Understanding Deaths in Custodial Environments: A Systematic Review of Global Trends and Risk Factors.

Deaths in custodial settings mark a critical intersection of human rights, public health, and state accountability and serve as a key indicator of systemic deficiencies within correctional institutions. Evidence consistently shows that suicide is the leading cause of death in custody, especially during the early detention period. This trend reflects increased psychological vulnerability, pre-existing mental health issues, and limited access to specialized care. Natural causes - such as cardiovascular and respiratory diseases, infections, and complications from chronic illnesses - also make up a significant portion of deaths, often associated with limited healthcare access, delayed treatment, and resource shortages, particularly in overcrowded or underfunded facilities. Additional factors include substance abuse, absence of rehabilitation programs, and violent incidents, suggesting potential limitations in supervision, policy enforcement, and institutional oversight. This study was conducted using a systematic review methodology, with the aim of identifying and synthesizing evidence on the causes of death among individuals in custody across different detention settings and geographical regions. The findings emphasize the ongoing disconnect between international legal frameworks, such as the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules), and their actual application across jurisdictions. As a response, the review offers several evidence-based recommendations: mandatory medical and psychiatric assessments before detention, improved healthcare infrastructure, the adoption of rehabilitation and substance control programs, and the creation of independent investigative and monitoring bodies for all custodial deaths. Ultimately, reducing deaths in custody requires coordinated healthcare, institutional, and monitoring strategies aimed at improving detainee safety and healthcare outcomes. Protecting the lives and dignity of detainees remains an important responsibility of custodial institutions and public health systems.