Behavioral Healthcare ServiceOrientation

Suicide Prevention/

Detection/Intervention

CDR Grady

MC, USN

Psychiatrist

OPSEC

Slides are unclassified

All talks are CONFIDENTIAL

Some U.S. Jail and Prison Statistics on Suicide

• 1989 jail survey: 1.07 per 1000 detainees, approximately 9-10 times the general population; has improved immensely over past 10 years with prevention

• most common method: hanging• time: at night• setting: segregation cell• associated with: a setback

Differences between Jails and Prisons

• Jails– Point of initial incarceration following arrest

– Predominantly pre-trial detention, outcome/sentence is unknown

• Prisons– Post-trial detention, sentence is known

– Mental Health issues usually identified and addressed

Some U.S. Jail and Prison Mental Health Statistics

Prevalence of severe mental illness: 6-13%

1st psychotic breaks: 4% Self mutilation: 2-8% Prisoners referred for forensic eval: 33%

feigning illness, most common is psychosis

Suicide Risk Factor Categories

Environmental Internal External

Suicide Risk Factors Environmental

• Authoritarian Environment• No Apparent Control Over the Future• Isolation and Fears• Shame of Incarceration• Dehumanizing Aspects of Incarceration• Insensitivity and Negative Attitudes of

Staff

Suicide Risk Factors Internal

Current mental illness, especially depression

Recent suicide attempts or suicidal ideation Impulsivity Prior suicide attempts or suicidal ideation History of mental illness, especially a

hospitalization History of substance abuse Previously imprisoned Involvement in same sex rape Severe guilt or shame over the crime

Suicide Risk Factors External

First time detention Loss of family support Negative response by loved ones - letters History of suicide in the family Long sentences under adverse conditions Recent loss of stabilizing forces

Factors that can Influence the Suicide Rate

• Idleness

• Boredom

• Inadequate monitoring

• Harsh emotional and physical conditions

Suicide Profiles

First incarceration Accused of heinous crime Past or current mental illness History of drug/alcohol abuse Significant behavioral or mood changes Unusual agitation High anxiety Prior suicide attempts or self injurious

behavior Threats of suicide

Signs of Suicidal Risk Looks Sad or Depressed Not Sleeping Withdrawn Period of Calm After Agitation Not Eating Suddenly Improves Unusually Agitated Looks Tired Refuses Treatment Draw Pictures with Sad or

Death Themes

Talks Like He is About to Get Out of the Camp

Has Increasing Difficulty Relating to others

Has No Sense of the Future Talking to Himself Looking Around “As If”

Seeing or Hearing Something Noticeable Mood and/or

Behavioral Changes Cutting or Burning Scars

Symptoms of Suicidal Risks Feel Hopeless or Helpless Feel Worthless Paranoid Hallucinations or Delusions Command Hallucinations Threatens Suicide Reports Suicidal Thoughts Reports Depression Guilt/Shame Preoccupation About His Fate Reports History of Mental Health Treatment

Times of Greatest Suicide Risks

Within 24 Hours After Arrival Following a Set Back or Receipt of Bad News Just Prior to or During a Commission Immediately After Sentencing After Extended Detention “Anniversary” or Meaningful Dates When observation is Reduced:

– During Prayers– While Performing Other Duties Such as

Meals, Showers, Transports, IRFs– Timing Between Scheduled Checks

Detainees

Suicide Intervention: Hanging/Asphyxiation

Damage may occur to the – Airway– Spinal Cord– Blood vessels

Get the detainee down as quickly as possible protecting the head and neck

Have another guard call DOC and request medical to respond to a “Traumatic Medical Emergency”

Keep the head and neck stable Use the modified jaw lift method to maintain

an open airway Do not leave the detainee alone

“Prisoner swallows rag to commit suicide” 1July02

A prisoner in Japan committed suicide by swallowing a rag.

The man had been under regular security checks in case he tried to take his own life.

Prison staff claim they never expected him to use the standard-issue rag and say it has never happened before.

Suicide Intervention: Cutting and Head Banging

Respond to each cutting/head banging behavior even when it is a detainee who displays this frequently

If a quart or more of blood is lost a person could go into shock. Death from bleeding can occur quickly.

Direct Pressure to Extremity Wound Have another guard call DOC and request

medical assistance Do not leave the detainee alone

Suicide Prevention Summary Understand the role of human interaction and

interpersonal communication Learn about Mental Health Disorders especially:

– Depression

– Psychosis Learn the signs and symptoms of suicide Respond to each suicidal threat from the detainee or his

neighbors Don’t be afraid to ask about plans of self-harm Make appropriate referral to Behavioral Healthcare Be familiar with times of increased suicide risk Know how to respond to hanging/cutting incidents