The National Center on Institutions and Alternatives (NCIA), commissioned by the U.S. Justice Department's National Institute of Corrections, released a major study on jail inmate suicides in May 2010. The study showed that there had been dramatic decrease in the rate of suicide in county jails during the past 20 years. The suicide rate in county jails was calculated to be 38 deaths per 100,000 inmates However; suicide is still the single leading cause of unnatural deaths in local jail, at a rate of 38 deaths per 100,000 inmates. This suicide rate is over 3 times greater than that in the general population.
Almost all of these deaths are preventable if correctional officers understand the risk factors for suicide, assess all detainees for suicidal ideation, and take any appropriate measures to protect a suicidal inmate from self harm. Whether you are an arresting officer or a corrections officer, you and your facility are ultimately responsible for your prisoner. In this day of relentless litigation, failure to prevent suicide or respond appropriately to an attempted suicide will inevitably result in a lawsuit.
The staggering statistics
Time and method of jail suicides:
- 24% occurred within the first 24 hours, 27% between 2 and 14 days, and 20% between 1 and 4 months.
- 32% occurred between 3:00pm and 9:00pm.
- 20% of the victims were intoxicated at the time of death.
- 31% of the victims were found dead more than 1 hour after the last observation.
- 38% of the victims were held in isolation.
- 93% of the victims used hanging as the method.
- Overdoses are the second most common method: hoarded medications, cleaners, etc.
- Self-inflicted injuries are the third most common: slashing, head banging, intentional falls, etc.
- CPR was not administered in 37% of incidents.
Suicide victims:
- 67% were white. Whites committed suicide at 4 times the rate of black (16 per 100,000) and twice the rate of Hispanic inmates.
- 93% were male. The incarcerated male suicide rate was 1.6 times higher than the female rate; however females attempted suicide twice as often as males.
- Juvenile offenders placed in adult detention facilities have an eight times greater suicide rate than juveniles housed in juvenile detention facilities.
- 43% were being held on a personal and/or violent charge. Offenders serving time for homicide, kidnapping, and rape have the highest suicide rates. Drug offenders had the lowest mortality rates from suicide.
- 47% had a history of substance abuse.
- 38% had a history of mental illness.
- 34% had a history of suicidal behavior.
- 28% had a history of medical problems.
Additional in-custody suicide risk factors
The most common suicide risk factors include a history of mental illness and/or previous suicide attempts, alcohol intoxication or drug usage and/or withdrawal symptoms. Additional high risk situation factors include:
- A young white male (ages 20-25)
- A highly publicized case, especially if the inmate was previously in a position of respect
- First time in custody
- Charges of spousal or child abuse, incest, or child molestation
- A harsh or surprising sentence
- Receiving upsetting news from the outside, especially from family
- Recent tragedy or personal disturbing events
- A newly diagnosed or debilitating medical condition
- Recent inmate vs. inmate conflict
- Recent disciplinary action
- Identifying with a culture that considers suicide an honorable response to disgrace
- Being a victim of physical, sexual or emotional abuse by other inmates or facility staff
- Currently, over three times the number of people who suffer from mental illness are being held in jails rather than hospitals. The NCIA study reported that over the past 20 years the number of mentally ill inmates who commit suicide has increased from 19% to 38% percent.
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.
In-custody suicides can occur at any time during the inmate's incarceration. Staff must diligently be alert to any new cues that an inmate has become suicidal. Talk with the inmate around the time of his sentencing or at any other anticipated critical or stressful period to identify suicidal intent. Any inmate who has a significant change in their legal circumstances or mental health status should immediately be re-evaluated for suicidal thoughts/feelings.
Yes, there are going to be inmates who make manipulative suicidal statements or gestures. There are numerous secondary gains for these inmates: delaying a court appearance, or bolstering an insanity defense, to gain cell relocation, to receive preferential staff treatment, or to seek compassion from unsympathetic family members. Nonetheless, and no matter how frustrating this may be to you or your facility, these individuals need to be placed on a suicide watch.
Additional behaviors that frequently indicate that an inmate is a suicide risk include:
- Evidence that the inmate is experiencing hallucinations or delusions
- Weight loss/gain or changes in appetite or sleep patterns
- Severe aggression or extreme restlessness
- Giving away possessions or placing them into property
- Refusing medications or asking for an increased dosage
- Writing goodbye notes to family/friends or starting a diary.
What to do in an in-custody suicide attempt
Hopefully, you have prepared for this. You have made sure that all emergency rescue equipment has been tested, is in good working order, and readily available. Follow your facilities protocol. Call for internal or external emergency medical staff but don't wait for them to initiate CPR and/or first aid.
What to do if an in-custody suicide occurs
Suicide happens, in-custody and not. It is crucial to debrief any in-custody suicide with correctional, supervisory, medical and mental health staff. In the debriefing, reconstruct the events, try to identify factors that may have led to the suicide, determine if something was missed, assess the emergency response, and discuss possible policy updates to improve any areas that were lacking.
Suicide attempts or completions are obviously extremely problematic for jails. There is a very strong probability that the facility and/or correctional officer will face a lawsuit following any suicidal incident related to federal civil rights or a state wrongful death case filed by the victim's family. The premise of these lawsuits is that prisoners and detainees are under the exclusive control of the facility and its staff, who are ultimately responsible for the inmates' care. Inmates have lost their freedom due to incarceration, which includes the ability to obtain medical or psychological treatment themselves. Courts have found that it is the obligation of the facility and staff to assess for suicidal ideation and intervene appropriately. When a suicide attempt results in death, and a liability is determined the settlement can be quite pricey. Failure to identify suicide risk factors or to take immediate and appropriate action in a suicide attempt is considered deliberate indifference.
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
