Suicide Prevention

1
Suicide Prevention

• In the Corrections Environment

2
Statistics

• Suicide is the leading cause of death in American
  Jails
• It is the third leading cause of death in
  American Prisons
• The majority of suicides are accomplished through
  hanging, which causes brain death in 4 minutes,
  and result in death in 5 or 6 minutes

3
Statistics Per State

• The leading 5 states in prison suicide are
  California, Texas, New York, Illinois, and
  Maryland.
• Nevada is tied for 27th in prison suicides per
  state for 3 in 2010

4
Mental Health Prevalence

• Major Depression
• 29.7 of population in Jails
• 23.5 of population in Prisons
• 16 of population in Federal Prisons
• Previous Mental Health Institutionalization
• 10 in combined population of all three have had
  at least one psychiatric hospitalization prior to
  incarceration
• APA review in 2000 found that 20 of prison and
  jail inmates are in need of psychiatric care and
  5 are actively psychotic

5
Risk Factors

• Depression
• Any serious mental illness, such as schizophrenia
  and bipolar disorder
• Substance Abuse
• The combination of mental illness and substance
  abuse
• Borderline and Antisocial Personality Disorders
• Impulsivity and aggression
• History of suicide attempt or family history of
  suicide
• Serious physical illness or chronic pain
• Long Sentence
• Severe guilt or shame
• Rape or threat of rape
• Any recent drug/alcohol ingestion (Depression
  sets in when the euphoric effects wear off)

6
High Risk Time Frames

• The first 24 hours of confinement!
• Intoxication or withdrawal
• Waiting for trial
• During sentencing
• After count time
• Around holidays
• After visitation
• Impending release
• After receiving bad news (i.e. death of a loved
  one, divorce, etc.)

7
Warning Signs

• Talking about suicide or wanting to die
• Discussing ways in which it can be completed
• Talking about feeling hopeless
• Talking about feeling trapped
• Acting agitated or aggressive
• Behaving recklessly
• Sleeping too little or too much
• Not talking to others not coming out of cell for
  yard or tier time
• Showing rage
• Displaying extreme mood swings

8
Warning Signs Continued

• Expressing excessive guilt or shame over offense
• Having a history of suicide attempts
• Expressing hopelessness/helplessness
• Excessive anxiety
• Extreme calm after a period of agitation
• Preoccupation with the past
• Packs up/gives away belongings
• Participates in self harming (parasuicidal)
  behaviors for attention
• Paranoia

9
Depression

• Though any of the previous factors may contribute
  to suicidal intent, 70 to 80 of all suicides
  are committed by people who are severely
  depressed
• The most common symptoms of depression include
• Feelings of inability to continue
• Extreme sadness and/or crying
• Social isolation
• Fluctuations in appetite, weight, and sleep
• Mood/behavior changes
• Tension and anxiety
• Loss of motivation

• Cont
• Loss of self esteem
• Loss of interest
• Poor hygiene
• Difficulty concentrating
• Easily angered or increased agitation

10
Suicide Prevention in Corrections

• Upon intake, assess suicide risk and imminent
  suicide risk. Risk status can change over time
  staff need to recognize and respond to changes in
  an inmates mental condition
• Information to follow an inmate in case of
  movement
• Previous/current threats
• Behaviors of depression
• History of psychiatric care
• PC or seg status
• Appropriate observation in isolation
  cellsremember, any segregation increases the
  risk for suicide!

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Identifying Suicidal Inmates

• PAY ATTENTION!!!!!

12
The MOST critical time to pay attention to
warning signs is during the intake process!!

• OBSERVATION
• Pay attention to the inmates speech, attitude,
  and state of mind.
• Look for scars from previous attempts.
• Look for signs of recent trauma.
• Look for signs of current intoxication or
  withdrawal.

13
Intake

• QUESTIONNAIRE
• This screens inmates personal histories as well
  as past/current mental and physical health.
• Try to do it in private and use language the
  inmate can understand.
• If the inmate is intoxicated, put under direct
  observation until he can participate.

14
Intake

• DISPOSITION
• Following the observation and interview steps, a
  housing determination is made.
• Automatic isolation is not the key for suicidal
  inmates!
• This reinforces the risk for suicide.
• If isolation is needed, they need to be under
  direct staff supervision.

15
Two Levels of Suicidality

• Low Risk Suicidal Inmates
• Not actively suicidal, but have a history of
  attempts or have current thoughts
• Should be housed with other inmates and checked
  by staff at regular, frequent intervals
• High Risk Suicidal Inmates
• Actively suicidal by expressing threats or
  engaging in suicidal behaviors
• Should be placed on suicide watch status and
  placed in suicide dress with no personal
  belongings

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But what about fakers?

• TAKE ALL THREATS SERIOUSLY! Do not make a
  judgment call regarding the sincerity of the
  threatcontact medical or mental health staff to
  assess and make a decision about the necessary
  intervention.

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When communicating with suicidal inmates, do not

• offer solutions or give advice
• become angry, judgmental, or threatening
• act sarcastically or make jokes
• placate and make promises
• challenge the inmate to follow through on the
  suicidal threat
• And above all, DO NOT IGNORE THE THREAT!

18
Manipulation

• Inmate may threaten suicidal behavior to get
  something they want, or avoid something they
  dont want.
• Remember, its not your responsibility to make
  this call!
• Refer the inmate to mental health and
• DOCUMENT, DOCUMENT, DOCUMENT!

19
Suicide Attempt/Completion

• 94 of inmate suicides are by hanging.
• NEVER assume the inmate is dead!
• 1. Call for back up
• 2. Survey the area for safety and security
• 3. Get help and cut inmate down
• Protect the head and neck as much as possible
• 4. Initiate CPR while back up calls for medical
• Even if there are no vital signs, do not stop CPR
  until medical staff tells you to do so

20
Suicide Myths (Dont believe them!!!)

• Myth 1 People who threaten suicide dont commit
  suicide.
• FACT Most people who commit suicide have made
  direct or indirect statements of their
  intentions.
• Myth 2 People who have attempted suicide in the
  past will not do it again.
• FACT A history of attempts increases the
  likelihood of repeated attempts.

21
Suicide Myths Continued

• Myth 3 Suicidal people are intent on dying.
• FACT Most suicidal people dont WANT to die, but
  they believe that is the only way out of their
  current situationthey think they are out of
  options.
• Myth 4 Talking to people about their suicidal
  thoughts will cause them to follow through.
• FACT You CANNOT make someone suicidal by
  discussing suicide.

22
Suicide Myths Continued

• Myth 5 All suicidal people are mentally ill.
• FACT Suicidal people are extremely depressed and
  unhappy, they are not necessarily mentally ill.
• Myth 6 If someone really wants to kill
  themselves, theres nothing you can do about it.
• FACT Almost ALL prison and jail suicides CAN BE
  PREVENTED!

23
You have the ability to prevent suicides.

• It takes attention to, observation of, and
  knowledge of the information weve discussed, and
  the courage to take action.

24
Discussion Case Example
25
Mr. Thomas

• Mr. Thomas is in his sixties. He has been
  incarcerated for 10 years for the murder of his
  wife. He is being treated for a serious medical
  condition which may be cancer.
• He has never had communication with family or
  friends. He works as a porter and is trusted by
  the officers. He was told yesterday that the
  parole board continued him for 10 more years.
• His parole appearance occurred during a week when
  the normal unit SC/O was on leave. Mr. Thomas
  often spoke with him about life in general.
• Today, two days after the parole hearing, Mr.
  Thomas was found hanging in the supply closet.

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What were Mr. Thomas's Risk Factors?

• Serious physical illness
• Possible undiagnosed depression
• Parole news creating hopelessness
• Lack of usual social stimulation while SC/O was
  away isolation
• Access to supply closet and lethal means

27
How could Mr. Thomas's suicide have been
prevented?
28
Hey youyeah, YOU!

• Correctional staff, NOT just inmates, can also be
  at risk for suicide. This includes officers,
  nurses, case workers, psychologists, etc.
• Not only do you have "normal" problemsnot enough
  money, not enough time, stress, bills, etc.you
  work everyday with some of the darkest of human
  kind that view you as "the enemy."

29
Sound familiar?

• After balancing the checkbook until 1am and
  finding that the mounting bills provided you
  nothing more than a fitful sleep, you wake up and
  realize that it's 445am, and your shift starts
  at 5am. No time to prepare yourself for the day,
  you battle terrible drivers, arrive at work, and
  are greeted by your supervisor that is none too
  happy about your tardiness. During your shift,
  you feel underappreciated by "the brass" and are
  subjected to constant verbal harassment by
  inmates. After enduring this for 8 hours, you
  encounter the same bad drivers on the way home,
  where financial, relational, and other stressors
  await.
• On top of other potential risk factors, is it
  really that surprising that officers,
  specifically, commit suicide at a rate that is
  double that of the regular population?

30
You are NOT alone!

• Don't hold everything in. Talk to family and
  friends. See a therapist. Set aside time for
  things you enjoy. But don't ignore your stress
  and hope it goes away.
• Stress, depression, anger, etc. will ONLY go away
  if you face it with healthy coping skills.

31
Put beautifully by a former C.O.

• We have all been in some very dark places in our
  lives.  I know that I have, and sometimes suicide
  seems like a solution. What has helped me to hold
  on in seemingly hopeless times is something my
  father shared with me in my darker days. No
  matter what position you are in, there is always
  hope and potential while you still have life.
  Once your life is gone there is no hope, there is
  no recovery. It is over, and there is no getting
  it back. If this reaches anyone out there who is
  contemplating this as an option, please talk to
  someone.Call the Ventline. I hate hearing the
  news of corrections workers killing themselves.
  Everyone makes mistakes, poor choices, and is
  afraid of consequences. But no consequence is so
  severe that one should do this to themselves. God
  bless you all. Take care of yourselves and one
  another.