Suicide Risk Assessment Difficult in Jails, Prisons

By Frieden, Joyce | Clinical Psychiatry News, January 2005 | Go to article overview

Suicide Risk Assessment Difficult in Jails, Prisons


Frieden, Joyce, Clinical Psychiatry News


SCOTTSDALE, ARIZ. -- Sometimes the importance of suicide risk assessment in correctional facilities can be brought home in very poignant ways, Michael Champion, M.D., said at the annual meeting of the American Academy of Psychiatry and the Law.

"A few weeks ago, we had a prisoner commit suicide in New Hampshire," said Dr. Champion of Dartmouth University, Hanover, N.H.

"The inmate was known to us. He had been an inpatient previously and had been discharged to the [correctional] community. He was getting ongoing suicide risk assessment and follow-up. He received some difficult news and jumped off a three-story balcony."

Dr. Champion noted that suicide is the third-leading cause of death in prison, after natural causes and AIDS-related complications. Generally, prison inmates are one and a half times more likely to commit suicide than the general population, he noted.

"It's important for clinicians to address" the issue in an effort to decrease morbidity and mortality, he said. The risk is even higher in shorter-term facilities: The suicide rate in jail is nine times higher than the general population, and in lock-up--the sheriff's holding facility for people on their way to jail--it's 250 times higher.

Several factors make the suicide risk higher in jails and prisons, Dr. Champion explained. The criminalization of the mentally ill means there is a higher percentage of mentally ill patients who are incarcerated. And then there are the stressors of the correctional environment itself. "The environment is primitive by design," he said, showing a picture of one correctional facility in Pennsylvania to illustrate how prisoners are "walled off" from the rest of society. "The person is separated from family and friends, and that's going to lead to radically increased stress. It's not designed to lift your spirits in any way."

Another problem frequently found in correctional facilities is the "handoff problem," he continued. "There is a lack of communication about critical risk factors [for suicide], and the ball ends up getting dropped." For instance, one shift might neglect to tell another that "'Joe Smith found out today that his wife is leaving him; we need to keep a watch on him.' It's important to pass that on from shift to shift. …

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