Dissertations / Theses on the topic 'Prison suicides'

L'objet de notre recherche a ete de comprendre le suicide a travers la theorie des choix rationnels. Les theories existantes, medicales et sociologiques, sont d'abord discutees ; notre modele explicatif, puis le champ de notre etude, sont ensuite precises : le milieu carceral, par la deprivation qu'il inflige a l'acteur, est un cadre privilegie pour etudier les conduites suicidaires. L'analyse des lettres de suicide laissees par les detenus constitue une premiere validation de notre modele, completee ensuite par une etude epidemiologique du suicide en prison. L'analyse montre que deux types de deprivation incitent l'acteur a choisir le suicide : une deprivation de l'autonomie ou des ressources affectives qui prend forme dans l'interaction, donnant generalement lieu a la redaction d'une lettre, une deprivation sociale et materielle, ne donnant pas lieu a la redaction d'une lettre. Le champ empirique est ensuite elargi a la periode precedant l'incarceration (au moyen des dossiers d'expertise psychiatrique) et au milieu libre (par le tirage au sort d'un groupe temoin). Ces dernieres observations convergent vers nos premieres conclusions : le suicide peut etre considere comme un choix a travers lequel l'acteur maximise sa satisfaction et obeit en cela a une certaine rationalite. Cette rationalite est limitee par le poids des contraintes qui influencent sa decision
The purpose of our research was to understand suicide by means of the theory of rational choices. The best known theories, medical as well as sociological, are first discused. Our explanatory model and the scope of our study where then examined : the prison, by the deprivation which it inflicts upon the actor, is an ideal framework to study the behavior of people who commit suicide. The analysis of the letters left by the prisoners enables us to validate our model. It is completed by an epidemiological study of suicide in jail. The analysis shows that deprivation leads the actor to choose suicide : a deprivation of autonomy or affective resources whichs follows jailing, usually gives rise to the writing of a letter whereas social and material deprivation does not. The empirical field of study is extended to the period which precedes jailing by means of documents about the psychiatric condition of the person who committed suicide and about the general public (randomly selected). These observations lead to the same conclusions. Suicide may be considered as a choice by which the actor maximises his satisfaction : it appears as a rational choice. However this rationality is limited by the constraints that influence his decision

Depuis le début des années 2000, la Cour européenne des droits de l’homme a donné un senset une portée juridique inédits au principe de dignité humaine appliquée à la détention, en se fondant notamment sur l’article 3 de la convention européenne des droits de l’homme qui proscrit la torture et les peines ou traitements inhumains ou dégradants. Cette évolution majeure, lui permettant de faire entrer largement sa jurisprudence dans les établissements pénitentiaires, a contraint le juge administratif français à revoir, de manière très profonde, sa jurisprudence consacrée aux mesures d’ordre intérieur et, sur le fond, à imposer la dignité humaine comme un principe matriciel à l’aune duquel l’ensemble desdroits fondamentaux des personnes détenues doit désormais être appréhendé. Elle a également influencé le législateur sur le vote de lois sur la privation de liberté, telles que la loi pénitentiaire de 2009. Sous inspiration européenne, mais également dans le cadre d’une dynamique interne de promotion générale des droits des administrés, la saisine de la vie en détention par le droit public a, dès lors, contribué au renforcement des droits accordés aux détenus (encadrement des sanctions et des mesures préventives de sécurité – mise à l’isolement et fouilles au corps notamment –, droit à la vie, droit au respect de sa vie privée et familiale, ou encore liberté de conscience et de religion...) et à uneréparation plus aisée des préjudices qui leur sont causés par l’activité pénitentiaire.Toutefois, de nombreux obstacles demeurent à la progression de l’état de droit en prison. En effet, la persistance de conditions de détention indignes et les limites à la mise en oeuvre de ces droits, à leur protection par le juge ou à leur application par l’administration posent la question de leur effectivité et de leur conformité aux standards européens établis par le juge de Strasbourg
As from the early 2000s, the European Court of Human Rights started to give unprecedentedlegal effect and meaning to the principle of human dignity applied to conditions of detention, drawing, when doing so, in particular on Article 3 of the European Convention on Human Rights prohibiting torture and inhumane or degrading treatment or punishment. This major development, which has enabled the Court to have its case law implemented to a significant extent in prisons, has forced French administrative courts to fully review their case law concerning internal measures and, in substance, to impose human dignity as a framework principle in the light of which all fundamental rights of detainees must henceforth be considered. This major development has also influenced the lawmaker when voting on laws concerning the deprivation of liberty, such as the Prisons Act of 2009.Under this European influence, but also as part of an internal movement concerning the general promotion of citizens rights, the referral, to courts of public law, of matters pertaining to prison life, has, since its inception, led to a reinforcement of the rights granted to detainees (framework for sanctions and preventive security measures - solitary confinement and body searches in particular - the right to life, the right to respect for privacy and family life, freedom of conscience and of religion, etc.) and facilitated compensation for damages caused to detainees by a penitentiary authorities.However, many obstacles remain to establishing constitutionality for detainees. Indeed, thepersistence of inhuman conditions of detention, and the limits applied on exercising detainees’ rights, and to ensuring that these rights are protected by a court of law or are implemented by Administration, raise the question of their effectiveness and of their compliance with European standards as set down by the Strasbourg Court

Self-harm and suicide is more prevalent within the prison environment than in community samples, with those in the first weeks of imprisonment at greatest risk. Descriptions and evaluations of static risk factors (e.g. mental health diagnosis) dominate the empirical literature with few dynamic (e.g. defeat) and protective factors (e.g. resilience) evaluated. Additionally, current research is largely atheoretical and the integration of existing knowledge into a unifying model may improve the predictability of assessment. In the current research Williams and Pollock’s cry of pain model provided the template for assessing predictors of self-harm or suicide. For three months, all new arrivals at a local prison were invited to complete baseline questionnaires to assess factors derived from the cry of pain model. It was hypothesised that the factors derived from the model (perceived stress, defeat, entrapment and absence of rescue factors) would be predictive of self-harm and suicide risk and would distinguish prior self-harmers from non self-harmers. Two hundred and seventy prisoners participated in the study. Prisoners with active psychosis and non-English speakers were excluded. All participants were followed up for four months for instances of self-harm. Eighteen participants engaged in self-harm during this period. The hypotheses derived from the model were supported in the prediction of future engagement in self-harm in prison and had some support in identifying those who engaged in previous self-harm and those at risk of suicide. Additional research is needed to confirm the factor structure of defeat and entrapment and the presence of ‘scripts’ as relevant factors in the cry of pain model. The 3 implications for practice are discussed including the identification of patterns of risk linked with self-harm and suicide. The measures utilised in the study were shown to be largely valid within this population. Methodological limitations are discussed together with their implications for future research.

Notre travail présent aborde la question majeure de l'autolyse, de la mort et de la mort que l’être humain en tant que sujet souffrant se donne. Il s’agit du suicide comme problème numéro 1 en matière de santé publique et en termes de science et de problème numéro 1 en matière de ressenti des émotions et en termes d’humanisme. Ce don merveilleux qui est la vie humaine peut disparaître dans des circonstances à risque comme par exemple la dépression ou edm. Nous abordons cette vaste problématique sous l’angle des diverses approches psychopathologique, phénoménologique clinique, éthique, épidémiologique, psychologique et globale. La contribution originale apportée par notre travail est de souligner et de prouver l’existence de la possibilité de prévenir le suicide dans la vraie vie et en milieu privatif de liberté, en prison en particulier
This present research incite to study the very important problem of suicide and autolysis of death and death that human being give to himself in prison. We will speak about suicide like number one problem in the champ of public health in scientifical terms and in terms of humanisme. This wonderful gift represented by human life could disappear in risk occurencies like the presence of depression or edm. We looking about all this champ and focusing on differents approaches like psychopathologic phenomenologic clinical epydemiological about deontology psychological and global approaches. The original contribution of our research working is to focuse and to prouve the possibility of suicide prevention in the real life and in prison particularly

Comparative analysis is crucial to academic studies of public administration because it provides understanding of the nature of different types of public service institution: in particular, it helps to show what they do and don’t have in common, what kinds of institution they are, and what kinds of problems they face. However, in order to effectively conduct comparative research of public service institutions it is important that some thought is given to how they can best be compared. Accordingly, it is argued in this study that the differences between public service institutions can be appropriately analysed by examining their respective risk control cultures. This study makes use of the grid and group cultural theory, as developed by Mary Douglas, Aaron Wildavsky and Christopher Hood, to analyse the risk control cultures of the English and Japanese prison services in regard to two specific types of risk, namely suicide and violence. The results show that particular patterns of organizational behaviour within the English and Japanese prison services can be identified with their respective risk control cultures. More specifically, the English prison service tends to try to control risk by using formal rules and granting strong leadership roles to governors. By contrast, the Japanese prison service tends to use informal rules and group pressures to control risk. Furthermore, the peculiar organizational patterns of risk control within both organizations are often not recognised by their members. As a result, the strengths and weaknesses of organizations can be identified by analysing the patterns of risk control behaviour within them.

Prison inmates are more prone to commit suicide than are individuals in the general population. Current scientific research has identified risk factors of suicide in the general population, such as mood disorders, but only a few research studies have examined risk factors that are particularly relevant to the incarcerated population. This study used a quantitative archival research design to examine the effect of primary and secondary psychopathic personality traits on the development of suicidal behavior in the mentally ill male prison inmate population at a U.S. federal prison located in the Southeast. Data on psychopathic traits as measured by the Psychopathy Checklist-Revised, and on depression as measured by the Personality Assessment Inventory, together with information on the number of suicide attempts coming from prison medical files, were gained from an archival database. The sample size was 203 participants where data were previously collected during their pretrial evaluation. The study was guided by Mann's diathesis-stress model of suicide, according to which impulsive-aggressive personality traits, both of which are characteristics of psychopathy, elevate the risk for suicide. Furthermore, depression may serve as the stress component of the model, and thus its effect was also added to the standard multiple regression model in the analysis. During the analysis, a pattern emerged in which the effect of secondary psychopathic traits was moderated by the percent of time spent in solitary confinement. The results of this research contribute to positive social change by helping professionals working with this population to address the issue of suicide prevention in prison settings via more effective treatment programs.

Rates of suicidal thoughts and behaviours are heightened amongst prisoners, and present a significant challenge to correctional facilities globally. Despite this, there is a paucity of theoretically driven research examining the factors that underlie suicidality in prisoners. Two theoretical models of suicide, the Cry of Pain model (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have highlighted the roles of negative appraisals and perceptions of defeat, entrapment, and hopelessness, as key psychological drivers for suicidal thoughts and behaviours. The overarching aim of this thesis was to investigate the psychological mechanisms that underlie suicidal thoughts and behaviours amongst prisoners. A corollary aim was to examine the psychological factors that may confer resilience to suicidal thoughts and behaviours amongst incarcerated individuals. Firstly, a comprehensive narrative review examined evidence of the applicability of current theoretical approaches to suicide, as applied to prisoner samples. The findings of this review highlighted gaps in the literature, from which a number of research questions were developed for investigation in the current thesis. Next, three empirical studies were designed to investigate the roles of perceptions of defeat, entrapment, hopelessness, and negative appraisals in suicidal ideation. In the first of these studies, cross-sectional evidence was obtained that perceptions of internal entrapment and hopelessness were predictive of suicidal ideation amongst prisoners (Chapter 4). In a second study, the predictive effects of defeat, hopelessness, and entrapment were examined in a longitudinal investigation, finding no significant longitudinal relationship (Chapter 7). In a further empirical study, support was provided for the role of momentary negative appraisals of the present and future as proximal predictors of the severity of suicidal thoughts (Chapter 5). Two further studies examined the role of impulsiveness in suicidality, and provided evidence for the deleterious effect of impulsiveness upon both suicidal ideation (Chapter 8) and self-harm ideation (Chapter 9) in prisoners. Two further studies provided the first theoretically driven investigations of potential resilience factors, conceptualized as positive self-appraisals, within a prisoner sample. Based on the Schematic Appraisals Model of Suicide (SAMS), it was proposed that positive self-appraisals would confer resilience against suicidal thoughts and behaviours. Two studies investigated this hypothesis. The first of these studies found that, contrary to predictions, positive self-appraisals of social support and social reciprocity did not buffer the impact of negative situational appraisals upon suicidal thoughts (Chapter 5). In the second study, evidence was obtained for a buffering effect of positive self-appraisals upon suicidal thoughts. In particular, positive appraisals of interpersonal problem-solving were found to buffer the effects of internal entrapment on suicidal thoughts (Chapter 6).Overall, the findings of this thesis serve to further our understanding of the psychological processes underlying the development of, and resilience to, suicidality amongst prisoners. These results underscore the need to empirically examine the applicability and transferability of psychological models of suicide within prisoner populations. Theoretical and clinical implications of these findings are outlined throughout the thesis.

La violence est un phénomène fréquent dans les prisons. D'après la théorie générale de la tension (Agnew, 1992, 2002), l'agressivité (Blevins et al., 2010) ou le suicide (Zhang et al., 2008) seraient le fruit de tensions éprouvées par les détenus. Notre recherche s'appuie sur le modèle d'Agnew pour créer et tester une échelle standardisée appliquée aux détenus. Les analyses en composantes principales et confirmatoires montrent des résultats satisfaisants, avec des indices de cohérence interne significatifs. Notre échelle est donc une première ébauche pour mesurer la tension en détention. Nos résultats montrent que les comportements agressifs et suicidaires peuvent être prédits de façon significative par la mesure de la tension. Toutefois, la tension en tant que variable indépendante et les stratégies de régulation émotionnelle et/ou de coping comme variables médiatrices ne permettent pas de mettre en évidence des modèles significatifs. Cela signifie que la tension doit être appréhendée comme une variable proximale. De même, nous testons les effets modérateurs des variables personnelles et judiciaires. Nos analyses infirment l'effet modérateur supposé des facteurs personnels et situationnels, même si la dépression et le stress ont un effet significatif. Enfin, nos analyses de médiations modérées ne sont pas significatives, que ce soit pour les comportements agressifs ou suicidaires. Pour conclure, la tension serait la variable la plus proximale pour prédire la violence en prison, alors que la régulation émotionnelle ou les stratégies de coping auraient un effet plus distal. Comme les variables modératrices n'ont pas d'effet significatif, nous proposons de les considérer comme des formes implicites de tension. La théorie de la tension appliquée aux détenus est un modèle prometteur mais récent, qui n'a pas été testé empiriquement. Ainsi, au travers de cette recherche, nous avons essayé de mesurer la tension, afin de tester ce modèle et d'identifier ses limites
Violence is common and frequent in most prisons. According to the general strain theory (Agnew, 1992, 2002), aggression (Blevins et al., 2010) or suicidality (Zhang et al., 2008) are caused by strains experienced by inmates. Our study intends to rely on Agnew's general strain theory in order to create and test a standardized scale applied to inmates, since no psychometric instrument evaluating Agnew's model exists. Principal component analyses and confirmatory analyses applied to our psychometric data show satisfying results, with significant internal consistency indices. Our scale is thus a first attempt to measure strain for inmates. In a second step, this research aims at understanding the effect of strains on inmates' violent behaviors. Our results show that aggressive and suicidal behaviors can significantly be predicted by the strain measure. The strains due to daily-life in jail have a direct effect (indirect for Agnew) on inmates' externalizing violent outcomes. Then, we test the mediating effects of coping skills and emotion regulation strategies. The model depicted by our analyses is not fully consistent with the general strain theory. Analyses considering strain as an independant variable and coping skills and emotion regulation strategies as mediating variables are not significant. This implies that strain measure could be seen as a proximal variable. This conclusion does not totally support Agnew's model, which considers strain as a distal variable. In a next step, we test the moderating effects of personal and judicial variables. Our analyzes invalidate the supposed moderating effect of such factors, even if depression and stress are significant moderating variables. Finally, our moderated mediating analyses are not significant, whether on aggressive or suicidal behaviors. As a conclusion, according to our results, strain would be a proximal variable to predict violence in prison, whereas emotion regulation or coping strategies would be more distal. As the moderating variables are not significant, we suggest to consider them as indirect forms of strains. The general strain theory, especially applied to inmates, is a promising but recent model which has not been empirically tested. Therefore, through this research, we tried to measure strain, in order to test this model and identify its limits

This study examined non-suicidal self injury among young wor,nen in two establishments detaining young offenders in England. The study explored the extent to which socio- environmental factors were implicated, since this has received relatively little attention in previous research. The study aimed to: 1) explore the perceptions of women prisoners and prison professionals about the extent to which the environment of prison impacted upon self injury behaviour and, 2) generate information to enhance custodial and healthcare practice in relation to women prisoners who self-injure. Primarily qualitative methods of inquiry were used, including semi-structured individual interviews with 30 young female prisoners and 49 custodial and other prison staff (primarily healthcare and prisoner welfare). Braun and Clarke's (2006) approach to thematic analysis was used to analyse interview material. Literature reviews foregrounded the study, examining nomenclature and definition, the prevalence of self injury among young women in prison relative to other relevant groups and aetiology. The research found that young women primarily engaged in self injury for reasons of affect regulation, often in response to prior traumatic life experiences. However, self injury was exacerbated by a number of socio-environmental factors such as the 'pains of imprisonment' , the imposition of prison discipline, the nature of social relations and the use and management of physical space. Examination of involvement with the Prison Service system for managing self harm risk (ACCT) and psycho-therapeutic interventions available showed scope for improved engagement. The study concludes with policy and practice recommendations such as the need for education for young women prisoners about self injury, full implementation of training for custodial staff, interventions to allow young women prisoners to constructively channel tensions and frustrations, better management of physical space and the investigation and provision of evidence-based psycho-therapeutic interventions to effectively address self injury among young women in prison.

L'objectif principal de cette thèse est de proposer une lecture spécifique des idées de suicide en jeu dans la décision de passer à l'acte à l'aide d'un instrument psychométrique, l'Evaluation de l'Ambivalence Suicidaire (EAS). Cette échelle EAS projette d'évaluer des pensées autorisant versus freinant la décision de se suicider, leur présence simultanée constituant l'ambivalence suicidaire. Lorsque le poids des pensées en faveur de la mort (motivation au suicide) pèse plus lourd dans la balance décisionnelle, les individus passeraient à l'acte. 120 patients hospitalisés dans le cadre d'une crise suicidaire ont été recrutés pour les besoins de l'étude. Certains venaient de réaliser une tentative de suicide très récente (< 6 jours), récente (< 6 mois) ou ancienne (> 6 mois). Une première étude a permis de vérifier les propriétés psychométriques de notre échelle censée évaluer l'ambivalence suicidaire, nous permettant d'envisager l'utilisation clinique future de cet instrument. D'autres résultats ont mis en avant une forte adhésion aux pensées motivant le suicide juste avant le geste suicidaire. Les idées permissives autorisant directement le suicide se manifestent plus fortement à l'approche du passage à l'acte. Concernant ceux qui viennent de passer à l'acte (< 6 jours), ils auraient tendance à avoir une motivation à la vie actuelle plus faible que les autres ; d'où l'importance d'intervenir très tôt après une tentative de suicide.Les conclusions de cette étude nous permettent de proposer une prise en charge cognitivo-motivationnelle des suicidants, intégrant le concept d'ambivalence suicidaire
The main objective of this thesis is to propose a specific reading of suicidal ideas involved in the decision to commit suicide by using a psychometric instrument, namely the Scale of Suicidal Ambivalence (EAS). This scale intends to evaluate suicide-promoting thoughts versus thoughts inhibiting the suicide act, with their simultaneous presence constituting suicidal ambivalence. When the weight of thoughts favouring suicide outbalances that of suicide-inhibiting thoughts in the decision scale, one is expected to proceed to the act.Suicidal crisis inpatients were recruited (N = 120) for the purposes of the study. Some of the patients had very recently committed an attempt to suicide (<6 days), others less recently (<6 months) and others before a considerable amount of time (> 6 months).A first study tested the psychometric properties of our scale anticipating the assessment of suicidal ambivalence, allowing us to regard suicidal ambivalence as a valid construct and consider the future clinical use of this scale. Other results highlighted a strong adherence to suicide-motivating thoughts just before the suicide attempt. Permissive ideas promoting suicide [P+] manifest more strongly in the actual passing to the act. Regarding those who recently attempted suicide (<6 days), they tended to have a lower current motivation for living compared to the others; hence the importance of intervening early after suicide attempt.The findings of this study allow us to propose a cognitive-motivational support for individuals who committed suicide, that integrates the concept of suicidal ambivalence

Le service militaire d’une durée de 9 mois constitue une obligation légale pour les jeunes hommes grecs. Cette conscription constitue une étape incontournable dans la vie sociale des Grecs: après le service, les jeunes sont considérés comme des hommes socialement validés, prêts à trouver un emploi stable et à fonder une famille. Toutefois, il s’avère qu’un nombre important de conscrits se suicident durant le service. Ce phénomène tabou relève d’un paradoxe: comment une institution qui prétend fabriquer les «vrais» hommes et les préparer à la vie civile peut-elle provoquer des comportements suicidaires? Par le choix (et la nécessité) d’une méthodologie plurielle permet d’analyser ce fait: entretiens semi-directifs de conscrits, parmi lesquels des appelés ayant fait une tentative de suicide, d’officiers et de sous-officiers de carrière qui ont vécu le suicide d’un appelé, de parents dont le fils s’est suicidé durant son service militaire, de psychiatres militaires, de militants et de journalistes; analyses des statistiques disponibles venant de sources multiples; analyse de contenu d’articles de presse et d’archives militaires; enfin, observation participante réalisée au cours d’un stage de trois mois dans l’un des trois hôpitaux militaires du pays. Inspirée par l’approche durkheimienne étudiant le suicide comme un fait social, l’analyse s’appuie sur la théorie des rapports sociaux de sexe et sur le concept d’institution totalitaire. Cette thèse se situe ainsi au croisement d’une sociologie du suicide, d’une sociologie de l’armée et d’une sociologie du genre pour éclairer à la fois les causes du suicide dans l’armée et le traitement social qui en est fait par l’institution
Completing their nine-month military service is a legal obligation for young Greek men. Conscription is an essential step in Greek men’s social life: after being released from the army, they are socially validated as independent adult males, who are ready to find stable employment and to start a family. Nonetheless, a good number of conscripts take their own lives during military service. This PhD thesis examines the taboo phenomenon of suicide, which is highly paradoxical. Indeed, how can an institution claiming to make ‘real men’ and prepare them for civilian life can at once trigger suicidal behaviour? Drawing from a plurality of methodologies, this study uses a mosaic of complementary data to analyse the phenomenon, including semi-structured interviews with conscripts (among whom conscripts having attempted suicide, officers and sub-officers who experienced a conscript’s suicide, parents whose sons took their own lives, military psychiatrists, militants and journalists), an analysis of available statistical data on suicide from a variety of sources, as well as newspaper articles and military archives, and finally, the author’s participant observation during her internship is one of Greece’s three military hospitals. Taking its inspiration from the Durkheimian concept of suicide as social fact, the analysis relies upon the theory of gender relations and Goffman’s framework of total institutions. This thesis therefore stands at the crossroads of a sociology of suicide, a sociology of the army and a sociology of gender to throw light both on the root causes of suicide in the army and on the institution’s approaches to tackling suicide

A l'heure actuelle, la prévention du suicide en pratique médicale repose sur la recherche de nombreux facteurs de risque, cliniques et démographiques, ayant une faible valeur prédictive. Améliorer la connaissance de la pathophysiologie des conduites suicidaires pourrait permettre à terme d'améliorer les mesures de prévention et de proposer des actions thérapeutiques pertinentes. Les connaissances actuelles suggèrent que les conduites suicidaires 1) sont des entités pathologiques à part entière, héritables et ayant une neurobiologie propre, 2) peuvent être abordées suivant un modèle stress-vulnérabilité, 3) pourraient bénéficier de la recherche d'endophénotypes. Dans cette perspective, nous avons entrepris une série de travaux autour d'une fonction cognitive, la prise de décision, chez des patients ayant réalisé un acte suicidaire. Nous montrons une association significative entre une prise de décision désavantageuse et la vulnérabilité aux conduites suicidaires. Dans la suite de ces résultats initiaux, nous présentons plusieurs études explorant les aspects génétiques, environnementaux, cliniques et développementaux de ces anomalies de prise de décision. Nous abordons en outre des travaux préliminaires sur l'imagerie fonctionnelle de la prise de décision chez le sujet sain et nous présentons des résultats sur les bases neurales du traitement des émotions chez les suicidants. L'ensemble de ces données nous a conduit à proposer une ébauche d'un modèle de neuroanatomie fonctionnelle de la vulnérabilité aux conduites suicidaires.

Tous ne survivent pas à la prison. On s’y suicide davantage que l’on y meurt de cause naturelle. Malgré l’existence et l’application de mesures préventives dans les établissements, notre recension des écrits met en lumière le fait que tant dans les pénitenciers que dans les prisons du Canada, la structure et le déploiement des services correctionnels témoignent de difficultés de nature systémique et organisationnelle, notamment lors de suicides. S’inspirant des théories sociocriminologiques en prévention situationnelle et en matière d’aménagement environnemental, nous émettons l’hypothèse selon laquelle la prison serait un milieu suicidogène, c’est-à-dire une institution dont diverses composantes institutionnelles/organisationnelles ne répondent pas aux enseignements constitutifs des approches théoriques et pratiques en matière de prévention. Dans le cadre de cette recherche, nous avons analysé 65 enquêtes administratives internes conduites lors des suicides survenus entre le 1er janvier 2000 et le 31 décembre 2006 dans les établissements de détention provinciaux du Québec. Au cours de notre étude, nous avons mis de l’avant les ressources dont dispose le personnel des établissements afin de prévenir efficacement le suicide des prisonniers et documenté les actions du personnel étant intervenu lors de la découverte d’un prisonnier inerte. Nos analyses suggèrent que le manque de formation du personnel, la consultation rarissime – voire nulle – du dossier social des prisonniers par les membres du personnel, les écarts dans le processus d’admission, les irrégularités quant à la fréquence des activités de surveillance et de sécurité ainsi que la sous-culture des agents correctionnels et celle des prisonniers contribuent principalement au caractère suicidogène de la prison. Nos analyses jettent également une lumière sur le rôle que peuvent jouer le délai encouru entre la découverte du détenu inanimé et l’appel fait au 9-1-1, l’omission de désigner préalablement des agents prêts à répondre à la découverte d’un prisonnier inerte et la non-exécution des recommandations des coroners et de celles issues des rapports d’enquête dans la pérennité du caractère suicidogène de la prison.

Tous ne survivent pas à la prison. On s’y suicide davantage que l’on y meurt de cause naturelle. Malgré l’existence et l’application de mesures préventives dans les établissements, notre recension des écrits met en lumière le fait que tant dans les pénitenciers que dans les prisons du Canada, la structure et le déploiement des services correctionnels témoignent de difficultés de nature systémique et organisationnelle, notamment lors de suicides. S’inspirant des théories sociocriminologiques en prévention situationnelle et en matière d’aménagement environnemental, nous émettons l’hypothèse selon laquelle la prison serait un milieu suicidogène, c’est-à-dire une institution dont diverses composantes institutionnelles/organisationnelles ne répondent pas aux enseignements constitutifs des approches théoriques et pratiques en matière de prévention. Dans le cadre de cette recherche, nous avons analysé 65 enquêtes administratives internes conduites lors des suicides survenus entre le 1er janvier 2000 et le 31 décembre 2006 dans les établissements de détention provinciaux du Québec. Au cours de notre étude, nous avons mis de l’avant les ressources dont dispose le personnel des établissements afin de prévenir efficacement le suicide des prisonniers et documenté les actions du personnel étant intervenu lors de la découverte d’un prisonnier inerte. Nos analyses suggèrent que le manque de formation du personnel, la consultation rarissime – voire nulle – du dossier social des prisonniers par les membres du personnel, les écarts dans le processus d’admission, les irrégularités quant à la fréquence des activités de surveillance et de sécurité ainsi que la sous-culture des agents correctionnels et celle des prisonniers contribuent principalement au caractère suicidogène de la prison. Nos analyses jettent également une lumière sur le rôle que peuvent jouer le délai encouru entre la découverte du détenu inanimé et l’appel fait au 9-1-1, l’omission de désigner préalablement des agents prêts à répondre à la découverte d’un prisonnier inerte et la non-exécution des recommandations des coroners et de celles issues des rapports d’enquête dans la pérennité du caractère suicidogène de la prison.

Suicide is a prevalent and international problem which has substantive economic and psychological consequences. This has led to governments placing prevention of suicide as a priority on healthcare agendas. Recognition has been given to vulnerable groups in society that have been identified as being at particularly high risk of self-harm and suicide. This includes those in contact with mental health and forensic services. There is a great deal of literature that has considered the risk factors, processes and mechanisms associated with suicide. Comparatively only a small amount of literature has looked at the concept of suicidality within restricted samples such as psychiatric inpatients and prisoners. This may be as a consequence of extensive ethical and procedural processes that are involved in conducting research in such settings. This results in it being necessary to continually make generalisations from community based literature, meaning that factors relating specifically to such settings may be overlooked or underestimated. In the first paper, the initial sections consider existing risk assessments and models of suicidality. Predominantly being structured around static risk factors, means they are often criticised for lacking predictive utility and specificity. Literature examining dynamic psychosocial factors of suicidality in restricted samples was reviewed and 20 articles were identified. A wide range of dynamic correlates are presented. These form a theoretical model of suicidality specific to restricted samples. The clinical and theoretical implications are discussed in terms of risk assessment procedures and adapting and shaping interventions in accordance with the findings. Developing risk assessments around more dynamic factors will allow for greater sensitivity and prediction of those at greatest risk of imminent harm. The second, empirical paper supports the promotion of recovery focused practice and explores the relationship between suicidality and perceived personal agency in patients in secure mental health settings; Personal agency having previously been suggested as conferring resilience to suicidality. Psychometric measures and experience sampling methodology were utilised to examine the relationship. Perceptions of personal agency were found to confer resilience against suicidality. Change in perceptions of personal agency was not associated with suicidality but the overall level of personal agency was. Implications for service delivery are discussed with emphasis given to fostering perceptions of agency, control and self-efficacy and promoting inclusion, empowerment and person centred care. The final paper provides a personal and a critical reflection on the research process. It highlights and discusses clinical and theoretical strengths and limitations of the two papers and considers the methodological processes of both papers in more detail. Further reflections on how practice could be adapted in line with the findings are given. Future directions for research within secure settings are considered, in the hope of maintaining the drive for research with this vulnerable and often overlooked population.

Toujours très médiatisé le suicide et les conduites suicidaires en milieu carcéral (avec ces institutions à caractère « totalisant » selon l'expression de A. Lefebvre, 1999, où l'individu est nié dans son attenté. . . ) sont beaucoup plus fréquents qu'en milieu libre, et particulièrement en France (D. A. P. , 2001). En effet, les morts par suicide y sont sept fois plus fréquentes, et les tentatives de suicide quatre à cinq fois (90% en Maison d'Arrêt). Le moyen le plus utilisé est la pendaison (90%). Les personnes les plus à risque sont les prévenus, les détenus ayant des antécédents d'incident en détention, ainsi que les personnalités carencées (Durand-Viel, 2000 : 60% fonctionnements limites, 15% fonctionnements psychotiques, 15% fonctionnements pervers, 10% fonctionnements névrotiques). Notre travail se propose donc d'étudier, chez les sujets incarcérés aux agirs violents et aux agirs violents suicidaires, dans une perspective métapsychologique freudienne et post-freudienne, les problématiques qui constituent le noyau de ces fonctionnements en majorité de type limite (cf. Statistiques officielles) à propos du traitement de la perte, des affects de honte et/ou de culpabilité en milieu carcéral, auprès d'un échantillon de 20 sujets (10 sujets non suicidaires, non suicidants ; 10 sujets suicidaires, suicidants). Pour ce faire, nous avons rencontré ces sujets, jeunes adultes et adultes, dans le cadre de nos activités cliniques (pendant huit ans) et de recherche sur la prévention du suicide (DDASS, 2001 ; cf. Alexithymie), au sein d'un SMPR d'une Maison d'Arrêt de la banlieue parisienne. Les épreuves projectives (Rorschach et TAT), nous ont été d'un apport précieux, pour mettre en évidence que les sujets incarcérés aux agirs violents et aux agirs violents suicidaires présentent une prévalence de fonctionnement limite et au-delà une problématique mélancolique (mélancolie blanche carcérale, perte « originaire » Freud), un narcissisme à « vif et à carapace », « pour ainsi dire, une pure culture de la pulsion de mort » (Freud). De plus, nous observons une pathologie de l'affect (barrières autistiques ; verrouillage de l'affect; affects « coincés » (Freud) ; affects « galère », « misère »), entre «honte et culpabilité» (C. Chabert) inconsciente, avec des difficultés identificatoires clairement sexuées et un refus du féminin passif (masculin carcéral : « féminin mélancolique» C. Chabert, «masculin maniaque» F. Neau), qui nous pousse à postuler l'hypothèse de l'élection de «cette silencieuse déesse de la mort carcérale » à travers la création d'une scène suicidaire carcérale dans ses polarités actives et passives (« se tuer, s'abandonner au corps pénitentiaire), dans un lieu où régnent « l'illusion législative », les stratégies de déni collectif et une pathologie de la communication (C. Dejours), en particulier dans le suicide carcéral réussi
Often covered by the media, suicide and suicide attempts in places of incarceration (with their "total institutions" A. Lefebvre, 1999) are much more frequent in prisons than in a free environment, especially in France. In fact in French jails, deaths by suicide are seven times more frequent and suicide attempts are four to five times more frequent (by 90 %). The means most used is hanging (90 %). The people most at risk are the defendants, the prisoners having previous incidents while in custody, as well as inmates with personality deficiency. Our work therefore proposes to study, amongst prisoners with violent behaviours and violent suicidal behaviours, with a Freudian and post-Freudian meta-psychological perspective, and investigate the components that constitute the core of these mainly borderline cases (cf. Official statistics), regarding the treatment of loss, affects of shame and/or guilt in prison for a range of 20 subjects (10 non suicidal, no attempts at suicide; 10 suicidal, attempts at suicide). In order to achieve this, we met those subjects, young adults and adults, within the frame of our clinical work and research on prevention of suicide (DDASS, 2001 ; alexithymia) in the heart of a prison in Paris suburbs. Projective tests (Rorschach and TAT) were of invaluable contribution, as they revealed that patients imprisoned, having violent behaviours and violent suicidal behaviours, show a prevalence of borderline state, along with a melancholic process (white melancholia in prison, "primal" loss Freud), a "sharp" narcissism and a narcissism with a "carapace", "a pure culture of death drive" (Freud). Moreover, we noticed a pathology of the affect (denial, negation; "hassle" affect), between unconscious "shame and guilt" (C. Chabert), with identification problems clearly sexed and a rejection of passive femininity (prison masculinity : "melancholic femininity" C. Chabert, "maniac masculinity" F. Neau), that leads us to postulate to the hypothesis of the selection of this "silent goddess of death in prison", through the creation of a suicidal scene in prison, in its passive and active polarities ("to kill oneself, to give up oneself to the prison body"), within a place governed by "legislative illusion", strategies of collective denial and a pathology of communication (C. Dejours), particularly in case of successful prison suicide

Dans le cadre des approches de psychopathologie développementale, l’objectif de la thèse est d’approfondir les connaissances sur les mécanismes en œuvre dans la mise en acte de comportements externalisés violents auto-agressif et hétéro-agressif chez des individus en milieu carcéral. Nous cherchons à retrouver l’impact des événements de vie (à la fois mental, social et environnemental) vécus à différentes périodes de vie sur ces troubles externalisés violents. À partir de la reconstruction des trajectoires de vie, nous avons retracé le parcours de vie de personnes incarcérées et étudié leurs trajectoires développementales en nous centrant sur le geste suicidaire en prison et le passage à l’acte sexuel transgressif. Dans une premièreétude, les trajectoires de vie des détenus suicidants, (c’est-à-dire présentant des antécédents de tentatives de suicide en détention) obtenues à partir d’une reconstruction avec l’entourage et les soignants ont été comparées à celles des détenus non-suicidants. Les résultats ont permis de développer un modèle prédictif du geste suicidaire en milieu carcéral qui démontre le rôle majeur des troubles de l’humeur avant l’incarcération et des troubles du comportement au cours de l’incarcération. La seconde étude réalisée auprès d’auteurs d’agression sexuelle a permis de mettre en évidence à partir de l’étude de leur trajectoire de vie, quatre profils spécifiques en fonction de l’occurrence d’événements appartenant à quatre domaines de vie majeurs. Les résultats des deux études empiriques nous permettent de discuter à la fois des perspectives théoriques et cliniques dans le cadre d’approches de psychopathologie développementale dans la compréhension de l’émergence des troubles du comportement et de leur accompagnement thérapeutique en milieu carcéral
As part of developmental psychopathology approaches, the aim of the thesis is tobroaden the knowledge of the mechanisms in the inmates’ violent externalised auto-agressive and hetero-agressive behaviour. Our concern is to find the mental, social and environmental impact of life events experienced in different life periods on these violent externalised troubles. From the reconstruction of life charts, the life course has been retraced and the developmental trajectories have been studied by focusing on the suicidal behaviour in prison and the transgressive sexual act. In a first study, life charts of inmates with a history of suicide attempt in prison, built with relatives and caregivers interviews, were compared to life charts of inmates without suicide attempts. The findings enabled to develop a predictive model of the suicidal behaviour proving the importance of mood disorders before the detention and behaviour disorders during the detention. In a second study, four sex offenders profiles created from life trajectories can be observed and distinguished according to the occurrence of events in four major domains of risk factors. The results of the two empiritical studies allow to discuss the theoretical and clinical perspectives as part of developmental psychopathology approaches in the understanding of violent externalised troubles and their care in prison

RESUMO: A população prisional é constituída por indivíduos geralmente sujeitos a alguma forma de exclusão social e que apresentam problemas de saúde física e mental mais frequentes do que na população em geral. A prevalência mais elevada de perturbações mentais e de suicídio nos reclusos, em relação à população civil, é consensual e está demonstrada em numerosos estudos internacionais. O abuso/dependência de substâncias, a depressão, as psicoses e a perturbação anti-social de personalidade são as perturbações mais comuns na população prisional. As perturbações mentais são importantes factores de risco de suicídio, de vitimização, de reincidência e de reentrada no sistema prisional. Assim sendo, o grupo de reclusos com perturbação mental constitui um grupo de risco relevante. A avaliação de necessidades de cuidados foi iniciada no Reino Unido como um método para o planeamento, medição dos resultados e financiamento dos cuidados de saúde. Para esta avaliação foram desenvolvidos instrumentos que avaliam as necessidades em diversos domínios (clínicos e sociais) para aplicação aos utentes, cuidadores e profissionais. Até aos anos noventa, a avaliação de necessidades no contexto prisional incidia especialmente nas necessidades de segurança dos serviços, segundo a perspectiva dos profissionais. Contudo, a partir do relatório Reed (1992), sobre a situação dos reclusos com perturbação mental, verificou-se uma abordagem mais abrangente, que incluía a avaliação das necessidades de cuidados dos reclusos. Embora as necessidades dos reclusos com perturbação mental pareçam ser similares às dos doentes psiquiátricos em geral, existem diferenças em determinados domínios como a comorbilidade do eixo II, o abuso de substâncias e o risco de violência. Por este motivo, as necessidades de cuidados de saúde mental dos reclusos são elevadas e frequentemente não se encontram satisfeitas. De forma a incluir estas especificidades foi desenvolvida a versão forense do Camberwell Assessment of Need (CAN), designada por CAN - Forensic Version (CANFOR). Actualmente existe um consenso generalizado entre as instituições internacionais do dever de proporcionar aos reclusos cuidados de saúde, de prevenção e de tratamento, equivalentes aos cuidados disponíveis para a população civil - o princípio da equivalência de cuidados. A presente investigação pretendeu caracterizar e avaliar as necessidades de cuidados dos reclusos acompanhados nos serviços de psiquiatria prisionais na área da Grande Lisboa (internamento no Serviço de Psiquiatria do Hospital Prisional de S. João de Deus (HPSJD) e consultas nos Estabelecimentos Prisionais (EP) de Caxias e de Tires). De modo a estabelecer uma comparação com sujeitos civis foi seleccionada uma amostra de conveniência de pacientes acompanhados num departamento de psiquiatria da mesma região, segundo um emparelhamento por sexo, escalão etário, e por diagnóstico, num período de 3 meses. Realizou-se um estudo de tipo observacional, transversal e comparativo. Aplicaram-se os seguintes instrumentos de avaliação: questionário específico, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning, CAN-R e CANFOR-R. No período do estudo (12 meses) foram assistidos 149 reclusos, dos quais, 35 (23,5%) não cumpriram os critérios de inclusão. A amostra final de reclusos (PRs) (n=114) foi constituída por 79 homens (69,3%) e 35 mulheres (30,7%), dos quais 77 eram condenados (67,5%) e 37 (32,5%) encontravam-se detidos preventivamente. A amostra final de participantes civis (PCs) foi constituída por 121 indivíduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%).A amostra final de participantes civis (PCs) foi constituída por 121 indivíduos, dos quais 76 eram homens (62,8%) e 45 eram mulheres (37,2%). Relativamente aos PRs, o diagnóstico mais frequente foi a Perturbação Anti-social da Personalidade (57,9%), seguida pela Depressão Major (56,1%). A maioria (53,5%) apresentava três ou mais categorias diagnósticas. Aproximadamente um terço dos PRs (30%) pontuou o nível elevado de risco de suicídio. A probabilidade deste risco aumentava, significativamente, nos portadores de Depressão Major, de um maior nível de psicopatologia e de uma condenação actual. Perto de metade dos PRs (47,4%) possuía duas ou mais condenações prévias e mais de metade estavam envolvidos em crimes contra pessoas (53,5%). A probabilidade de condenações múltiplas foi significativamente superior nos portadores de Perturbação Antisocial da Personalidade e nos reclusos com maior número de necessidades totais. Entre os PRs dos dois sexos, as principais diferenças significativas residiram na maior frequência de consumo de substâncias e no maior número de necessidades de cuidados nãosatisfeitas nos homens versus mulheres. A comparação entre os PRs, antes da detenção, e os PCs mostrou que os primeiros possuíam menor escolaridade, menos medicação psiquiátrica, mas mais emprego e mais consumos de substâncias ilícitas. A Perturbação Anti-social da Personalidade (OR=26,4; IC95%: 10,7-64,9), a Perturbação Pós-stress Traumático (OR=15,0; IC95%: 3,5-65,4), a Dependência/Abuso de Substâncias (OR=8,5; IC95%: 4,2-17,6) a Depressão Major (OR=2,6; IC95%: 1,5-4,4) e o Risco de Suicídio Elevado (OR=2,6; IC95%: 1,4-5,0) foram significativamente mais frequentes nos PRs versus PCs. Relativamente à avaliação de necessidades de cuidados, os PRs mostraram maior número de necessidades não-satisfeitas e maior necessidade de ajuda profissional, em relação aos PCs. Embora diversas necessidades não-satisfeitas possam resultar da condição de recluso, outras, em domínios da saúde física, da segurança do próprio e dos consumos tóxicos, poderão indicar que os PRs recebem um nível de cuidados inferior ao necessário, em comparação com os PCs. Os PRs apresentaram patologia mental, predominantemente não-psicótica e elevado risco de suicídio/auto-agressão, associado a depressão, necessidades de cuidados e uma pena de prisão. Possuíam, numa frequência elevada, características, consistentemente, associadas à reincidência criminal (personalidade anti-social, consumos tóxicos, condenações anteriores), pelo que se justifica um especial acompanhamento deste grupo, no período pré e pós-libertação. A comparação de necessidades de cuidados no contexto civil e prisional indica um maior nível de necessidades e um menor nível de cuidados recebidos pelos PRs, em relação aos PCs. O princípio da equivalência de cuidados poderá estar comprometido nos indivíduos reclusos com perturbação mental. A utilização do CANFOR foi fácil e poderá contribuir para um melhor planeamento, oferta e avaliação de resultados ao nível individual. Os PRs e PCs revelaram características clínicas e de necessidades muito diferentes entre si, pelo que, os reclusos com perturbação mental deverão ser assistidos em serviços de saúde mental preparados para abordar as suas especificidades.---------------ABSTRACT: The prison population is generally made up of individuals who are usually subject to some sort of social exclusion and who show physical and mental problems more frequently than the general population. Various international studies have found higher rates of mental disturbances and suicide within the prison population. The most common mental disturbances found are substance abuse or dependency, depression, psychosis, and anti-social personality disturbance. Such mental disturbances are important factors in suicide, victimization, delinquency recurrence, and the risk of reentry into prison. As a result, prison inmates with mental disturbances are a relevant at risk group. Assessment of needs of care first started in the United Kingdom as a method of care planning, results measuring and finance health care. The method involved the development of certain measuring instruments to be used by patients, caregivers and professionals in order to evaluate needs in various domains (clinical and social). Until the nineties, the assessment of needs of care in a prison context focused mainly on the service’s security needs. However, after the Reed (1992) report on mentally disturbed inmates, a much wider approach was considered, which included evaluation of the inmate’s needs of care. However similar mentally disturbed prison inmates’ needs may appear to those of other psychiatric patients, there are some differences in particular domains, namely, co-morbidity of Axis II, substance abuse and the risk of violence. For this reason, inmates’ mental health care needs are high and very often not met. In order to include these specificities, a forensic version of the Camberwell assessment of need (CAN,) designated CAN – Forensic version (CANFOR) was developed. There is now generalized consensus among international institutions of the duty under the equivalent health care principle to provide inmates with preventative health care and treatment, that are equivalent to the care available to the civil population. This investigation aims to characterize and assess the health care provision of prison inmates admitted to Lisbon’s Psychiatric Prison ward - the Psychiatric Ward of São João de Deus Hospital (HPSJD) - and inmates in the Caxias and Tires Prison Establishments (EP) undertaking outpatient treatment. In order to establish a comparison between prison and civilian patients, a convenience sample was selected from civilian patients being treated in a psychiatric ward in the same geographical area. This sample was paired by gender, age group and diagnosis during a three month period. The study was observational, transversal and comparative. The following measuring instruments were used: a purpose-built questionnaire, Brief Psychiatric Rating Scale 4.0, Mini International Neuropsychiatric Interview 5.0.0, Global Assessment Functioning Scale, CAN-R and CANFOR-R. During the research period (12 months), 149 inmates received care, of whom 35 (23.5%) did not comply with the prerequisite criteria of this study. The final sample of inmates (PRs) (n=114) comprised 79 men (69.3%) and 35 (30.7%) women, of whom 77 (67.5%) were convicted prisoners and 37 (32.5%) were in preventive custody. The final sample for Civilian Participants (PCs) was made up of 121 individuals, of whom 76 (62.8%) were men and 45 (37.2%) were women. The most common diagnosis among the PRs was Anti-Social Personality Disorder (57.9%), followed by Major Depression (56.1%). More than half of the subjects in the sample (53.5%) showed three or more diagnostic categories. Approximately one third (30%) of the PRs showed a high level of suicide risk. The probability of this risk was significantly higher among Major Depression patients, those showing a higher level of psychopathology and those with a current conviction. Almost half of the PRs (47.4%) had been given two or more prior convictions and more than half (53.5%) were involved in crimes against people. The probability of multiple convictions was significantly higher among inmates with Anti-Social Personality Disorder and in those with more total needs. With regard to gender, the main significant difference among the PRs was that men were found to have a higher frequency of substance use and a greater number of unsatisfied caring needs than women. Comparison between the PRs prior to detention and PCs revealed that the former held lower educational qualifications and received less psychiatric medication, but had higher levels of employment and showed greater consumption of illicit substances. In addition Anti-Social Personality Disorder (OR=26.4; IC 95%: 10.7-64.9), Post-Stress Traumatic Disturbance (OR=15.0; IC 95%: 3.5-65.4), Substance Dependency/Abuse (OR=8.5; IC 95%: 4.2-17.6), Major Depression (OR=2.6; IC 95%: 1.5-4.4), and High Suicide Risk (OR=2.6; IC 95%: 1.4-5.0) were significantly more frequent amongst PRs than PCs. The results for needs assessment revealed that the PRs showed higher levels of unmet needs and a greater need for professional help in comparison with the PCs. Although various unmet needs may result from the inmate’s condition, other needs - in particular those regarding physical health, personal security and toxic substance use - suggest that the care given to PRs may be inadequate in comparison with that given to PCs. This implies that the principle of equivalent health care for PRs with mental illnesses may not be upheld. Furthermore, the mental morbidity results of the PRs indicated that they suffer predominantly from non-psychotic and high suicide/self inflicted aggression risk associated with depression, caring needs and a prison sentence. They also often showed characteristics that are consistently associated with criminal recidivism (Anti-social Personality, use of toxic substances, prior convictions). This result justifies that there should be special follow-up for this group in the pre- and after release period. The use of CANFOR proved to be simple and the application delay was acceptable. No difficulties were encountered in the understanding of its categories by its users. As a result, itcould contribute towards better planning, supply and assessment of results at an individual level. Given that the PRs and PCs revealed different clinical and needs characteristics, it is recommended that inmates with mental disturbances should be assisted in mental health services that are adequately prepared to address their specificities.

Walleräng, A. (2020). Suicide prevention within the Swedish Prison and Probation service – Employees experiences of “Guidelines for suicide prevention”. Bachelor thesis in Public Health Science. Department of Public Health and Sport Science. University of Gävle, Sweden.   A qualitative interview study with people working in the Swedish Prison and Probation service was conducted to explore their experiences of “Guidelines for suicide prevention”. As a starting point were the guidelines used within prisons and the probation service. Semi-structured interviews, where the respondents were allowed to reflect over its content and how they used it in their daily work, were used together with an interview guide. The data was then analysed through content analysis and later categorised. The result was divided into two domains; the individual and the organisation. Each category was described in the result. The main finding was that the responders described the guidelines as a good support in their work. Although they also reported a lack of clear descriptions of how the cooperation between the Prison and Probation service and external psychiatry was to be conducted. Guidelines were mostly directed inwards. In conclusion, the guidelines are produced to simplify the suicide preventive work. The importance of staff presence and personal engagement are key factors to successfully reduce suicides and self-harm.   Key words: Suicide prevention, prison, guidelines, experiences, interview study.
Sammanfattning Syftet med studien vara att undersöka hur anställda vid Kriminalvården upplever Handboken för suicidprevention som används inom häkte, anstalt och frivård. Anställda inom samtliga verksamhetsgrenar deltog i 4 st. semi-strukturerade intervjuer som utgick ifrån en intervjuguide. Deltagarna fick möjlighet att reflektera fritt utifrån sina upplevelser av suicidpreventivt arbete. Det insamlade materialet analyserades utifrån en innehållsanalys där kategorier identifierades. Kategorierna delades upp inom två teman; Individen och Organisationen. Utifrån dessa analyserades resultatet och redovisas utifrån kategorier. Resultatet ger att handboken upplevs som ett bra stöd i verksamheten och som källa till rutiner överlag. Resultatet visar även att handboken har brister och kan upplevas som otydlig. Bristerna består främst i att den inte upplevs beskriva hur samverkan skall går till mellan Kriminalvården och psykiatrin. Det suicidpreventiva arbetet vänder sig främst till häkte och anstalt även om det stora antalet klienter finns inom frivården.   Nyckelord: Suicidprevention, Kriminalvård, Handbok, Upplevelse, Intervju

De nombreuses recherches, principalement nord-américaines, ont mis en évidence un lien significatif entre orientation sexuelle et comportements suicidaires des adolescent e s / jeunes adultes (Beck & al., 2010). L’homophobie à laquelle les jeunes homo/bisexuel-le-s sont exposé e s est considérée comme l’hypothèse la plus sérieuse pour expliquer ce lien, mais, jusque-là, cette hypothèse n’avait jamais fait l’objet d’une recherche quantitative dans notre pays. Nous l’avons prise en compte dans le cadre d’une enquête réalisée sur la base d’un auto-questionnaire informatisé - composé notamment à partir des échelles « Adolescent Risk inventory » (A.R.I, Lescano & al., 2007), « Suicidal Behaviors Questionnaire – Revised » (SBQ-r, Linehan, 1989), et « Homophobia Scale » (Wright, Adams & Bernat, 1999) - auquel ont répondu 475 filles et 426 garçons, âgé-e-s de 18 à 24 ans. Les résultats confirment la sursuicidalité des jeunes homo/bi-sexuel-le-s. Cependant, dans les analyses menées auprès des participants de sexe masculin, l’orientation sexuelle n’apparait plus comme un prédicteur significatif des tentatives de suicide et des conduites à risque dans les modèles explicatifs où l’on introduit les variables «Victimation Verbale Homophobe en milieu scolaire» et «Victimation basée sur la Non-conformité de genre». Ces variables s’avèrent d’ailleurs les plus forts prédicteurs des comportements suicidaires chez les garçons. Ceux-ci présentent des scores moyens à l’échelle d’homophobie/lesbophobie significativement plus élevés que les filles, et la victimation verbale homophobe semble beaucoup plus répandue que la victimation verbale lesbophobe. Cette dernière ne présente par ailleurs pas d’effet significatif sur les tentatives de suicide et les conduites à risque des filles. En revanche, la lesbophobie intériorisée a un effet significatif sur les comportements suicidaires dans le sous-échantillon des filles attirées sexuellement par le même sexe ou en questionnement (ASMSQ), alors que l’homophobie intériorisée n’en présente pas chez les garçons ASMSQ. Ce dernier résultat, basé sur un plus faible effectif, demande à être confirmé par des recherches ultérieures tandis que les analyses portant sur l’ensemble des participants mettent en évidence l’ampleur de la victimation homophobe en milieu scolaire et son impact chez les adolescents et jeunes adultes de sexe masculin
Several studies (mostly North-American) put into light a significant link between sexual orientation and suicidal behaviors among teenagers and/or young adults. Homophobia to which the young homosexuals are exposed is considered the most serious hypothesis to explain this link. However quantitative studies have never been conducted on this hypothesis in France. We took it into account while carrying out a survey based on a self-questionnaire built up from scales from “Adolescent Risk Inventory” (Lescano & al., 2007), Suicidal Behaviors Questionnaire – revised” (Linehan, 1989), and Homophobia Scale” (Wright, Adams & Bernat, 1999). Said survey was answered by 475 young women, and 426 young men aged 18-24.Results confirmed oversuicidality among young homo/bisexuals. However, in the analysis conducted on male participants only, sexual orientation ceases to appear a significant predictor of suicide attempts or risk behavior in explanatory models in which variables « Homophobic Verbal Bullying in school » and « Bullying based on Gender nonconformity » are introduced. Said variables turn out to be the strongest predictors of suicidal behaviors among male adolescents and young adults. Young men have mean scores on the homophobia/lesbophobia scale that are significantly higher than young women's, and homophobic verbal bullying seems a lot more common than lesbophobic verbal bullying. Besides, lesbophobic verbal bullying does not have a significant effect on suicidal attempts and risk behaviors among young women. However, internalized lesbophobia has a significant effect on suicidal behaviors of the sub-sample of young women sexually attracted to same-sex individuals or wondering (ASMSQ), whereas internalized homophobia has no effect on ASMSQ young men. This last result is based on a lower population, and should be confirmed by subsequent studies, whereas analysis on all participants highlight the extent of homophobic bullying in school, and its impact on male teenagers and young adults

Le Trouble Déficit de l'Attention/Hyperactivité (TDA/H) et le Trouble des Conduites (TC) sont associés à des Conduites à Risque (CAR) comme les consommations de substances psycho-actives, les comportements suicidaires et les comportements sexuels à risque. Cependant, la question des rôles respectifs du TDA/H et du TC dans l'émergence des CAR reste controversée : le TDA/H est-il un facteur de risque indépendant de la survenue ultérieure de CAR? Le TC est-il un facteur de confusion ou un modificateur de l'effet de la relation entre TDA/H et CAR? L'objectif de cette thèse était d'examiner le lien entre les symptômes de l'hyperactivité-inattention dans l'enfance et l'adolescence et la survenue de CAR à l'adolescence et au jeune âge adulte, en prenant en compte différents facteurs de risque potentiels dont les symptômes du trouble des conduites. Nous avons mené cinq analyses à partir des données de la cohorte GAZEL enfants issue de la population générale française. Les résultats suggèrent des effets différents des symptômes de l'hyperactivité-inattention selon le type de conduite à risque considéré et selon le genre. Ils montrent chez les garçons un effet des symptômes de l'hyperactivité-inattention sur la survenue de CAR plus sévères comme la consommation régulière de cannabis, l'expérimentation de drogues illégales et la survenue de comportements suicidaires. Chez les filles, on retrouve un effet des symptômes de l'hyperactivité-inattention sur la consommation ultérieure régulière de tabac. L'initiation de CAR pourrait être aggravée par la présence de hauts niveaux de symptômes de l'hyperactivité-inattention chez les jeunes présentant simultanément des hauts niveaux de symptômes du trouble des conduites. Ce travail renforce la connaissance de l'existence d'une association entre troubles du comportement perturbateur dans l'enfance et survenue ultérieure de conduites à risque. Il souligne la nécessité de reconnaitre l'existence de ces troubles, pour les identifier et mieux les prendre en charge afin d'en prévenir les possibles conséquences à long terme
Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are associated with Youth Risk Behaviors (YRB) such as substance-related problems, suicidal behaviors and sex risk behaviors. However, a main issue is the respective role of ADHD and CD regarding YRB : is ADHD an independent risk factor for YRB? Is CD a confounding factor or a moderator of the relationship between ADHD and YRB? The aim of this thesis was to assess the link between childhood hyperactivity-inattention symptoms and subsequent YRB, controlling for other risk factors among which conduct disorder symptoms. We have conducted five analyses from a French community-based sample belonging to the youth GAZEL cohort. Results suggest different effects of hyperactivity-inattention symptoms on YRB according to the the type of YRB and gender. In males, they show an effect of hyperactivity-inattention symptoms on more severe YRB such as regular cannabis use, illicit drug experimentation and suicidal behaviors. In females, they show an effect of hyperactivity-inattention symptoms on regular tobacco use. The risk of YRB initiation was increased in youths with high levels of conduct disorder symptoms, particularly in combination with simultaneously high levels of hyperactivity-inattention symptoms. This thesis enhances the knowledge of a link between disruptive behaviors in childhood and subsequent risk behaviors. It underscores the importance of a better acknowledgement of these disorders, in order to better identify and treat them to prevent negative long-term outcomes

Dissertação de mestrado integrado em Psicologia
A relação entre o tempo de reclusão, a psicopatologia e a ideação suicida em mulheres reclusas não tem sido considerada. Este estudo teve como objetivos (1) analisar o efeito do tempo de pena cumprida na psicopatologia em mulheres reclusas e (2) analisar o efeito da psicopatologia na ideação suicida em mulheres reclusas. A amostra foi composta por 84 mulheres reclusas recrutadas num estabelecimento prisional em Portugal. Adotando uma metodologia transversal, as participantes completaram medidas de psicopatologia e ideação suicida. Os resultados revelaram (1) efeitos significativos do tempo de pena cumprida na psicopatologia em mulheres reclusas e (2) efeitos significativos da psicopatologia na ideação suicida em mulheres reclusas. As mulheres reclusas com pena cumprida por tempo inferior a 2.58 anos revelaram maiores níveis obsessões e compulsões, depressão, hostilidade e ansiedade fóbica. As mulheres reclusas com elevada somatização, obsessões e compulsões, sensibilidade interpessoal, depressão, ansiedade, hostilidade, ansiedade fóbica e total de psicopatologia revelaram níveis mais elevados de ideação suicida. Este estudo poderá ter sido um contributo para a literatura sobre a adaptação das mulheres ao meio prisional, sugerindo (1) efeitos do tempo de pena cumprida na psicopatologia em mulheres reclusas e (2) efeitos da psicopatologia na ideação suicida em mulheres reclusas.
The relationship between the time served, psychopathology and suicidal ideation in women inmates have not been considered. This study aimed (1) to analyze the effect of time served in women inmates’ psychopathology and (2) to analyze the effects of women inmates’ psychopathology in suicidal ideation. The sample was comprised of 84 women inmates recruited in a prison at Portugal. Through one assessment time, participants completed selfreport measures of psychopathology and suicidal ideation. Results showed (1) significant effects of time served on women inmates’ psychopathology and (2) significant effects of women inmates’ psychopathology on suicidal ideation. Women inmates with the time served less than 2.58 years reveled higher levels of obsessions and compulsions, depression, anxiety, hostility and phobic anxiety. Women inmates with high somatization, obsessions and compulsions, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety and total psychopathology, reveled higher levels of suicidal ideation. This study might be a contribute to women inmates adaptation to prison literature, suggesting (1) effects of the time served on women inmates’ psychopathology and (2) effect of women inmates’ psychopathology on suicidal ideation.

This thesis presents the first empirical study into the accommodation needs of Australian Aboriginal prisoners in prison custody. The over-representation of Aboriginal people in the Australian prison system is increasing and the continuing deaths of Aboriginal peoples in prison custody by suicide are an important national issue. Previous prison studies have not addressed all of the issues surrounding this problem. Although the varying and differing accommodation needs of Aboriginal prisoners have been recognised since the 1800s, there is a limited understanding of the relationship between the prison environment and the rates of suicide among Aboriginal prisoners. The aim of the thesis is to investigate the issues and present findings which may contribute to the creation of prison environments which reduce stress levels, and may in turn decrease rates of suicide among Aboriginal prisoners. The research investigates the prison environment for the Aboriginal prisoner from a people-environments approach, locates the act of suicide among a series of behaviours which may occur in response to an environment incongruent with the needs of users. These responses are influenced by a complex of personal, environmental and institutional factors. Data for the research was gathered by studying five South Australian prisons and conducting a series of interviews with 55 male Aboriginal prisoners incarcerated within them. The prisons were documented using observations, interviews with staff and prisoners, photographic surveys and environmental walkthroughs. Both the accommodation standards, and the responsibility to provide those standards by the Department for Correctional Services (South Australia), are examined. The needs and preferences of the subject group were investigated using a three-stage interview process which included gathering personal and incarceration profiles, a forced choice experiment employing photographic sets and a number of drawing exercises to elicit design preferences. The results present a picture of the Aboriginal prison population in South Australia and their design needs. It shows that there are commonalities among the Aboriginal prisoner population in that they are relatively young, have relatively large numbers of children and are dependent on other family members for stability outside the prison environment. Aboriginal people display non-complaint and resistance behaviours and are consequently segregated at an alarming rate in South Australian prisons. The research identifies that prison environments in South Australia are often incongruent with the needs of Aboriginal prisoners. The thesis presents the argument for prison environments to move from being designed within philosophies of segregation and separation to recognising the importance of Aboriginal domiciliary practices, lifestyles structured around the social group and the need to maintain connections to country for all Aboriginal prisoners. The need for prison environments to take into account the identity and spirituality of Aboriginal prisoners is highlighted. The thesis yields further understandings on the design of prison environments for Aboriginal prisoners and will stimulate debate on incarcerating Aboriginal people in a Western tradition.
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Thesis (Ph.D.) - University of Adelaide, School of Architecture, 2008

Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia da Justiça)
A relação entre adversidade na infância, depressão e tentativas de suicídio tem sido estudada, mas nunca o foi em amostras exclusivamente femininas da comunidade. Por outro lado a literatura sugere que existe uma elevada prevalência de adversidade, depressão e tentativas de suicídio em reclusas. Este estudo teve como objetivos analisar estas variáveis em mulheres da comunidade e compará-las com um grupo de reclusas, analisando o contributo da adversidade para a depressão e tentativas de suicídio. Um total de 394 mulheres (211 reclusas e 183 da comunidade) completou o Adverse Childhood Experiences Study Questionnaire e a sub-escala da depressão do Psychopathological Symptom Inventory. As mulheres na comunidade relatam muitas experiências adversas e estas são preditoras da sintomatologia depressiva e das tentativas de suicídio. As reclusas relataram mais abuso sexual, abuso de substâncias na família, familiares em reclusão e divórcio dos pais, enquanto as da comunidade relataram mais violência doméstica. Não há diferenças entre os dois grupos quanto ao total de experiências adversas. A depressão e as tentativas de suicídio são superiores nas reclusas. Nos dois grupos a adversidade é preditora tentativas de suicídio. Programas de prevenção comunitários e projetos prisionais que considerem a história de vida e problemas específicos são necessários em contexto prisional.
The relationship between childhood adversity, depression and suicide attempts has been studied, but never in exclusively female community samples. On the other hand the literature suggests that there is a high prevalence of adversity, depression and suicide attempts in female inmates. This study aimed to analyze these variables in women from the community and compare them with a group of inmates, analyzing the contribution of adversity to depression and suicide attempts. A total of 394 women (211 inmates and 183 from community) completed the Adverse Childhood Experiences Study Questionnaire and the depression subscale of the Psychopathological Symptom Inventory. Women in the community reported many adverse experiences and these are predictors of depressive symptoms and suicide attempts. Female inmates reported more sexual abuse, substance abuse in the family, family members in prison and divorced parents, while the community reported more domestic violence. There are no differences between the two groups in the total number of adverse experiences. Depression and suicide attempts are higher among inmates. In both groups the adversity predicts suicide attempts. Prevention community programs and projects that consider life history and specific problems are needed in the prison context.