A/HRC/42/20 common cause of death in correctional settings. 85 Studies have found that the risk of suicide is three times higher for male prisoners and nine times higher for female prisoners than the general population.86 27. Conditions of detention can contribute to self-harm, to which detainees sometimes resort in order to draw public attention to their treatment and conditions of detention. 87 Overcrowding has been identified as a factor in self-harm and suicide.88 Conditions on death row, including solitary confinement, inadequate food and the constant use of restraints, have been acknowledged as often leading prisoners to develop psychological disorders and commit suicide.89 28. Other factors contributing to self-harm include the insufficient number of psychologists and psychiatrists and the lack of training of prison staff in how to maintain or improve the mental health of detainees.90 Lack of vigilance towards persons requiring special protection is an additional factor. In its general comment No. 36 (2018) on the right to life, the Human Rights Committee highlighted the duty of States to take adequate measures to prevent suicides of individuals deprived of their liberty. Additional vigilance is required for detainees with psychosocial disabilities, a history of self-harm and suicide attempts, a history of substance abuse and signs of increased risk of suicide, such as lack of family visits, both at the moment the person is sentenced or when a relative dies. 91 3. Lack of adequate access to health care 29. States must respect the right to health and ensure equal access for all persons, including those deprived of their liberty, to preventive, curative and palliative health services.92 However, access to health care is often inexistent or inadequate and infringements of the right to health contribute to deaths in situations of deprivation of liberty.93 30. Rates of disease, drug dependency and mental illness in the prison population are much higher than in the general population.94 Indeed, mortality rates are high and have been shown to be as much as 50 per cent higher for prisoners than for people in the wider community.95 Infectious and communicable diseases are often not adequately treated with potential lethal consequence.96 Infection rates for tuberculosis are between 10 and 100 times greater among the prison population.97 Prisoners are five times more likely to be living with HIV and are often left without treatment.98 The full impact of overcrowding on access to health care by persons deprived of their liberty has been addressed in previous reports of the High Commissioner on human rights in the administration of justice.99 31. Inadequate access to health care often stems from routine underfunding, understaffing and lack of prison health policy. This can result in shortages of medicine and medical supplies and a lack of specialists,100 which requires detainees to pay to receive 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 See World Health Organization and the International Association for Suicide Prevention, “Preventing suicide in jails and prisons” (Geneva, 2007). Submission of Penal Reform International. See CAT/C/KAZ/CO/3. See CAT/C/GBR/CO/5; Hans Wolff and others, “Self-harm and overcrowding among prisoners in Geneva, Switzerland”, International Journal of Prisoner Health, vol. 12, No. 1 (2016). See CAT/C/VNM/CO/1. Submission of Penal Reform International. Submission of the Comisión de Derechos Humanos del Distrito Federal (Mexico). See A/HRC/30/19. Ibid. Submission of Penal Reform International. See A/HRC/38/36; submission of Penal Reform International. See A/HRC/30/19. See World Health Organization Regional Office for Europe, Prisons and Health (Copenhagen, 2014). See Joint United Nations Programme on HIV/AIDS, The Prevention Gap Report (Geneva, 2016); CAT/OP/BEN/3. See A/HRC/30/19; A/HRC/36/28. See CAT/OP/BEN/3. 9