Prison Deaths (Hansard, 8 December 1993)

§ Mr. Peter Lloyd

Responsibility for these matters has been delegated to the director general of the Prison Service, who has been asked to arrange for a reply.

Letter from A. J. Butler to Mr. Keith Vaz, dated December 1993: The Home Secretary has asked me, in the absence of the Director General from the office, to reply to your three recent Parliamentary Questions about deaths in custody.

Death of Nauwit Zinzuwadia at Leicester Prison You asked for a statement about the death of Mr. Zinzuwadia in Leicester prison on 16 June this year. I will endeavour to explain the sequence of events, but may I say at the outset how very saddened we in the Prison Service are by this tragedy. Mr. Zinzuwadia was received into Leicester prison from Leicester Magistrates' Court on 24 July 1991 charged with burglary, threats to kill, affray, and having an imitation firearm with intent. Upon reception, Mr. Zinzuwadia did not display any suicidal tendencies although he did report a history of alcoholism, and treatment for depression at Leicester General Hospital. Mr. Zinzuwadia was granted bail on 11 September 1991. On 7 January 1992 he was committed for trial to Leicester Crown Court, and on 5 October 1992 he was convicted of affray and possessing an imitation firearm with intent, and was remanded for pre-sentence reports. On 30 October 1992 he was sentenced to 30 months' imprisonment, and on 10 November 1992 he was transferred to Ashwell Prison. At Ashwell Mr. Zinzuwadia was treated for various minor physical complaints, but did not show any psychiatric symptoms until 18 May 1993, when he was diagnosed as depressed and paranoid but not suicidal. Anti-depressive medication was prescribed and Mr. Zinzuwadia was to be seen again the following day. It appears from the medical records that Mr. Zinzuwacdia 273W expressed dislike of the open regime at Ashwell. On 19 May consideration was given to transferring Mr. Zinzuwadia to Leicester after his condition was reviewed and continued to cause concern. Initially, Dr. de Silva at Leicester was not prepared to accept Mr. Zinzuwadia due to pressure on accommodation in the small health care centre at that prison. After discussions with the Duty Principal Medical Officer, however, the transfer was agreed. On arrival at Leicester Mr. Zinzuwadia was located in the ward and he was seen by Dr. de Silva on 20 May. Mr. Zinzuwadia indicated that he was being "got at" by other inmates at Ashwell and felt unable to cope with prison. He displayed no suicidal Mr. Zinzuwadia settled well at Leicester and associated normally with other prisoners. On 24 May his medical condition was reviewed. He was assessed by Dr. de Silva as stable, level in mood and displaying no evidence of serious mental disorder or suicidal ideation, and was returned to Ashwell. His symptoms are ascribed to cannabis abuse, and he was warned about this. On 15 June Mr. Zinzuwadia became disturbed, assaulted a member of staff and had to be restrained using Control and Restraint techniques. He appeared to have become paranoid about staff. Dr. Moore, the medical officer at Ashwell, was concerned about Mr. Zinzuwaida's disturbed mental state and contacted Dr. de Silva to see whether Mr. Zinzuwadia could be returned to Leicester. She considered he needed further psychiatric assessment at the parent health care facility at Leicester. It was agreed that Mr. Zinzuwadia was suitable for transfer. On arrival back at Leicester Mr. Zinzuwadia was placed in single furnished accommodation in the health care centre under normal observation. At 8.30 hours on 16 June Mr. Zinzuwadia made a phone call to his wife, and was permitted to make further calls on the official line as his phonecard had been used up. A Health Care Officer noted that the phone conversation seemed normal. Later that morning Dr. de Silva interviewed Mr. Zinzuwadia and concluded that he was displaying symptoms of an acute paranoid psychosis. He prescribed 100mgs of Largactil to be taken three times a day. No suicidal tendencies or fears of injury from anyone else were identified. Mr. Zinzuwadia was located in single accommodation as a precaution, as he had recently been displaying paranoid tendencies and had assaulted staff only 24 hours previously. Later on 16 June Mr. Zinzuwadia requested a family visit for the following day, and this request was agreed by Dr. de Silva, who noted that he did not seem in a depressed mood at this time. Dr. de Silva saw him again on the landing of the health care centre at around 15.30 and noted no signs of distress. At 18.30 on 16 June both a Health Care Officer and an inmate cleaner spoke to Mr. Zinzuwadia after the evening meal and he gave no obvious indications of any distress, although the Health Care Officer formed the view that Mr. Zinzuwadia "didn't seem talkative". At 19.10 on 16 June the same Health Care Officer looked in to Mr. Zinzuwadia's cell and saw that he was standing against the window bars, opposite the cell door. He was looking towards the floor, and his arms were hanging down by his side. The Health Care Officer spoke to Mr. Zinzuwadia, who did not reply, so he entered the cell and established that Mr. Zinzuwadia was hanging from the window bars by a ligature made of white cord. He supported Mr. Zinzuwadia by using his own body to wedge Mr. Zinzuwadia's body against the window bars while he unhooked the ligature from around the neck. He carried Mr. Zinzuwadia to the bed, shouted for help, and began resuscitation. No pulse was detected. An inmate responded to the shouts, ran to the cell and at the Health Care Officer's request ran to the office to summon help. The inmate also collected a resuscitation box from the treatment room. Another officer then arrived with Dr. Chahal, and resuscitation was continued. An external ambulance crew also arrived and attempted to monitor Mr. Zinzuwadia's respiration. After discussion between Dr. Chahal and the ambulance crew, resuscitation was discontinued, and Mr. Zinzuwadia was pronounced dead at 19.30 hours. At the inquest, the jury concluded that he died from suicide whilst the balance of his mind was disturbed. There was no finding of any lack of care on the part of the Prison Service.

Deaths in custody 1978–1993 You asked for a breakdown of deaths in custody by Prison Service establishment since 1978, distinguishing suicides from 274W other deaths. The information is set out in the attached tables. Information about suicides includes all apparent self-inflicted deaths.

Measures to reduce deaths in prisons There are generally around 70–80 deaths in Prison Service custody each year. A little over half of these (41 in 1992) are self-inflicted. Most of the remainder are by natural causes. I shall assume that our interest lies principally in self-inflicted deaths. Suicide is a very complex problem, to which there is no simple or single solution. There are many vulnerable people in prison, and we cannot remove all the causes of distress which lead to emotional crisis. Identifying prisoners at risk is an imprecise science, and much depends on the willingness of prisoners to confide their feelings in staff or volunteer befrienders. It is also extremely difficult, without resort to oppressive measures, to prevent a prisoner who is absolutely determined to kill himself from doing so. The Prison Service is, however, committed to the care of prisoners and we are taking a wide range of measures to enhance the quality of care. Our strategy involves both "primary care" to create an environment which helps prisoners to cope with problems, combined with "special care" to identify and support prisoners in times of crisis. The strategy aims to minimise the risk of suicide though it cannot eliminate it. The key elements of primary care are good relationships between staff and prisoners, active regimes, decent physical conditions and maintaining a safe and ordered environment. This includes action to reduce bullying: one of the main causes of suicidal crisis, particularly among young prisoners. We issued an anti-bullying guide to establishments in June. Personal officer schemes have now been introduced into the vast majority of establishments. The relationship between the personal officer and the prisoner is the crucial first line of help with the prisoner's problems. Our approach to the provision of special care is multi-disciplinary. Suicide is far from being simply a medical problem and we aim to involve the whole prison community. All establishments have Suicide Awareness Teams which meet regularly to review local policy, monitor incidents and develop new ideas. They also maintain staff and prisoner awareness and identify training needs. We have a dedicated Suicide Awareness Support Unit in Prison Service Headquarters to develop national policy and spread good practice. Branches of the Samaritans are represented on local Suicide Awareness Teams and at most establishments visit prisoners regularly. Some also have special phone links. Samaritan services to prisoners are co-ordinated by a national liaison officer. Listener" Schemes, in which selected prisoners are trained by the Samaritans to befriend other prisoners in distress, are now established in 40 prisons and planned in many others. You may be aware that Leicester prison is currently introducing a Listener scheme. Staff training in suicide awareness has been reviewed in the light of new research, and a new package recently issued to establishments, together with a video ("Misadventures") which was produced in collaboration with the Samaritans. We have also carried out a thorough review of our procedures and documentation for managing prisoners identified as at risk. This review has taken as its starting-point Judge Tumim's conclusion in his report of 1990 that the existing procedures relied too heavily on medical assessment and treatment. New procedures, which will be introduced by 1 April 1994, aim to improve communication and teamwork, and particularly to make greater use of the skills of prison officers in identifying, counselling and supervising those at risk. A new screening form will also be introduced, aimed at improving the way prisoners' health care needs—both physical and mental health—are identified on reception. Assessment of suicide risk will continue to be part of the new reception procedure. The provision of specialist health care services remains an important aspect of the strategy, particularly where suicide risk is related to treatable psychiatric problems. The Director of Health Care is carrying out a comprehensive programme of development aimed at ensuring that prisoners have access to the same standards of health care in prison as people in the community. Where prisoners are suffering from mental disorders under the Mental Health Act 1983 the policy of the Government is that they should be cared for within the NHS rather than the penal system. 275W The Prison Service, the Criminal Department of the Home Office and the Department of Health are together taking a range of measures aimed at diverting mentally disordered people from prison, improving the psychiatric assessment of prisoners and facilitating transfers to hospital under the 1983 Act in appropriate cases. As the tables accompanying this letter are too lengthy to be produced in Hansard, copies have been placed in the House of Commons Library.