Suicide prevention in correctional facilities: reflections and next steps.

Data from a recent national study of inmate suicides indicates that the suicide rate in county jails throughout the United States has steadily decreased. Despite this progress, the author argues that rather than developing and maintaining comprehensive policies and practices, policymakers and correctional administrators appear preoccupied with the notion that suicides can only be prevented when inmates are on suicide precautions. Measures such as closed-circuit television monitoring, suicide-resistant jail cells, safety smocks, and new technology are popular tools to keep certain inmates safe. There is more to suicide prevention than simply observing suicidal inmates and waiting for them to attempt suicide. The author argues that suicides are prevented and suicide rates reduced when correctional facilities provide a comprehensive array of programming that identifies suicidal inmates who are otherwise difficult to identify, ensures their safety on suicide precautions, and provides a continuity of care throughout confinement.

National study of jail suicide: 20 years later.

Findings from a national study of jail suicide are provided, including the extent and distribution of suicides in holding and detention facilities, and descriptive data on demographic characteristics of each victim, incident, and facility. Among significant findings are that suicides were evenly distributed from first few days of confinement to over several months of confinement, many suicides occurred during waking hours, most inmates were not under the influence of drugs and/or alcohol at the time of death, and many suicides occurred in close proximity to a court hearing. Suicide prevention programming was found to be uneven in most facilities that experienced suicides. There has been a significant decrease in the rate of suicide in detention facilities.

Juvenile suicide in confinement--findings from the first national survey.

Findings from the first national survey on juvenile suicide in confinement are provided, and include the extent and distribution of juvenile suicides, as well as descriptive data on demographic characteristics of each victim, incident, and juvenile facility which sustained the suicide. Among the significant findings were that suicides were evenly distributed, i.e., the same number of deaths occurred within the first few days of confinement as occurred over many months of confinement; most deaths occurred during traditional waking hours; a strong association between room confinement and suicide was found, and no relationship between intoxication and suicide was found. Suicide prevention resources were found to be particularly lacking in juvenile detention centers that experienced suicides.

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons.

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities.

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

Juvenile suicide in confinement in the United States results from a national survey.

The first national study of juvenile suicide in confinement in the United States determined the extent and distribution of juvenile suicides (in juvenile detention centers, reception centers, and training schools); as well as gathered descriptive data on demographic characteristics of each victim, characteristics of the incident, and characteristics of the juvenile facility which sustained the suicide. Significant findings were found in the areas of time and location of the deaths, as well as adequacy of suicide prevention measures in facilities sustaining the deaths.

Demographic, criminal, and psychiatric factors related to inmate suicide.

A review of 19 studies suggests that it may be feasible to identify prisoners with suicide risk on the basis of demographic, psychiatric, and criminal characteristics. The present study aimed to identify combinations of characteristics that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of six characteristics (age 40+, homelessness, history of psychiatric care, history of drug abuse, one prior incarceration, violent offence) was capable of correctly classifying 82% of the Dutch suicide victims (82% specificity). Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. It is concluded that a set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons.