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Suicide In The Correctional Environment

By: Raymond P. Mooney, PA-C, DFAAPA
Tel: 517-902-1091
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Suicide is a threat to all persons (inmates as well as staff) involved in corrections. The rates of inmate suicide are far higher than the national averages and even higher still for special populations such as juvenile and LGBTI inmates.

Correctional officers have a 39% higher chance of suicide than other occupations.

Incarcerated people are particularly vulnerable to suicide for a variety of complex reasons.

According to the U.S. Department of Justice, suicide is the leading cause of death in Jails, and the suicide rate in prisons continues to increase.

Jails are known to have more suicides and suicide attempts than prisons. While in jail, inmates are confronted with long term, life-changing events. News of long prison sentences, separation from family, divorce, loss of child custody, loss of home, and fear of an unknown future is paralyzing. It can easily place an inmate in a situation where they are not thinking clearly and despondent, especially with individuals known to be impulsive and have poor coping skills. Tragically, too many of them die by suicide as a means of ending what feels like inescapable pain.

Fortunately, understanding of suicide risks and warning signs specific to incarcerated populations is expanding.

With my over twenty years of correctional experience in the Michigan Department of Corrections, we, the medical and correctional staff, would receive yearly training on the signs of individuals at risk for suicide. Officers were well trained on the warning signs of an inmate at risk of suicide and to especially watch for changes in inmate behavior, i.e., from being quiet to expressing extreme anger, changes in an inmates’ behavior after being notified of a family death, refusing to eat or shower and self-mutilation.

They would regularly refer these inmates to the prison emergency room where I would perform an assessment and, if indicated, admit the inmate to the hospital for observation until they were evaluated by a qualified mental health professional.

This type of interaction was especially common on the weekends when the availability of mental health staff was limited.

The point was for all staff to recognize anything out of the ordinary and report it to the medical staff immediately.

Suicide prevention was always the goal.

While under suicide observation, the prisoners would be placed in a paper gown; their diet would consist of finger foods (utensils would provide instruments that could be used for self-harm)  and a mattress on the cell floor to remove any potential mechanisms (from a bed frame) that they could use to harm themselves. They would also be placed in one on one constant supervision. In Michigan, we regularly used other specially trained inmates who were supervised by a correctional officer. This process worked very well and provided the suicidal individual the opportunity to talk with another prisoner and avoid the apprehension they may feel when being observed by a correctional officer. This also significantly decreased episodes where inmates would “act out” and cause further disruption. This contributed to avoiding custody from any confrontational situations. It is always better to deescalate a situation.

When an individual is in a suicidal crisis, their thinking becomes limited and less flexible, and they feel tremendous pain and desperation. In these moments, they don’t have access to their usual coping abilities, and protective factors such as family, friends, religion, and hope may be stretched.

In 2017 the Suicide Prevention Resource Guide was conceived, where a group of mental health experts convened with the National Commission on Correctional Health Care leadership for the inaugural Suicide Prevention Summit.

Combining NCCHC’s knowledge of correctional mental health care with AFSP’s expertise in suicide prevention represented a unique opportunity to develop solutions that can affect real change and save lives.

The goal of suicide prevention is to reduce the risk for individuals before it becomes a crisis.

A group at exceptionally high risk are Lesbian, Gay, Bisexual and Transgender individuals, especially LGBT youth who are exposed to even more challenges as they seek understanding, empathy, and compassion.

In my experience, the group at the highest risk for attempted as well as completed suicide is the transgender population. Little research has examined the link between incarceration and suicide among transgender inmates. These individuals do face unique circumstances within the correctional setting that exposes them to potentially harmful conditions, including correctional policies that limit access to proper medical care and expose them to threats of harassment and violence.

Correctional policies may detrimentally impact transgender inmates’ access to transgender-related medical care and expose transgender inmates to elevated levels of gender-based victimization (G. Brown & McDuffie, 2009; Summers & Jennings, 2014; Tarzwell, 2006).

Another group that deserves specific mention is LGBT youth. Research has shown that LGBT youths are more likely to confront specific barriers and environmental risk factors connected to their sexual orientations and gender identities. For example, as compared with their heterosexual  peers, LGBT youths are more likely to experience bullying at school (Mitchum and Moodie-Mills 2014), more likely to experience rejection or victimization perpetrated by their parents/caregivers (often resulting in youths’ running from home) {Friedman et al. 2011}, more likely to face homelessness (Burwick et al. 2014), twice as likely to be arrested and detained for status offenses and other nonviolent offenses (Irving 2010), and at higher risk for illicit drug use (Heck et al. 2014).

While many inmates are “institutionalized” due to long sentences and or repeated offenses and consider prison and their fellow inmates as home and family, this is not true for those newly incarcerated. It is those individuals, especially the inmates in the above groups, that are especially vulnerable and need the closest observation.

The opinions stated in this article are those of the author and are based on his experience in correctional medicine and dealing with completed suicides and inmates at high risk for suicide. Many articles and web sites have been relied on in assisting in the preparation of this article.

Raymond P. Mooney, PA-C, DFAAPA is a Physician Assistant with 46 years of experience in Family Practice, Emergency Medicine, Urgent Care, and Correctional Medicine as well as over twenty years of experience in reviewing medico-legal cases. He has extensive experience in deposition as well as trial testimony in state as well as federal court. With a diverse background as a Physician Assistant, Mr. Mooney has been providing the legal industry with his expert opinion for over 20 years. He is available to objectively evaluate cases for alleged medical negligence or a deviation in the standard of care on physician assistant practice.

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