths: an increase from one death in 1993/94 to a peak of eight in 2000. Just over half (51%) of the women were unsentenced/on remand; 14 (43%) had an open F2052SH at the time of death, compared with 28% of all self‐inflicted deaths in the general prison population between 1997‐2001, and nine were known to have self‐ harmed previously (27%).Of the 13 case studies, all but one had recently used illicit drugs. Many had shown disturbed and difficult behaviour throughout their short time in custody, including non‐compliance with medication for mental health problems and behaviour resulting in adjudications. The women all had multiple problems in the days and weeks prior to their deaths, including withdrawal from drugs, lack of contact with families, bereavement and relationship problems within the prison. However more than two thirds had recently been relocated, often against their wishes or to accommodation they found less acceptable.

This article describes three studies on several aspects of police custody in The Netherlands. The first study shows that the quality of accommodation, facilities, interaction and differential treatment are substandard in Dutch police stations, but dependent of the organisational size, degree of specialisation of the custodial task and extensiveness of duty‐prescriptions and registration. Detention circumstances in police stations are worse than in remand centres. The second study reveals high prevalence rates of symptoms of depression and somatisation (SCL‐90) among police custody detainees. Police custody detainees' symptom levels are higher than those in a jail population and a male general population. The third study addresses the prevalence rates of suicides and other deaths in Dutch police custody in the period 1983‐1993 and shows that the mortality rate, suicide rate and deadly poisoning rate are higher than those in remand centres and the general population. The findings of the three studies demonstrate that police custody is an area of concern.

The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals.

The researchers undertook a review of the literature on the medical theories relating to restraint‐related deaths and an analysis of deaths in custody in the UK for the time period 1 Jan 1999 to 1 Jan 2010.

Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also biophysiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual.

It is evident that those in vulnerable groups when restrained in a prone position, or in a basket hold, for a prolonged period and who are agitated and resistive, are most at risk of death in custody. Consistency in reporting relevant deaths locally and nationally is necessary to facilitate analysis of key information and prevent deaths in custody in the future. Staff training and awareness are also key factors.

This paper summarises the findings of an unpublished Prison Service report into self‐inflicted deaths in prisons in England and Wales over the period 1990‐2001. The key findings are that the number and rate of deaths in prisons has increased during the period examined. The majority of deaths are among men, although there has been a recent increase in the number of women who have died over and above any increase in their proportion in the prison population. Women are likely to be younger than men when they die. There is a statistically significant association between increased rates of throughput in local prisons and an increase in the rate of self‐inflicted deaths. Deaths are most likely to occur soon after prisoners have been received into custody. Few prisoners who die have been identified as at increased risk of suicide. There is some evidence that the period immediately following closure of an F2052SH is a high‐risk period. Most prisoners who die are in single cells. Those who die in shared cells are usually alone at the time of death. The findings support the direction of the current Safer Custody strategy: in particular the focus on local prisons, on improved vigilance and care in the early days of custody and on providing improved facilities and care in health care centres and segregation units.

This paper describes the current levels of ‘self‐harm’, suicide and violence in prisons in England and Wales, outlines key high‐risk groups within the prison population and gives relevant national targets on self‐inflicted deaths and serious assaults ‐ now included in the National Offender Management Service (NOMS) national targets for 2005‐06. It outlines the case for Safer Custody Group to continue to provide on‐going services to tackle ‘self‐harm’, suicide and violence, as part of health and offender partnerships. The link with the ‘health agenda’ is explored, and concrete examples are given of successful collaborative work with the Department of Health and others. The delivery of services intended to promote and mainstream safety, health and well‐being in both public and private prisons is described, as are current and future projects aimed at delivering better services to prisoners, staff and bereaved families.

This article draws upon the international literature to focus on the investigation of prisoner deaths in England and Wales, concentrating on clinician involvement in this process.

This is a viewpoint paper regarding clinician involvement in coroner investigations of prisoner deaths in England and Wales.

Compared to colleagues practising in the community, the authors suggest that there is a higher burden of investigation upon clinicians practicing in secure environments and recommend improved training for prison clinicians regarding expectations of the coroner's inquest and also a system whereby questioning in coroners' courts is directed through the coroner.

This paper provides an updated perspective on the issue of coroner investigations following a death in prison custody, from the position of practising prison clinicians.

The custody environment is not designed nor can it hope to meet the needs of individuals who are experiencing acute mental distress. The article reports the findings of analysis of the recorded incidents of self‐harm that occurred in the custody of one English police force during an eight‐month period in 2006. There were 168 such incidents in this period. The ratio of male/female detained persons, who harmed themselves was 3:1. The most common method used was a ligature either from the detained person's own clothes or the paper suits that are used in custody. Alcohol or substance misuse was identified as a clear risk factor. The police response is analysed and recommendations made for improved access to health care for those in custody.

This paper addresses the issue of deaths in police custody. The role and effects of ‘proactive’ and ‘reactive’ policing in addressing suicidal and non‐suicidal deaths is considered. Failings in the training and public accountability of police services and forensic medical examiners are discussed. Some of the past failings, it is argued, seem set to continue in the face of the Secrecy Bill (1999).