It is important to remember that all inmates, whether they have a history of mental illness or not, can become suicidal during their incarceration. Being locked up in a jail or prison comes with numerous inherent stresses. These stressors include shame and/or guilt, fear of the unknown, isolation from family, having no control of the future, losing outside relationships, legal frustration, dehumanizing factors, overcrowding of the housing unit, and increases in harsher and/or mandatory sentencing laws which include the death penalty and life sentences.
Profile of a new detainee at risk for suicide
Typically, the inmate will be male and between the ages of 20-25. He will be intoxicated. He will have no prior criminal history, and his offense is not major. He may be a person of accomplishment, and for the most part be law-abiding. He will express very high levels of guilt and shame about the arrest and worry excessively about incarceration. He will show signs of depression such as crying and will verbalize feelings of hopelessness. He will probably have a history of mental illness, or will act unusually, and has made at least one previous suicide attempt. Additionally, he will have a very poor support network. He will admit to current suicidal thoughts and planning. If he attempts suicide, it will be within the first 24 hours of incarceration (often in the first few hours). A detainee may also be at risk around the time of his court appearance, especially if he anticipates a guilty verdict or severe sentencing.
Profile of a sentenced inmate at risk for suicide
Sentenced inmates who commit suicide usually have been charged with violent crimes and are older. Peak risk times for suicide are within the first 30 days after sentencing, particularly during the first 3 days after court appearances. This is especially true if they have received an unexpected or harsh sentence. They have lost hope of release. Frequently, they have made previous suicide attempts and/or have a history of mental illness. Suicides increase on anniversaries related to their arrest, sentencing, holidays, or birthday.
Smaller jails versus large institutions
Suicide rates are six times higher in small jails (holding 50 or fewer inmates) compared to the largest jails. The rate of suicide in the small jails is 167 per 100,000. The rate in the largest facilities is the suicide rate is 27 per 100,000 inmates. This discrepancy is most likely related to the fact that large jails have a better capacity to provide a variety of suicide prevention measures.
Suicide Prevention and Intervention
In general, jails do an admirable job of safely managing inmates identified as suicidal and placed on suicide precautions. Only 8% of all completed jail suicides were committed when inmates had been placed on a suicide watch. The biggest problem institutions face is preventing the suicide of an inmate who is not easily identifiable as being at risk for self-harm.
All new detainees should be screened for suicidal thoughts or tendencies, previous attempts, and a history of mental illness. Ideally this screening for suicidality needs to be done immediately. Either the correctional officer or screening nurse should ask a series of questions to determine if the detainee is suicidal. Take your time and provide as much privacy as possible. If the detainee states he does feel suicidal, ask about any plans he or she has. Inquire about previous suicide attempts; what situations precipitated the attempt(s); what was the method(s), and how lethal were these attempts. New detainees should be physically assessed to see if they have injured themselves recently or in the past. Take note if the detainee presents with any of additional risk factors previously described. Document everything about the screening using quotes. If you identify an inmate as a high risk of suicide, request a more comprehensive evaluation by a mental health clinician, if your facility has such resources.
If any inmate verbalizes suicidal intent he should be promptly placed in a safety cell, especially if he is intoxicated. Initiate suicide watches per your facility's protocol; the more frequent the observation the better. Inmates who have been identified as actively suicidal need constant supervision. Others who have been identified as at risk may require less frequent monitoring. Some facilities use cameras in lieu of visual checks by officers to supervise suicidal inmates. Typical safety cell protocol includes clothing and bedding restrictions, no access to any personal items or sharps (including pens and pencils), and providing only finger foods or foods that can be eaten with a Styrofoam spoon.