Sunday, March 29, 2009

Jail Suicides: Still A Problem Despite Solid Efforts At Risk Reduction

Suicide by hanging is by far the most common method of jail suicide. Estimates of time taken until death range from 3 to 7 minutes depending on how much force can be exerted to effectively crush the individuals airway or close off air flow completely. Completed suicide rates in the general population are fixed at about 13 per 100,000 persons. Suicide rates within the incarcerated population have been reduced from a high of over 100 per 100,000 to around 38 per 100,000 today in the USA: a significant and important reduction to say the least. There is still a lack of valid data on the exact number of attempts versus completed suicides but it seems prudent (if not cautiously conservative) to assume a minimum ratio of at least 2 attempts to every 1 completed.

Most studies of suicide within the inmate population have led to a focus upon the advantages of staff training to proactively identify and segregate high risk candidates. Little has been written about the physical and social environmental factors that make hanging possible and with the advent of video monitoring, interpretation of just how effective early identification and segregation really is, just is not scientifically possible. One need only to read about the recent developments at Marion County Jail in Florida and the proposed federal investigation ( here ) to understand how complex the problem of jail suicide really is. Read this as well related to another story.

Here at CCA our intent is not to throw stones at the quality work that has been done in this area. Nor is it to detract from the significant advances based upon that work. Rather our point is this; to view suicide as a one dimensional problem that somehow occurs within an individual, suffers from the same limitations as any other psychological theory that attempts to pathologize the individual rather than viewing that person in light of their physical surroundings and current life circumstances. Pathologizing the individual also tends to blind people to a large bank of reasonable and cost effective options for prevention that exist within any facility for incarceration. Additionally it serves to take time and attention away from focusing on important measures to protect your facility and the taxpayers from unnecessary and costly litigation.

The basis of litigation over suicides in jail or while under incarceration lies in the the process of steps taken (or not taken) to prevent it and not the outcome itself. Did your facility and officers take prudent, professional and non-negligent steps to avoid it? Did any of your officers show willful disregard or deliberate indifference to a known possibility? These are the area's that define successful litigation in inmate suicides.

At CCA we believe suicide prevention requires multiple interventions at several levels including but not limited to assessment and segregation. Too often methodologies are employed that rely heavily on segregation and the use of mechanical or technological devices that are costly and present additional problems. The risk of suicide can never be alleviated but the risk to your facility and staff can be reduced to even more significant levels than they are currently. We also believe that the greatest current risk to the incarceration field in general lies in the smaller, limited hold facilities where access to medical and mental health care is limited and officers are understandably faced with multiple tasks. Given the fact that community mental health problems are becoming more of a police issue than ever before, it makes sense to prepare as you would for other facility and officer safety issues.

Knowing that up to 70% of female jail inmates are likely to suffer from a mental health issue and that people in their mid twenties who come in under the influence pose your greatest immediate risk, it would seem prudent to act now before local news stories and litigation force the issue. At CCA we can show you how to reduce your risk in a cost effective and prudent manner.

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