Who, What, Why: Can a prison cell be suicide-proof?
Ariel Castro, who abducted and imprisoned three women in Cleveland, has died after hanging himself in his prison cell. So is it possible to make a cell suicide-proof?
A sentence of life in prison plus 1,000 years lasted only a few weeks.
The man who kidnapped, raped and beat three women he held captive for a decade - crimes that deeply shocked the US - was found hanging in his cell.
The details are yet to emerge but his death raises the question of how prison cells can be designed to minimise the risk of suicide or, indeed, eliminate it.
"The term we like to use is 'suicide resistant' not 'suicide-proof'", says Lindsay Hayes, one of the top experts on suicide prevention in US prisons and jails.
"This means that you do your due diligence trying to ensure as much as you can the physical safety of a cell by trying to outwit the inmate and looking at all the potential accoutrements and possessions they have or don't have and trying to make it as safe as possible.
"But there are times when, because they are in that cell 24 hours a day, they have the time and the opportunity to think up creative ways of committing suicide."
Not every cell in a prison - where sentences are served - or jail, where inmates are awaiting trial, is made suicide resistant, just the ones that are going to be used for suicide watch.
Of over-riding importance is stopping an at-risk inmate from getting hold of something they can use as a ligature.
"You can't keep sheets and clothing away from all inmates but if an inmate is identified as at risk of suicide, you can put them in a safety smock and prevent certain items from going into the cell," says Hayes.
A safety smock is made of very heavy and bulky material like canvas, so it can't be torn or turned into a tourniquet.
But even with a ligature, suicidal inmates look for something upon which it can be hooked - what the authorities call "anchors".
A cell can have as many as four grilles or grates on the walls and ceilings, for ventilation or to cover lights and smoke alarms. A third of suicides in US prisons and jails are hangings from these grilles.
To make them suicide resistant, they should have holes no more than 0.18in wide because otherwise a prisoner can weave a piece of clothing or bedding through these holes, says Hayes, a project director at the National Center on Institutions and Alternatives. That diameter has now become an industry standard in new prison cells.
Secondly, beds should ideally be either heavy moulded plastic or solid concrete slab with rounded edges, he adds, although these come at some cost. And metal bunks should be bolted flush to the wall with the frame constructed to prevent its use as an anchoring device.
A third risk comes in older prisons that still have cell bars, but these are usually clearly visible to prison officers so not often used.
About 90% of prison suicides in the US are by hanging - the other 10% use a smuggled sharp instrument or drugs.
The overall suicide rates have fallen due to better research, training and care. There were 42 suicides per 100,000 inmates in US jails in 2010, down from 107 in 1986. The number in prisons has been steady between 15 and 20 for the past two decades. In the general US population it's 12 per 100,000.
Suicide rates are higher in UK prisons, where serial killers Harold Shipman and Fred West are two notable examples.
The number of deaths in England and Wales per 100,000 inmates for the three years to the end of 2010 was on average 71, a figure that has fallen since 2004 when it was 130 deaths.
Whatever measures are implemented, inmates can always find a way, says Anasseril Daniel, a psychiatrist in Maryland who is a member of the International Association for Suicide Prevention, and has written extensively on prison suicides.
"I've come across situations where you can remove all the potential anchors like hooks and rails, and anything which can be used as an anchor can be removed, but still people who are intent on committing suicide will accomplish their goal."
The ways in which they do this can be either ingenious or obvious, but there are often no warning signs before suicides happen in prison, says Dr Daniel. While 90% of suicides in the general US population are preceded by warning signs like depression, in prisons that figure falls to two thirds.
The best preventive measure is human supervision, he says.
"While a perfectly designed suicide-proof cell is unlikely, it is important that the entire interior of each cell be visible from the walkway. Frequent monitoring of inmates in their cells is more important than any cell design. Nothing can replace human supervision as a deterrent to suicide."
Given the cost of keeping prisoners fed and clothed, some may question why money is spent on preventing them from killing themselves.
But the prison system has a duty of care towards inmates, says Dr Daniel, and prisoners' rights have been upheld up the Supreme Court.