Review of Un-natural Deaths in Punjab Prisons A Dilemma of Poor Psychiatric Services

Abstract

Objective: The increasing trend of unnatural deaths in custody is a concern globally. So this
study was conducted to examine the causes of unnatural deaths in Punjab prisons.
Methods: A retrospective review of all available files of unnatural deaths from 2006 to 2009 was
carried out in June-July 2010. The death certificates, inquest reports, postmortem reports and fact
finding enquiry reports were examined in detail. Facts of each unnatural death were discussed
with medical officer and superintendent of concerned jail. Causes of unnatural death were
categorized as accidental, homicide, and overdose with substance of abuse or medication and
suicide
Results: Crude mortality rate for un-natural deaths was 53/100,000 per year. These account for
11% (111/1007) of the total deaths. All unnatural deaths were among males with mean age of 35
years (Range; 16-90). Mostly 85% (n=94) were under trial and 15% (n=17) convicted prisoners.
Of the 111 unnatural deaths 49% (n=55) were from overdose, suicide 21% (n=23), homicide 16%
(n=18) and accidental deaths 14% (n=15). Majority of the suicidal deaths was by hanging (20/23).
50% of all un-natural deaths occur within 1st week of their entry in to jail. Majority (91%) of those
committed suicide have a history of psychiatric illness. Suicidal, homicidal and accidental deaths
accounts for 43% of potential years of life lost of these persons. Postmortem of only 35% of cases
conducted on the stress of prisoner heiress.
Conclusion: Among unnatural deaths suicide by hanging and deaths due to substance over dose are dominant. No psychological assessment being done at jail entry. Most of these premature deaths are preventable. Mental health services should be the integral part of primary health care in prisons. Inquest files have incomplete data which limits our study