In the UK, and in other countries, there are organisations promoting and lobbying for transgender people and their rhetoric is becoming synonymous with claims of suicide risk. We hear that transgender people are very likely to attempt suicide during their lifetime, although the studies do not make clear whether these attempts are more likely to occur before or after transition. Parents are told they need to allow their child to transition if they want to avoid their suicide, despite child suicide being a vanishingly rare phenomenon. We also hear trans activists claim that conditions in prison are so awful for transgender people that they will commit suicide if sent to a prison that does not match their gender identity. This is apparently reason enough to demand that all transwomen should be housed in women’s prisons irrespective of their legal status or stage of transition. The rights and safety of the women prisoners who would be forced to live with these male-bodied transwomen is rarely considered.

Suicide rates are unacceptably high for all prisoners

In the past 10 years there have been 6 self-inflicted deaths by transgender prisoners. This is tragic but not a surprise. Conditions in prison are terrible and prison suicide is at an all-time high, with one prisoner committing suicide every three days in England and Wales. Official statistics from the Ministry of Justice (MoJ) show an annual rate of approximately 1 suicide for every 1000 prisoners. Since 2006 there have been 830 suicides in prison (annual figures up until the end of 2016). Transgender prisoner suicides represents 0.7% of all prisoner suicides over the past decade: a rate that is in fact similar to the overall percentage of transgender people in the general population (1% estimated by GIRES in 2015). The high rate of suicides in prison is a horrific state of affairs which needs to be addressed for all prisoners.

Figure 1: Ministry of Justice Safety in custody Statistic Bulletin

There are strict media guidelines on the reporting of suicide for a reason

It is a widely held, but unsubstantiated, belief that holding a transgender prisoner in a prison that does not align to their gender identity is a recipe for guaranteed suicide. However, this risks engendering such fear in transwomen facing prison that their mental health will suffer before a decision is even made. If everywhere they turn are assertions that it is expected that they will attempt to kill themselves if imprisoned with others of their birth sex there is a very real danger that it will become a self-fulfilling prophecy.

Contagion is a very real issue with suicide. Samaritans have set out strict media guidelines on reporting suicide as a way to reduce the likelihood of copycat attempts. Teenagers are particularly vulnerable to social contagion and some towns in the US have had spates of teen suicides which have led to the loss of many lives. The observation of a cluster of four transgender prisoner suicides in the past two years is a worrying sign.

Stories of suicides are being weaponised to promote an agenda

Obviously no-one should feel that suicide is their only option. Prisons have a duty of care to the people incarcerated within them and every death in custody is a tragedy which should have been avoided and warrants investigation. The problem is the unconscionable weaponising of these stories to promote an agenda. Threats of suicide can be used to control or emotionally abuse others, often within the context of intimate relationships- “If you leave me I’ll kill myself”. They can be a hallmark of Borderline Personality Disorder as well as other mental illnesses when it can be a form of attention seeking or a misguided attempt to coerce someone into a closer relationship with the person. When someone threatens suicide as a way to force another person to change their behaviour or alter their decision that is an act of emotional abuse.

This tactic of emotional abuse is being given free rein in the UK press and social media, and is being used effectively against the government, the NHS, schools, public bodies and the prison service to influence law and policies.

It permits one point of view to be elevated above other, equally valid points of view. This is wrong and it needs to stop. Transgender people have a right to be treated with dignity and respect while in prison. They do not have a right to be transferred to the female estate if they pose a risk to the vulnerable women incarcerated there and it is neither transphobic nor bigoted to want decisions around this to be taken seriously, risk-assessed and thoroughly investigated before informing policy and being enshrined in law.

Clear guidelines are in place for the care and management of transgender prisoners

It has long been prison policy that prisoners are located according to their legal gender, which in the vast majority of cases is the same as their birth sex. We have separate prisons for men and women for obvious reasons; women prisoners need to be protected from male sexual attention and male violence for their own physical and psychological well being.

Only a tiny proportion of women are imprisoned for violent crime and so their facilities reflect that. Women considered to be exceptionally violent are housed in the male estate where they have the facilities and expertise to deal with violent prisoners.

Transgender people have a right to be treated with dignity and respect while in prison. The same is true for women. This means there needs to be a careful and informed risk assessment of the circumstances in which a transgender prisoner is considered for transfer to the female estate, to establish whether they pose any kind of risk to the vulnerable women incarcerated there. Balancing the needs of both groups of people means that transgender-identifying male prisoners who are not legally female cannot simply have the automatic right to be transferred to a women’s prison. However, in some circumstances this is allowed.

In January 2017 new and improved prison guidelines were published for the care and management of transgender prisoners. The formulation of the new guidance was overseen by Peter Dawson of the Prison Reform Trust and Jay Stewart of Gendered Intelligence. The new guidance directs that:

“People who are living in a gender different to that of their assigned sex at birth should, as a general presumption, be treated by offender management services according to the gender in which they identify” “Decisions on the allocation of transgender people to binary services, especially custody, must include the possibility of a review and rapid remedy if it appears that the initial allocation might have an unforeseen and detrimental impact on the person’s mental health or wellbeing, their social integration and access to services, or an impact on safety to themselves or the safety of others.” “Regardless of where prisoners are held, they should be respected in the gender in which they identify, being provided with those items that enable their gender expression.”

The new policy guidelines, Prison Service Instruction 17/2016 describes how the decision to locate a transgender prisoner in a female prison is made if they have not changed their legal gender (click the image to see the info-graphic in a new window).

Prisoners must be asked their view of the part of the prison estate that reflects their gender identity; however a decision to locate them in a prison which does not accord with their legal gender can only be made following a Transgender Case Board. A Transgender Case Board is convened to assess the evidence of living in the gender with which they identify and assessments for transfer will be made on a case by case basis.

At the same time Nigel Newcomen, the Prisons and Probations Ombudsman published lessons learned following his investigations into transgender equality complaints and recent deaths in custody of transgender prisoners.

So current prison policy supporting transgender prisoners, endorsed by the transgender lobby group Gendered Intelligence and the Prisons Ombudsman, is already in place. The rights and needs of transgender prisoners are already catered for with in a framework that necessarily also considers the rights and needs of other groups.

Government proposals to reform the GRA 2004 Act and to demedicalise and speed up the process of changing legal sex threaten to destabilise this careful balance in prison. If self-declaration of legal sex goes ahead any male (transgender or not) can choose to become eligible for transfer to a women’s prison. Extending the rights and privileges of transgender prisoners to have free access to women’s prisons to the detriment of the safety of female prisoners is strongly opposed by Fair Play For Women. There is currently no robust evidence that this change is a proportionate response to a legitimate need.

There have been six self-inflicted deaths of transgender prisoners in the last 10 years

Suicide is an incredibly emotive subject. The reasons why someone may commit suicide are complex. It is rarely due to a single factor, and is usually caused by a combination of mental illness and a juxtaposition of various external pressures which combine to cause the person to experience a sense of utter despair.

Not everyone who is found to have killed themselves intended to do so. Suicide attempts are often carried out for reasons not linked to an intention to die. They may be a form of self harm which has potential to endanger life; a cry for help; seeking attention; following through on a threat made, or a culmination of attempts to coerce, control or shame others into changing their behaviour or personal boundaries.

There have only been six transgender offenders who have committed suicide while in prison since 2006, with four of them occurring in the last two years. They were all born male. One of the transgender prisoners was living in a women’s prison when they died. The others were living in role as women in male prisons, in line with prison guidance, and did not have a GRC nor had they undergone any gender reassignment surgery. Four had complex mental health issues. One death was recorded by the coroner as ‘not intended’. There is no evidence that any of these suicides were connected to poor treatment as a transgender prisoner or that living in a prison that matched their gender identity would have prevented their suicide.

The background of each of the six suicides is described below. The following information is not intended to show any lack of compassion towards the people who took their lives. It is a factual record of the circumstances in question to highlight the truth of these tragic deaths to aid a constructive and informed debate.

Lisa Woodhall

Self-inflicted death in custody on 8 October 2006. This prisoner was born male and underwent a gender reassignment operation in September 2004, two years before their death in 2006 aged 28. Woodhall was imprisoned for an offence of wounding with intent and sentenced to four and a half years for slashing the eyelids of an ex-boyfriend’s male partner. They served their sentence in the women’s prison HMP Eastwood. The prisoner was a repeat self-harmer who was also judged a threat to other prisoners and to staff. They were in segregation at the time of their death and on suicide watch being checked three times an hour. A psychiatrist diagnosis was that the offender had a personality disorder with emotionally unstable and dis-social traits. They appeared to believe that there was a conspiracy against them. Their last written words were, ‘Goodbye all those not in a plot against me’. An inmate said Ms Woodhall had been “picked on” by other prisoners, and had lost faith in the prison officers’ ability to do anything about it. There was no evidence that this death was due to the prisoner’s transsexual status.

Prisoner Y Self-inflicted death in custody on 13 July 2012. The prisoner was sentenced to life with a minimum period to serve of six years, for the kidnap and sexual assault of a minor in 1991. In 1996, they were convicted of the rape of another prisoner and received an eight year concurrent sentence. This prisoner had been in a category A prison for more than twenty years (meaning they were highly dangerous to the public, police or national security if they were to escape). Their category and sentence progression caused them much frustration, and previous applications to reduce the category had been refused. In 2011 the prisoner socially transitioned and had been living as a woman for nine months at the time of their death aged 44. They wore women’s clothing, had access to make up and the majority of staff referred to them as a female. There is no report that they were taking hormones nor that they had undergone gender surgery. This prisoner did not have a GRC and was legally male so was not eligible for transfer to a women’s prison and remained in a male prison (Full Sutton). On the afternoon of their death, a prisoner made an accusation of sexual assault against them. Prisoner Y was found hanging in their cell later that night. In a letter found in their cell, they wrote of alleged blackmail related to the sexual assault and how these accusations would have affected category review and progress towards gender reassignment. There was no evidence that the suicide was due to their treatment as a transgender prisoner nor had they requested to be transferred to a women’s prison.

Vikki Thompson

Self-inflicted death in custody on 13 November 2015. Twenty-one year old Vikki identified as female for over ten years but had never had any surgical or hormone treatment. Vikki was in custody awaiting sentencing for robbery and was being held in a single-occupancy cell at the male prison HMP Leeds. Her family and partner campaigned from the outset for a move to a female prison and quoted Vikki as saying she would “leave in a box” if imprisoned in a male one. Vikki was assessed by a mental health nurse, but not offered any further mental health support, and was prescribed anti-depressants by a doctor who did not evaluate in person. Community health records were not obtained. Vikki self-harmed throughout her first month at the prison. Vikki was placed on a vulnerable prisoner wing and staff had been checking on her hourly. Sadly Vikki was found dead in the cell at HMP Leeds in November 2015. The inquest into the death concluded that the management of their treatment and mental state of mind were lacking in professionalism and inadequate for an individual of such complex issues. It was also concluded that it was correct that Vikki was placed in a male jail and that “she did not intend to take her own life”.

Joanne Latham

Self-inflicted death in custody on 27 November 2015. Originally imprisoned for an attempted murder in 2001, they had also attempted to murder a prisoner in 2007 and a fellow patient at Rampton in 2011. Thirty eight year old Joanne was an exceptionally violent and mentally ill prisoner and had spent a number of years in a high security psychiatric hospital and often self-harmed. Since May 2014, they had been held in the close supervision centre at Woodhill, part of a national system for managing the most disruptive and dangerous prisoners. Staff assessed that there was a risk that Ms Latham might attack someone at any time, with the intention of killing them or causing serious harm. Ms Latham who had begun identifying as transgender three months earlier, was serving a life sentence for three attempted murders when the death in custody occurred. The inquest heard that this prisoner “went through phases” and was not committed to changing gender. Indeed earlier that year Ms Latham told staff that they wanted to become a Muslim and made plans to change their name. However, one month later, they asked an officer to change the records of religion from Muslim to no religion. Ms Latham had not requested a transfer to the female estate and the inquest concluded that the transition had been handled correctly. Had this prisoner been a natal female, the level of violence and risk to staff and fellow prisoners means they would have still needed to have been incarcerated within the high security male estate, in line with UK policy. Women’s prisons do not have the required high security facilities; the risk Ms Latham represented to staff and other prisoners required that 5 prison guards were present whenever their cell door was opened. Ms Latham was being monitored under Prison Service suicide and self-harm prevention procedures at the time of death. The coroner said “I am concerned that these procedures did not operate fully effectively and the frequency of observations did not reflect her high risk at the time. While I recognise that Ms Latham was regarded as a high risk of violence towards staff, as well as to herself, I consider that it took prison staff too long to go into her cell after she had barricaded it, seriously self-harmed, and then did not respond at a welfare check. National and local guidance to deal with cell barricades were not followed. Sadly, when staff eventually intervened, it was too late to save Ms Latham“. There is no evidence that Joanne Latham’s death was because of their transgender status or because of not living in a women’s prison.

Jenny Swift

Self-inflicted death in custody 30 December 2016. Jennifer Swift, who was legally known as Jonathan Swift, seriously assaulted Eric Flanagan in an unprovoked attack with a kitchen knife and a broken shovel, after drinking alcohol and taking crack cocaine. Mr Flanagan died in hospital as a result of his injuries a month later. Following Mr Flanagan’s death the Crown Prosecution Service authorised a charge of murder but Swift was found hanged in the cell at HMP Doncaster while on remand before being formally charged. While in custody Swift had been assessed as having personality disorder issues and made a number of comments including saying there was “no remorse”. Issues reported by a friend included difficulty in accessing hormone treatment while in prison. Jenny had been self-medicating for three years but did not have a prescription for her hormones. It is also reported that Swift asked to be put into a women’s prison when she was charged with attempted murder at Doncaster Magistrates’ Court but this request was denied, meaning Swift did not have a GRC. Jenny’s inquest will be held in December 2017.

UPDATE: The Inquest has now happened but we are still awaiting publication of the fatal incident report on the Prison Ombudsmen website.

Jade Eatough Self-inflicted death in custody 19 August 2017. Jade committed a double assault as Martin Eatough and was serving a life sentence for the rape of a 15 year old girl at knife-point, shortly after the assault and attempted rape of a 19 year old in 2006. Serving the sentence in a male jail on the Isle of Wight, Eatough had begun to transition while incarcerated and was taking hormone replacements as the first stage of gender reassignment. Jade was not on a suicide watch and was living normally. They were found dead during a routine check at 5am. The inquest has yet to be carried out so there is no further information about whether a transfer to the female estate had been requested. There is currently no evidence that this death was connected to the prisoner’s transgender status.

Addendum:

Two additional examples of deaths in custody not included in the list of self-inflicted deaths by transgender prisoners.

It has been reported that Nicola Cope died at Foston Hall Prison in November 2016. Cope, born male, was convicted of nine charges of rape and four of indecent assault on two young girls and jailed for 16 years at Stafford Crown Court in 2015 and also ordered to register as a sex offender for life. The rapes were committed prior to Cope undergoing gender reassignment surgery. Cope was serving the sentence at a women’s prison. No inquest or fatal incident report by the Prisons & Probations Ombudsman is available online so it is unknown if Cope’s death was the result of natural causes or not.

Nina/Senthooran Kanagasingham had a history of mental health problems and was diagnosed with gender dysphoria in 2009. He had started taking hormones in early 2010 but had stopped his gender transition over a year before his death aged 37. In October 2010, he pushed a friend under a tube train and was remanded into custody. He was convicted of manslaughter by reason of diminished responsibility. He was sentenced to life imprisonment in December 2011 and was serving his sentence at Belmarsh. He decided not to continue with treatment for gender dysphoria and lived according to his birth gender. He was found dead in his cell in April 2013. He had complex mental health issues and the inquest highlights inadequate clinical care. There is no evidence that his past gender dysphoria was connected to his suicide.