Thoughts on Suicide in Corrections
At a recent conference that I attended, it was reported that suicide rates in prisons and jails were on the rise. Being the scientist/practitioner that I am, I went to the literature to verify this statement and, sure enough, 2014—the last year for which trend data is reported—was an especially bad year for both jail and prison suicide rates.
The Bureau of Justice Statistics reports that in 2014, 372 individuals died by suicide in local jails (a rate of 50/100,000), up from a low of 228 suicides (29/100,000) in 2008. In prisons, the number of suicides rose from 168 (14/100,000) in 2001 to 372 (20/100,000) in 2014. A closer look at the data found that the numbers and rates have fluctuated year over year, some years being lower than others.
These data collectively brought three thoughts to mind: even one suicide is tragic on many levels; how far we have come since the 1980s in identifying risk and preventing suicides in our prisons and jails; and how far we still need to go in our efforts to further reduce suicide rates. I’d like to talk briefly about each of these thoughts.
Even One Suicide Is Tragic on Many Levels
Each correctional suicide impacts any number of individuals. For the family of the victim, the event marks the loss of a loved one. For responding and treatment staff, it often triggers second-guessing about how they handled the event and grief over the loss of someone for whom they were responsible. For staff tasked with investigating the event, identifying missed cues for intervention or inadequate responses from staff may also produce conflicting emotions. For other inmates, the event may remind them of their own circumstances and generate feelings of loss, depression or anger.
In short, suicide is a tragic and traumatic event on many levels. How notifications are made to next of kin, how follow-up investigations are managed and how responding staff are counseled all matter. NCCHC standards offer some guidance on how these issues should be managed.
How Far We Have Come
In the 1980s, suicide rates were reported to be 129/100,000 in jails and 34/100,000 in prisons. By 2002, the rates had dropped to 47/100,000 in jails and 16/100,000 in prisons. What changed during that time period was the development and implementation of suicide prevention and intervention programs.
NCCHC standards define key components of an effective suicide prevention and intervention program: training, identification, referral, evaluation, treatment, housing, monitoring, communication, intervention, notification, review and debriefing. Collectively, these components point to key areas of importance.
- All staff must be aware of the signs and symptoms of suicide; ongoing training is essential to increase awareness.
- Effective assessment practices will help to ensure that potentially suicidal individuals are identified, monitored and treated as soon as possible.
- Effective referral and communication procedures must be understood by all stakeholders (e.g., health and mental health staff, correctional officers, community health care agencies and providers), who also must know their role in the referral/treatment process.
- Finally, when a suicide does occur, the precipitating factors must be investigated in an effort to avoid future suicides
What is clear to me is that one program with clearly defined standards has had a significant impact on prison and jail suicide rates.
How Far We Still Need To Go
However, we still have a long way to go in lowering suicide rates. Toward that end, NCCHC has entered into a partnership with the American Foundation for Suicide Prevention to develop a national response plan for suicide prevention in corrections. AFSP has identified the correctional environment as one of four key areas with the highest potential for saving lives through suicide prevention efforts and it has set the ambitious goal of a 20% reduction in suicides by the year 2025.
Other partners in this effort include health and mental health experts and private vendors operating in correctional settings, as well as other leaders from the correctional and suicide prevention communities. Working collaboratively, these partners have identified three areas for further investigation: assessment, intervention and training/education. They have also set a series of short- and long-term goals, including development of a position statement and promising practices in the area of suicide prevention, multidisciplinary training curriculum guidelines and, perhaps most significant, corrections-specific assessment instruments and treatment protocols.
I commend these partners for their recognition that jail and prison suicide is a public health problem rather than just a corrections problem, and for their collaborative, multidisciplinary efforts. Let’s hope that these efforts lead to another dramatic reduction in correctional suicide rates in the future.
– Thomas J. Fagan, PhD, CCHP-MH, is the chair of the NCCHC board of directors. This column first appeared in the Spring 2019 issue of CorrectCare, Vol. 33, Issue 2.