Suicide PreventionSuicide Prevention

In the Corrections In the Corrections EnvironmentEnvironment

StatisticsStatistics

Suicide is the leading cause of death Suicide is the leading cause of death in American Jailsin American Jails

It is the third leading cause of death It is the third leading cause of death in American Prisonsin American Prisons

The majority of suicides are The majority of suicides are accomplished through hanging, which accomplished through hanging, which causes brain death in 4 minutes, and causes brain death in 4 minutes, and result in death in 5 or 6 minutesresult in death in 5 or 6 minutes

Statistics Per StateStatistics Per State

0

10

20

30

40

50

60

CA TX NY IL MD NV

PrisonSuicides PerState 2010

The leading 5 The leading 5 states in prison states in prison suicide are suicide are California, Texas, California, Texas, New York, Illinois, New York, Illinois, and Maryland.and Maryland.

Nevada is tied for Nevada is tied for 2727thth in prison in prison suicides per state suicides per state for 3 in 2010for 3 in 2010

Mental Health PrevalenceMental Health Prevalence Major DepressionMajor Depression

– 29.7% of population in Jails29.7% of population in Jails– 23.5% of population in Prisons23.5% of population in Prisons– 16% of population in Federal Prisons16% of population in Federal Prisons

Previous Mental Health InstitutionalizationPrevious Mental Health Institutionalization– 10% in combined population of all three have 10% in combined population of all three have

had at least one psychiatric hospitalization had at least one psychiatric hospitalization prior to incarcerationprior to incarceration

APA review in 2000 found that 20% of prison and APA review in 2000 found that 20% of prison and jail inmates are in need of psychiatric care and jail inmates are in need of psychiatric care and 5% are actively psychotic5% are actively psychotic

Risk FactorsRisk Factors DepressionDepression Any serious mental illness, such as schizophrenia and Any serious mental illness, such as schizophrenia and

bipolar disorderbipolar disorder Substance Abuse Substance Abuse The combination of mental illness and substance abuseThe combination of mental illness and substance abuse Borderline and Antisocial Personality DisordersBorderline and Antisocial Personality Disorders Impulsivity and aggressionImpulsivity and aggression History of suicide attempt or family history of suicideHistory of suicide attempt or family history of suicide Serious physical illness or chronic painSerious physical illness or chronic pain Long SentenceLong Sentence Severe guilt or shameSevere guilt or shame Rape or threat of rapeRape or threat of rape Any recent drug/alcohol ingestion (Depression sets in when Any recent drug/alcohol ingestion (Depression sets in when

the euphoric effects wear off)the euphoric effects wear off)

High Risk Time FramesHigh Risk Time Frames The first 24 hours of confinement!The first 24 hours of confinement! Intoxication or withdrawalIntoxication or withdrawal Waiting for trialWaiting for trial During sentencingDuring sentencing After count timeAfter count time Around holidaysAround holidays After visitationAfter visitation Impending releaseImpending release After receiving bad news (i.e. death of a After receiving bad news (i.e. death of a

loved one, divorce, etc.)loved one, divorce, etc.)

Warning SignsWarning Signs Talking about suicide or wanting to dieTalking about suicide or wanting to die Discussing ways in which it can be completedDiscussing ways in which it can be completed Talking about feeling hopeless Talking about feeling hopeless Talking about feeling trappedTalking about feeling trapped Acting agitated or aggressiveActing agitated or aggressive Behaving recklesslyBehaving recklessly Sleeping too little or too muchSleeping too little or too much Not talking to others; not coming out of cell for Not talking to others; not coming out of cell for

yard or tier timeyard or tier time Showing rageShowing rage Displaying extreme mood swingsDisplaying extreme mood swings

Warning Signs ContinuedWarning Signs Continued

Expressing excessive guilt or shame over offenseExpressing excessive guilt or shame over offense Having a history of suicide attemptsHaving a history of suicide attempts Expressing hopelessness/helplessnessExpressing hopelessness/helplessness Excessive anxietyExcessive anxiety Extreme calm after a period of agitationExtreme calm after a period of agitation Preoccupation with the pastPreoccupation with the past Packs up/gives away belongingsPacks up/gives away belongings Participates in self harming (parasuicidal) Participates in self harming (parasuicidal)

behaviors for attentionbehaviors for attention ParanoiaParanoia

DepressionDepression Though any of the previous Though any of the previous

factors may contribute to factors may contribute to suicidal intent, 70% to 80% suicidal intent, 70% to 80% of all suicides are of all suicides are committed by people who committed by people who are severely depressedare severely depressed

The most common The most common symptoms of depression symptoms of depression include:include:– Feelings of inability to continueFeelings of inability to continue– Extreme sadness and/or cryingExtreme sadness and/or crying– Social isolationSocial isolation– Fluctuations in appetite, Fluctuations in appetite,

weight, and sleepweight, and sleep– Mood/behavior changesMood/behavior changes– Tension and anxietyTension and anxiety– Loss of motivationLoss of motivation

Cont:Cont:– Loss of self esteemLoss of self esteem– Loss of interestLoss of interest– Poor hygienePoor hygiene– Difficulty concentratingDifficulty concentrating– Easily angered or Easily angered or

increased agitationincreased agitation

Suicide Prevention in Suicide Prevention in CorrectionsCorrections

Upon intake, assess suicide risk and imminent Upon intake, assess suicide risk and imminent suicide risk. Risk status can change over time; staff suicide risk. Risk status can change over time; staff need to recognize and respond to changes in an need to recognize and respond to changes in an inmate’s mental conditioninmate’s mental condition

Information to follow an inmate in case of Information to follow an inmate in case of movement:movement:– Previous/current threatsPrevious/current threats– Behaviors of depressionBehaviors of depression– History of psychiatric careHistory of psychiatric care– PC or seg statusPC or seg status

Appropriate observation in isolation cells—Appropriate observation in isolation cells—remember, any segregation increases the risk for remember, any segregation increases the risk for suicide!suicide!

Identifying Suicidal Identifying Suicidal InmatesInmates

PAY ATTENTION!!!!!PAY ATTENTION!!!!!

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

process!!process!! OBSERVATIONOBSERVATION

Pay attention to the inmate’s speech, Pay attention to the inmate’s speech, attitude, and state of mind.attitude, and state of mind.

Look for scars from previous attempts.Look for scars from previous attempts.

Look for signs of recent trauma.Look for signs of recent trauma.

Look for signs of current intoxication or Look for signs of current intoxication or withdrawal.withdrawal.

IntakeIntake

QUESTIONNAIREQUESTIONNAIRE

This screens inmates’ personal histories This screens inmates’ personal histories as well as past/current mental and as well as past/current mental and

physical health.physical health.

Try to do it in private and use language Try to do it in private and use language the inmate can understand.the inmate can understand.

If the inmate is intoxicated, put under If the inmate is intoxicated, put under direct observation until he can direct observation until he can

participate.participate.

IntakeIntake

DISPOSITIONDISPOSITION

Following the observation and interview Following the observation and interview steps, a housing determination is steps, a housing determination is

made.made.

Automatic isolation is not the key for Automatic isolation is not the key for suicidal inmates!suicidal inmates!

This reinforces the risk for suicide.This reinforces the risk for suicide.

If isolation is needed, they need to be If isolation is needed, they need to be under direct staff supervision.under direct staff supervision.

Two Levels of SuicidalityTwo Levels of Suicidality

Low Risk Suicidal InmatesLow Risk Suicidal Inmates– Not actively suicidal, but have a history of Not actively suicidal, but have a history of

attempts or have current thoughtsattempts or have current thoughts– Should be housed with other inmates and Should be housed with other inmates and

checked by staff at regular, frequent intervalschecked by staff at regular, frequent intervals High Risk Suicidal InmatesHigh Risk Suicidal Inmates

– Actively suicidal by expressing threats or Actively suicidal by expressing threats or engaging in suicidal behaviorsengaging in suicidal behaviors

– Should be placed on suicide watch status and Should be placed on suicide watch status and placed in suicide dress with no personal placed in suicide dress with no personal belongingsbelongings

But what about fakers?But what about fakers?

TAKE ALL THREATS SERIOUSLY! Do TAKE ALL THREATS SERIOUSLY! Do not make a judgment call regarding not make a judgment call regarding the sincerity of the threat—contact the sincerity of the threat—contact medical or mental health staff to medical or mental health staff to

assess and make a decision about assess and make a decision about the necessary intervention.the necessary intervention.

When communicating with When communicating with suicidal inmates, do not…suicidal inmates, do not…

……offer solutions or give adviceoffer solutions or give advice

……become angry, judgmental, or become angry, judgmental, or threateningthreatening

……act sarcastically or make jokesact sarcastically or make jokes

……placate and make promisesplacate and make promises

……challenge the inmate to follow through challenge the inmate to follow through on the suicidal threaton the suicidal threat

And above all, DO NOT IGNORE THE And above all, DO NOT IGNORE THE THREAT!THREAT!

ManipulationManipulation

Inmate may threaten suicidal behavior Inmate may threaten suicidal behavior to get something they want, or avoid to get something they want, or avoid

something they don’t want. something they don’t want.

Remember, it’s not your responsibility Remember, it’s not your responsibility to make this call! to make this call!

Refer the inmate to mental health andRefer the inmate to mental health and

DOCUMENT, DOCUMENT, DOCUMENT!DOCUMENT, DOCUMENT, DOCUMENT!

Suicide Attempt/CompletionSuicide Attempt/Completion

94% of inmate suicides are by hanging.94% of inmate suicides are by hanging. NEVER assume the inmate is dead!NEVER assume the inmate is dead!

– 1. Call for back up1. Call for back up– 2. Survey the area for safety and security2. Survey the area for safety and security– 3. Get help and cut inmate down3. Get help and cut inmate down

Protect the head and neck as much as possibleProtect the head and neck as much as possible

– 4. Initiate CPR while back up calls for 4. Initiate CPR while back up calls for medicalmedical Even if there are no vital signs, do not stop CPR Even if there are no vital signs, do not stop CPR

until medical staff tells you to do sountil medical staff tells you to do so

Suicide Myths (Don’t believe Suicide Myths (Don’t believe them!!!)them!!!)

Myth #1: People who threaten suicide Myth #1: People who threaten suicide don’t commit suicide.don’t commit suicide.– FACT: Most people who commit suicide FACT: Most people who commit suicide

have made direct or indirect statements have made direct or indirect statements of their intentions.of their intentions.

Myth #2: People who have attempted Myth #2: People who have attempted suicide in the past will not do it again.suicide in the past will not do it again.– FACT: A history of attempts increases FACT: A history of attempts increases

the likelihood of repeated attempts.the likelihood of repeated attempts.

Suicide Myths Continued…Suicide Myths Continued…

Myth #3: Suicidal people are intent on dying.Myth #3: Suicidal people are intent on dying.– FACT: Most suicidal people don’t WANT to FACT: Most suicidal people don’t WANT to

die, but they believe that is the only way die, but they believe that is the only way out of their current situation—they think out of their current situation—they think they are out of options.they are out of options.

Myth #4: Talking to people about their Myth #4: Talking to people about their suicidal thoughts will cause them to follow suicidal thoughts will cause them to follow through.through.– FACT: You CANNOT make someone suicidal FACT: You CANNOT make someone suicidal

by discussing suicide.by discussing suicide.

Suicide Myths ContinuedSuicide Myths Continued

Myth #5: All suicidal people are mentally Myth #5: All suicidal people are mentally ill.ill.– FACT: Suicidal people are extremely FACT: Suicidal people are extremely

depressed and unhappy, they are not depressed and unhappy, they are not necessarily mentally ill.necessarily mentally ill.

Myth #6: If someone really wants to kill Myth #6: If someone really wants to kill themselves, there’s nothing you can do themselves, there’s nothing you can do about it.about it.– FACT: Almost ALL prison and jail suicides FACT: Almost ALL prison and jail suicides

CAN BE PREVENTED!CAN BE PREVENTED!

You have the ability You have the ability to prevent suicides. to prevent suicides.

It takes attention to, observation It takes attention to, observation of, and knowledge of the of, and knowledge of the

information we’ve discussed, and information we’ve discussed, and the courage to take action.the courage to take action.

Discussion: Case Discussion: Case ExampleExample

Mr. ThomasMr. Thomas Mr. Thomas is in his sixties. He has been Mr. Thomas is in his sixties. He has been

incarcerated for 10 years for the murder of his incarcerated for 10 years for the murder of his wife. He is being treated for a serious medical wife. He is being treated for a serious medical condition which may be cancer.condition which may be cancer.

He has never had communication with family or He has never had communication with family or friends. He works as a porter and is trusted by friends. He works as a porter and is trusted by the officers. He was told yesterday that the the officers. He was told yesterday that the parole board continued him for 10 more years.parole board continued him for 10 more years.

His parole appearance occurred during a week His parole appearance occurred during a week when the normal unit SC/O was on leave. Mr. when the normal unit SC/O was on leave. Mr. Thomas often spoke with him about life in Thomas often spoke with him about life in general.general.

Today, two days after the parole hearing, Mr. Today, two days after the parole hearing, Mr. Thomas was found hanging in the supply closet. Thomas was found hanging in the supply closet.

What were Mr. Thomas's Risk What were Mr. Thomas's Risk Factors?Factors?

Serious physical illnessSerious physical illness Possible undiagnosed depressionPossible undiagnosed depression Parole news creating hopelessnessParole news creating hopelessness Lack of usual social stimulation while Lack of usual social stimulation while

SC/O was away; isolationSC/O was away; isolation Access to supply closet and lethal Access to supply closet and lethal

meansmeans

How could Mr. Thomas's How could Mr. Thomas's suicide have been suicide have been

prevented?prevented?

Hey you…yeah, YOU!Hey you…yeah, YOU!

Correctional staff, NOT just inmates, Correctional staff, NOT just inmates, can also be at risk for suicide. This can also be at risk for suicide. This includes officers, nurses, case includes officers, nurses, case workers, psychologists, etc.workers, psychologists, etc.

Not only do you have "normal" Not only do you have "normal" problems—not enough money, not problems—not enough money, not enough time, stress, bills, etc.—you enough time, stress, bills, etc.—you work everyday with some of the work everyday with some of the darkest of human kind that view you darkest of human kind that view you as "the enemy."as "the enemy."

Sound familiar?Sound familiar?After balancing the checkbook until 1am and finding that After balancing the checkbook until 1am and finding that

the mounting bills provided you nothing more than a the mounting bills provided you nothing more than a fitful sleep, you wake up and realize that it's 4:45am, fitful sleep, you wake up and realize that it's 4:45am, and your shift starts at 5am. No time to prepare and your shift starts at 5am. No time to prepare yourself for the day, you battle terrible drivers, arrive yourself for the day, you battle terrible drivers, arrive at work, and are greeted by your supervisor that is at work, and are greeted by your supervisor that is none too happy about your tardiness. During your none too happy about your tardiness. During your shift, you feel underappreciated by "the brass" and shift, you feel underappreciated by "the brass" and are subjected to constant verbal harassment by are subjected to constant verbal harassment by inmates. After enduring this for 8 hours, you inmates. After enduring this for 8 hours, you encounter the same bad drivers on the way home, encounter the same bad drivers on the way home, where financial, relational, and other stressors await. where financial, relational, and other stressors await.

On top of other potential risk factors, is it really that On top of other potential risk factors, is it really that surprising that officers, specifically, commit suicide at surprising that officers, specifically, commit suicide at a rate that is double that of the regular population?a rate that is double that of the regular population?

You are NOT alone!You are NOT alone!

Don't hold everything in. Talk to Don't hold everything in. Talk to family and friends. See a therapist. family and friends. See a therapist. Set aside time for things you enjoy. Set aside time for things you enjoy. But don't ignore your stress and But don't ignore your stress and hope it goes away.hope it goes away.

Stress, depression, anger, etc. will Stress, depression, anger, etc. will ONLY go away if you face it with ONLY go away if you face it with healthy coping skills.healthy coping skills.

Put beautifully by a former Put beautifully by a former C.O.:C.O.:

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