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Suicide Prevention


Suicide Prevention In the Corrections Environment – PowerPoint PPT presentation

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Title: Suicide Prevention

Suicide Prevention
  • In the Corrections Environment

  • Suicide is the leading cause of death in American
  • 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

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

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

Risk Factors
  • Depression
  • Any serious mental illness, such as schizophrenia
    and bipolar disorder
  • Substance Abuse
  • The combination of mental illness and substance
  • Borderline and Antisocial Personality Disorders
  • Impulsivity and aggression
  • History of suicide attempt or family history of
  • 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)

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.)

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

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

  • Though any of the previous factors may contribute
    to suicidal intent, 70 to 80 of all suicides
    are committed by people who are severely
  • 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

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
  • 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!

Identifying Suicidal Inmates

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

  • 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.

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

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

But what about fakers?
    judgment call regarding the sincerity of the
    threatcontact medical or mental health staff to
    assess and make a decision about the necessary

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!

  • 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

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

Suicide Myths (Dont believe them!!!)
  • Myth 1 People who threaten suicide dont commit
  • FACT Most people who commit suicide have made
    direct or indirect statements of their
  • 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.

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
  • Myth 4 Talking to people about their suicidal
    thoughts will cause them to follow through.
  • FACT You CANNOT make someone suicidal by
    discussing suicide.

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

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.

Discussion Case Example
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.

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

How could Mr. Thomas's suicide have been
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,
    work everyday with some of the darkest of human
    kind that view you as "the enemy."

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
  • 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?

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.

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