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Friday, May 6, 2022

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)
The Lancet, Vol 44, 101266



People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.


Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).
 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.