The United States has the highest number of incarcerated individuals in the industrialized world. Suicide is a major issue in jails, prisons, and other correctional institutions in the United States. Suicide is considered a serious health problem in U.S. correctional facilities. Suicide is the second leading cause of deaths in jails and the third leading cause of deaths in prisons. There are some crucial matters associated with suicide in jails, prisons, and other correctional facilities that need to be considered:
- Suicidal ideation and thoughts
- Suicide screening
- Profile of a suicidal inmate
- Recognizing suicide risk
Suicidal Ideation and Thoughts
Suicidal ideation, also known as suicidal thoughts, range from thinking about taking one’s life to detailed planning to do so. Suicidal thoughts are deemed to be strong predictors of the likelihood of future suicide attempts. With that said, they do not necessarily predict that an individual will complete a suicide attempt.
Researchers and mental health professionals reveal that there is a positive correlation between suicidal ideation and past suicide attempts. This particularly is the case when it comes to suicidal ideation and suicide attempts within the past six months.
Unfortunately, when it comes to correctional institutions on all levels, there is very little information about inmates self-reporting suicide thoughts or ideations. Correctional facilities by their very nature do not foster an environment of self-disclosure.
Only 40% of inmates who have suicidal ideations report these thoughts while incarcerated. With that said, a considerable percentage of inmates who do take their lives leave notes behind.
50% of inmates who die by suicide had the opportunity to tell a correctional facility staff member of their suicidal ideations or thoughts before taking their lives. While the opportunity to tell staff of their suicidal ideations existed, about half of the cohort that had an opportunity to do so did not.
Most inmates with suicidal ideations do not want to be placed in a suicide observation cell. They want to remain in their own cells. There are a number of reasons for this desire, including wanting to avoid close observation. Moreover, a suicide observation cell typically is devoid of even the minimal relative “comforts” of inmates’ own cells.
When it comes to suicidal ideation, correction facilities are well-advised to organize programming that involves:
- Family members
- Mental health professionals
- Correctional officers
50% of inmate suicide victims had seen a mental health professional within two weeks of their deaths. This reality points out that a better course of continual care and mental health interdiction is necessary.
Although a difficult question to raise, experts in the field of suicide prevention do maintain that inmates should be asked if they are thinking about or contemplating suicide. The question should be raised during the initial booking process and throughout the time inmates are in custody.
While the question should be asked, it must again be noted that a majority of inmates will not self-report suicidal ideations or will lie about them if asked. Inmates with strong risk factors for suicide should receive at least some degree of extra attention, including regular contact with mental health professionals. The risk factors identified by the National Institute of Mental Health that apply in a correctional setting are:
- Depression, other mental disorders, or substance use disorder
- Certain medical conditions
- Chronic pain
- A prior suicide attempt
- Family history of a mental disorder or substance abuse
- Family history of suicide
- Family violence, including physical or sexual abuse
- Being exposed to others’ suicidal behavior, such as that of family members, peers, or celebrities
Jails, prisons, and other correctional institutions typically utilize a set of screening questions in an attempt to elicit information that correlates to a suicide risk. The screening should occur at the time of booking, admission to a new facility, and other times as the situation warrants. Based on the responses to these questions, institutions oftentimes use a three-tier rating system for the responses to each question used to identify inmates or arrestees that might be at risk for suicide:
- 0 – No suicide risk present
- 1 – Moderate suicide risk
- 2 – High suicide risk
If an inmate scores 8 or higher, that incarcerated person should be placed on suicide watch.
There are some questions and observations that should be given critical consideration and warrant further examination or placement on suicide watch:
- When an arresting officer believes a detainee may be suicidal
- Arrestee is thinking about hurting or killing himself
- Arrestee lacks close friends or family in the community
- Arrestee experienced a significant loss within the past six months
- Arrestee is apprehensive about problems other than the current situation
- Arrestee has a history of mental health issues, including use of psychiatric medication
- Arrestee has a history of alcohol or drug abuse
- Arrest holds a position of respect in the community
- Arrestee is accused of or charged with a shocking crime
- Arrestee has previous suicide attempts
- Arrestee feels helpless or hopeless
- Arrestee shows signs of depression
- Arrestee acts in a strange manner (lack of focus, seeing things that aren’t there)
- Arrestee is under the influence of alcohol or drugs
- Arrestee shows signs of withdrawal from alcohol or drugs
Once a screening is complete, the staff member that undertook the process typically reports findings to a direct supervisor or shift commander. If necessary, immediate steps should be taken to place a confined person on suicide watch.
Profile of a Suicidal Inmate
When it comes to profiling inmates most likely to be prone to attempt to commit suicide, the most vulnerable incarcerated people are:
- Young males
- Socially disenfranchised individuals
- Socially isolated individuals
- Mentally ill individuals
- Individuals with substance abuse issues
- Incarcerated individuals with little outside family support
- People who’ve attempted suicide in the past
Oftentimes, inmates are placed in settings that lack policies regarding dealing with potentially suicidal inmates. In addition, it’s commonplace that overworked and undertrained staff members overlook potentially suicidal inmates.
There are some additional factors that come into play when it comes to the profile of a potentially suicidal inmate:
Most suicides involve people with a low integration into society
Inmates in maximum security prisons oftentimes believe that their lives will never improve
Inmates prone to attempt suicide tend to suffer from mental health issues that include psychosis, bipolar disorder, borderline personality disorder, or antisocial personality disorder
A considerable percentage of inmates who attempt suicide have attempted to take their lives at some juncture before they were incarcerated.
Recognizing Suicide Risk
There are a pair of factors that play a role in recognizing suicide risk. These are static factors and dynamic factors.
Static factors, of those factors that are relatively constant, are:
- Mental disorder
- Substance abuse
- Maximum security detention
- Pretrial status
- Past suicide attempts
Dynamic factors include:
- Current depressive episode
- Alcohol intoxication
- Alcohol withdrawal
- Opioid withdrawal
- Benzodiazepine withdrawal
Alcohol-induced suicide usually occurs with 24 to 48 hours of confinement. Heroine-induced suicide can occur as late as seven to 10 days after confinement.
Other notable suicide risk factors are:
- Prospect of receiving a harsh sentence
- Loss of loved one during confinement
- Loss of custody of children
- Severe guilt or shame over offense
- Sudden discontinuation of psychotropic medication
Even though an impending release from custody is a positive development in many ways, it is also a time when the risk of suicide increases. A person on the verge of release may develop suicidal ideations because of uncertainty about a place to live, employment, and other issues.