Suicide prevention programming is one of the most important elements provided in any correctional institution. There are many ways to create a sound prevention program as there are references, manuals and tools available for assistance. All of them have merit, but may be impractical for many facilities. This article focuses on the most viable and cost-effective means to implement or improve existing suicide prevention programs. Areas such as "suicide-proofing," training, and policies and procedures are described in detail. The positive and negative aspects of different approaches are reviewed as culled from a multidisciplinary viewpoint. And vignettes describe actual approaches that were taken to improve different institutions' programs.
The issue of inmate suicide causes many sleepless nights for correctional medical professionals. National studies have demonstrated that correctional institutions have a much higher incidence of suicide than the general public. According to The National Study of Jail Suicides, by Lindsay Hayes and Joseph Rowan, there is an 11 percent to 57.5 percent increased incidence of suicide in jails compared to the general public. The San Francisco Suicide Prevention Web site claims that as of 1996, there was a 16 percent increased suicide rate in jails and prisons compared to suicides in the "free" world. The 1995 Prison Suicide: An Overview and Guide to Prevention states that there is a 50 percent greater risk of suicide in prison, with an average of 20.6 deaths per 100,000 inmates, than in the general public. This comes as no surprise to those who walk the runs of jails and prisons.
Incarcerated individuals often are desperate, frightened and overwhelmed. This conglomeration of feelings can prove to be deadly. Sadly, many institutions themselves are desperate, frightened and overwhelmed by the task of providing quality medical care while faced with minimal resources and an ever-burgeoning population. There is a large body of suicide prevention literature available to health care providers. Many of the suggestions are excellent, but prove to be impractical due to cost, physical plant, commitment of resources and lack of staff. Often, suicide prevention strategies are researched and implemented after a facility has been faced with an "untoward" event. Suicide prevention must be a foreseen, ongoing commitment.
Practical suicide prevention should be approached from many different angles. No one path should be relied upon to provide the necessary coverage to ensure the safety of inmates. Education of detention and medical staff, as well as inmates, is one part of the picture. Physical plant changes -- Suicide proofing -- is a second avenue. Policy and procedures for suicide watches, use of restraints and forced medication constitute a third path. Thorough intake screening, mental health assessments and continuity of care is a fourth component. Morbidity and mortality review procedures and critical incident debriefing are essential ingredients. Finally, good, reliable communication between inmates and staff is essential.
KNOWLEDGE IS POWER
Suicide prevention education should begin upon hiring both medical and correctional staff. A suicide prevention module should be a mandatory presentation in new employee orientations and officers' training academies. Routine refresher courses also should be required every one to two years for all staff. A suicide prevention review course should be as crucial to continued work as CPR certification. Current "graduation" from a suicide prevention class can be incorporated into employees' performance evaluations. Other avenues for disseminating this type of information are to use the institution's newsletter, briefing bulletins or by creating a short educational video.
There are several agencies and institutions that market modules on this topic, ranging from simple workbooks to testing kits and videos. Courses can span one to four or more hours in length. Another option is to "borrow" and adapt, if possible, a program that has been created by another agency. Contacting local educational institutions or mental health training programs to provide such a class also is an option. Finally, if the institution has staff who are knowl edgeable in suicide prevention, an individual training module can be produced that is tailored to that institution's specific needs.
For small institutions with limited staff, it may be worthwhile to purchase or borrow a prepared curriculum. This may be useful if mental health staff resources are sparse so as not to monopolize their hours writing and conducting the classes. This also allows a small institution to use non-mental health staff, who often are available in larger numbers, to teach the courses without being placed in the role of "expert." Consideration should be given to having two curricula, a more advanced course targeting the institution's mental health staff and a "meat and potatoes" class for other medical and correctional staff.
It is recommended that the initial course, given at orientation, be very thorough -- about four hours in length. The "refresher" classes may be shortened to one or two hours. If a training video is used, it is suggested that the video be shown in a classroom setting, including interaction with an instructor, to ensure that participants actually watch and learn from the material presented. (A video alone would not …