Source · Deaths in custody

PPO Fatal Incident Reports

6,401 incidents 5,674 published 1,165 recommendations 1,633 self-inflicted 3,373 natural causes

Deaths in custody investigated by the Prisons and Probation Ombudsman. 26% of deaths are self-inflicted. Source: PPO.

Learning & thematic publications

74 cross-establishment publications

Learning Lessons Bulletins (50), thematic reviews (2), consultation responses (11), Policy into Practice (5) and annual reports (6): the systemic patterns the Ombudsman draws from many investigations.

TitleTypeDateSource
PPO response to JSC Inquiry into Children and Young Adults in the Secure Estate  Consultation response Jun 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 22: Self-inflicted deaths in reception prisons Learning Lessons Bulletin Mar 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 21: Segregation Learning Lessons Bulletin Mar 2026 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 20: Epilepsy Learning Lessons Bulletin Nov 2025 PDF
Annual Report 2024 to 2025 Annual report Jul 2025 PDF
Policy into Practice: Handling of prisoners’ property Policy into Practice Mar 2025 PDF
Policy into Practice: Handling of property complaints Policy into Practice Mar 2025 PDF
Complaints Investigations Learning Lessons Bulletin Issue 11: Property complaints Learning Lessons Bulletin Mar 2025 PDF
PPO response to JSC Tackling Drugs in Prison Inquiry Consultation response Feb 2025 PDF
PPO response to JHAC Inquiry into Prison Culture Consultation response Feb 2025 PDF
PPO response to JSC inquiry into Rehabilitation and Resettlement Consultation response Feb 2025 PDF
Policy into Practice: Emergency Response Policy into Practice Jan 2025 PDF
PPO response to the Independent Sentencing Review 2024/25 call for evidence Consultation response Jan 2025 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 19: Post-release death investigations 2 Learning Lessons Bulletin Jul 2024 PDF
Annual report 2022-23 Annual report Jul 2024 PDF
Annual Report 2023-24 Annual report Jul 2024 PDF
Policy into practice: Use of force Policy into Practice Feb 2024 PDF
PPO response to the inquiry into prison population and capacity Consultation response Nov 2023 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 18: Self-inflicted deaths of IPP prisoners Learning Lessons Bulletin Sep 2023 PDF
Investigating deaths after release from prison – a pilot evaluation Learning Lessons Bulletin Jan 2023 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 17: Post-release death investigations Learning Lessons Bulletin Jan 2023 PDF
PPO response to the inquiry into the Prison Operational Workforce Consultation response Jan 2023 PDF
Annual Report 2021-22 Annual report Oct 2022 PDF
Policy into Practice: Use of restraints on escort Policy into Practice Sep 2022 PDF
PPO Response to the Inquiry into IPP sentences Consultation response Jan 2022 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 16: Second wave COVID-19 related deaths Learning Lessons Bulletin Dec 2021 PDF
Annual Report 2020-21 Annual report Sep 2021 PDF
PPO responses to the Inquiry into Women in Prison Consultation response Aug 2021 PDF
Fatal Incident Investigations Learning Lessons Bulletin Issue 15: COVID-19 PPO fatal incident investigations Learning Lessons Bulletin Feb 2021 PDF
Complaints Investigations Learning Lessons Bulletin Issue 10: COVID-19 PPO Complaints Learning Lessons Bulletin Dec 2020 PDF

Incidents

6,401 records
Name Establishment Cause Status Date of death Recs
Individual at Low Newton HMP Low Newton Other Published 13 Nov 2010
Individual at Isle of Wight HMP Isle of Wight Natural Published 12 Nov 2010
Individual at Wandsworth HMP Wandsworth Natural Published 8 Nov 2010
Individual at Maidstone HMP Maidstone Natural Published 8 Nov 2010
Individual at Norwich HMP Norwich Natural Published 2 Nov 2010
Individual at Norwich HMP Norwich Natural Published 29 Oct 2010
Individual at Wymott HMP Wymott Natural Published 28 Oct 2010
Individual at Dovegate HMP Dovegate Natural Published 27 Oct 2010
Individual at Isle of Wight HMP Isle of Wight Natural Published 24 Oct 2010
Individual at Exeter HMP Exeter Natural Published 20 Oct 2010
Individual at Hewell HMP Hewell Self-inflicted Published 20 Oct 2010
Individual at Frankland HMP Frankland Natural Published 19 Oct 2010
Individual at Brixton HMP Brixton Other Published 18 Oct 2010
Individual at Hull HMP Hull Natural Published 16 Oct 2010
Individual at Manchester HMP Manchester Natural Published 15 Oct 2010
Individual at Birmingham HMP Birmingham Natural Published 12 Oct 2010
Individual at Brook House IRC Brook House Other Published 12 Oct 2010
Individual at Nottingham HMP Nottingham Self-inflicted Published 10 Oct 2010
Individual at Frankland HMP Frankland Natural Published 10 Oct 2010
Individual at Gartree HMP Gartree Self-inflicted Published 10 Oct 2010
Individual at Leeds HMP Leeds Self-inflicted Published 6 Oct 2010
Individual at Durham HMP Durham Natural Published 4 Oct 2010
Individual at Leicester HMP Leicester Natural Published 2 Oct 2010
Individual at Manchester HMP Manchester Natural Published 1 Oct 2010
Individual at Linden Bank Linden Bank Self-inflicted Published 29 Sep 2010
Individual at Isle of Wight HMP Isle of Wight Natural Published 28 Sep 2010
Individual at Bedford HMP Bedford Self-inflicted Published 27 Sep 2010
Individual at Ty Newydd Ty Newydd Natural Published 26 Sep 2010
Individual at Birmingham HMP Birmingham Self-inflicted Published 26 Sep 2010
Individual at Cardiff HMP Cardiff Natural Published 26 Sep 2010
Individual at Altcourse HMP Altcourse Natural Published 25 Sep 2010
Individual at Lindholme HMP Lindholme Natural Published 24 Sep 2010
Individual at Wymott HMP Wymott Natural Published 21 Sep 2010
Individual at Wealstun HMP Wealstun Other Published 19 Sep 2010
Individual at Pentonville HMP Pentonville Natural Published 19 Sep 2010
Individual at Swansea HMP Swansea Self-inflicted Published 18 Sep 2010
Individual at Full Sutton HMP Full Sutton Natural Published 17 Sep 2010
Individual at Acklington HMP Acklington Self-inflicted Published 17 Sep 2010
Individual at Hewell HMP Hewell Self-inflicted Published 12 Sep 2010
Individual at Pentonville HMP Pentonville Self-inflicted Published 10 Sep 2010
Individual at St Christophers House St Christophers House Other Published 9 Sep 2010
Individual at Wymott HMP Wymott Natural Published 8 Sep 2010
Individual at Maidstone HMP Maidstone Natural Published 6 Sep 2010
Individual at Wymott HMP Wymott Natural Published 4 Sep 2010
Individual at Birmingham HMP Birmingham Natural Published 3 Sep 2010
Individual at Chorlton Chorlton Natural Published 3 Sep 2010
Individual at Norwich HMP Norwich Self-inflicted Published 1 Sep 2010
Individual at Birmingham HMP Birmingham Self-inflicted Published 30 Aug 2010
Individual at Holloway HMP Holloway Other Published 29 Aug 2010
Individual at Parc HMP Parc Self-inflicted Published 24 Aug 2010