 |
Home  Locations |
 |
Key Components
of a Suicide Prevention Program
Lindsay M. Hayes©National Center on Institutions and Alternatives, 2007 All correctional facilities, regardless of size, should have a comprehensive suicide prevention policy that addresses the following key components. Staff Training
The essential component to any suicide prevention program is properly
trained correctional staff, who form the backbone of any jail or
prison facility. Very few suicides actually are prevented by mental
health, medical or other professional staff because suicides usually
are attempted in inmate housing units, and often during late evening
hours or on weekends when they are generally outside the purview
of program staff. These incidents, therefore, must be thwarted by
correctional staff who have been trained in suicide prevention and
have developed an intuitive sense about the inmates under their
care. Correctional officers are often the only staff available 24
hours a day; thus, they form the front line of defense in preventing
suicides.
All correctional staff, as well as medical and mental health personnel, should receive eight (8) hours of initial suicide prevention training, followed by a minimum of two (2) hours refresher training each year. Training should include obstacles to prevention, research, why correctional environments are conducive to suicidal behavior, potential predisposing factors to suicide, high-risk suicide periods, warning signs and symptoms, identifying suicidal inmates despite the denial of risk, guiding principles to suicide prevention, components of an effective suicide prevention policy, critical incident staff debriefing, and liability issues. In addition, all staff who have routine contact with inmates should receive standard first aid and cardiopulmonary resuscitation (CPR) training. All staff should also be trained in the use of various emergency equipment located in each housing unit. In an effort to ensure an efficient emergency response to suicide attempts, “mock drills” should be incorporated into both initial and refresher training for all staff. Intake Screening/Assessment
Screening and assessment of inmates when they enter a facility
is critical to a correctional facility’s suicide prevention
efforts. Although the psychiatric and medical communities disagree
about which factors can be used to predict suicide in general, there
is little disagreement as to the value of screening and assessment
to the increased likelihood of preventing suicide. Intake screening
for all inmates and ongoing assessment of inmates at risk is critically
important because prior research has consistently reported that
at least two thirds of all suicide victims communicate their intent
some time before death and that any individual with a history of
one or more suicide attempts is at a much greater risk for suicide
than those who have never made an attempt.
Intake screening may be contained within the medical screening
form or as a separate form, and should include inquiry regarding:
past suicidal ideation and/or attempts; current ideation, threat,
plan; prior mental health treatment/hospitalization; recent significant
loss (job, relationship, death of family member/close friend, etc.);
history of suicidal behavior by family member/close friend; suicide
risk during prior confinement; and arresting/transporting officer(s)
belief that inmate is currently at risk. The process should also
include referral procedures to mental health and/or medical personnel
for assessment. Following the intake process, should any staff hear
an inmate verbalize a desire or intent to commit suicide, observe
an inmate making a suicidal gesture, or otherwise believe an inmate
is at risk for suicide, a procedure should be in place that allows
that staff member to take immediate steps to ensure that the inmate
is continuously observed until appropriate medical, mental health,
and/or supervisory assistance is obtained. Communication
Certain behavioral signs exhibited by the inmate may be indicative
of suicidal behavior and, if detected and communicated to others,
can prevent a suicide. There are essentially three levels of communication
in preventing inmate suicides: between the arresting/transporting
officer and correctional staff; between and among facility staff
(including medical and mental health personnel); and between facility
staff and the suicidal inmate.
In many ways, suicide prevention begins at the point of arrest. During Level 1, what an individual says and how they behave during arrest, transportation the jail, and at booking are crucial to detecting suicidal behavior. The scene of arrest is often the most volatile and emotional time for the arrestee. Arresting officers should pay close attention to the arrestee during this time; suicidal behavior may be manifested, and previous behavior can be confirmed by onlookers such as family and friends. Any pertinent information regarding the arrestee’s well-being must be communicated by the arresting/transporting officer to correctional staff. During Level 2, effective management of suicidal inmates often comes down to communication among correctional officers and other professional staff. Because inmates can become suicidal at any point during incarceration, correctional officers must maintain awareness, share information and make appropriate referrals to mental health and medical staff. During Level 3, facility staff must use various communication skills with the suicidal inmate, including active listening, staying with the inmate if they are in immediate danger, and maintaining contact through conversation, eye contact, and body language. Correctional staff should trust their own judgment and avoid being misled by others (including mental health staff) into ignoring signs of suicidal behavior. A common factor found in the review of many inmate suicides has been the communication breakdown between correctional, medical, and mental health personnel. Housing
In determining the most appropriate housing location for a suicidal
inmate, correctional officials (with concurrence from medical and/or
mental health staff) often tend to physically isolate and sometimes
restrain the individual. These responses might be more convenient
for all staff, but they are detrimental to the inmate since the
use of isolation escalates the inmate’s sense of alienation
and further removes the individual from proper staff supervision.
To every extent possible, suicidal inmates should be housed in the
general population, mental health unit, or medical infirmary, located
close to staff. Further, removal of an inmate’s clothing (excluding
belts and shoelaces) and the use of physical restraints (e.g., leather
straps, straitjackets, chairs, etc.) should be avoided whenever
possible, and used only as a last resort when the inmate is physically
engaging in self-destructive behavior. Handcuffs should never be
used to restrain a suicidal inmate. Housing assignments should be
based on the ability to maximize staff interaction with the inmate,
not on decisions that heighten depersonalizing aspects of incarceration.
All cells designated to house suicidal inmates should be suicide-resistant, free of all obvious protrusions, and provide full visibility. These cells should contain tamper-proof light fixtures and ceiling air vents that are protrusion-free. Each cell door should contain a heavy gauge Lexan (or equivalent grade) glass panel that is large enough to allow staff a full and unobstructed view of the cell interior. Each cell housing a suicidal inmate should not contain any electrical switches or outlets, bunks with open bottoms, any type of clothing hook, towel racks on desks and sinks, radiator vents, or any other object that provides an easy anchoring device for hanging. Finally, each housing unit in the facility should contain various emergency equipment, including a first aid kit, pocket mask or face shield, Ambu-bag, and rescue tool (to quickly cut through fibrous material). Correctional staff should ensure that such equipment is in working order on a daily basis. Levels of Supervision
Medical experts warn that brain damage from strangulation caused
by a suicide attempt can occur within four minutes, and death often
within five to six minutes. In jail and prison suicide attempts,
the promptness of the response is often driven by the level of supervision
afforded the inmate. Standard correctional practice requires that
“special management inmates,” including those housed
in administrative segregation, disciplinary detention and protective
custody, be observed at intervals that do not exceed every 30 minutes,
with mentally ill inmates observed more frequently. Inmates held
in medical restraints and “therapeutic seclusion” should
be observed at intervals that do not exceed every 15 minutes.
Consistent with national correctional standards and practices, two levels of supervision are generally recommended for suicidal inmates: close observation and constant observation. Close Observation is reserved for the inmate who is not actively suicidal, but expresses suicidal ideation (through verbalization or behavior) and/or has a recent prior history of self-destructive behavior. In addition, an inmate who denies suicidal ideation or does not threaten suicide, but demonstrates other concerning behavior (through actions, current circumstances, or recent history) indicating the potential for self-injury, should be placed under close observation. Staff should observe such an inmate at staggered intervals not to exceed every 15 minutes (e.g., 5, 10, 7 minutes, etc.). Constant Observation is reserved for the inmate who is actively suicidal, either threatening or engaging in the act of suicide. Staff should observe such an inmate on a continuous, uninterrupted basis. Other aids (e.g., closed-circuit television, inmate companions or watchers, etc.) can be used as a supplement to, but never as a substitute for, these observation levels. Finally, mental health staff should observe, assess, and interact with suicidal inmates on a daily basis. Intervention
Following a suicide attempt, the degree and promptness of the staff’s
intervention often foretell whether the victim will survive. National
correctional standards and practices generally acknowledge that a
facility’s policy regarding intervention should be threefold.
First, all staff who come into contact with inmates should be trained
in standard first aid procedures and cardiopulmonary resuscitation
(CPR). Second, any staff member who discovers an inmate attempting
suicide should immediately survey the scene to ensure the emergency
is genuine, alert other staff to call for medical personnel, and begin
standard first aid and/or CPR as necessary. Third, staff should never
presume that the inmate is dead, but rather should initiate and continue
appropriate life-saving measures until relieved by arriving medical
personnel. In addition, medical personnel should ensure that all equipment
utilized in responding to an emergency within the facility is in working
order on a daily basis. Reporting
In the event of a suicide attempt or suicide, all appropriate correctional
officials should be notified through the chain of command. Following
the incident, the victim’s family should be immediately notified,
as well as appropriate outside authorities. All staff who came into
contact with the victim prior to the incident should be required to
submit a statement as to their full knowledge of the inmate and incident.
Follow-Up/Morbidity-Mortality Review
An inmate suicide can be extremely stressful for staff. They may
also feel ostracized by fellow personnel and administration officials.
Following a suicide, misplaced guilt is sometimes displayed by the
officer who wonders: “What if I had made my cell check earlier?”
When crises occur and staff is effected by the traumatic event,
they should receive appropriate assistance. One form of assistance
is Critical Incident Stress Debriefing (CISD). A CISD team, comprising
professionals trained in crisis intervention and traumatic stress
awareness (e.g., police officers, paramedics, fire fighters, clergy,
and mental health personnel), provides effected staff an opportunity
to process their feelings about the incident, develop an understanding
of critical stress symptoms, and develop ways of dealing with those
symptoms. For maximum effectiveness, the CISD process or other appropriate
support services should occur within 24 to 72 hours of the critical
incident.
Every completed suicide, as well as serious suicide attempt (i.e., requiring hospitalization), should be examined through a morbidity-mortality review process. (If resources permit, clinical review through a psychological autopsy is also recommended.) The morbidity-mortality review should be conducted by a multidisciplinary team that includes representatives of both line and management level staff from the corrections, medical and mental health divisions. The review process should comprise a critical inquiry of: 1) circumstances surrounding the incident; 2) facility procedures relevant to the incident; 3) all relevant training received by involved staff; 4) pertinent medical and mental health services/reports involving the victim; 5) possible precipitating factors leading to the suicide; and 6) recommendations, if any, for changes in policy, training, physical plant, medical or mental health services, and operational procedures.
|