Inmates have suicide rates nine times higher than individuals in the general public. In fact, suicide is the second leading cause of death in jails (illness is #1) across the United States. It is the third leading cause of prison deaths following illness and AIDS. For every completed in-custody suicide, there are many more attempts.
Almost all of these deaths are preventable if correctional officers understand the risk factors for suicide, assess all detainees for suicidal ideation, and take any appropriate measures to protect a suicidal inmate from self harm.
Whether you are an arresting officer, a corrections officer or a jail deputy, you and your facility are ultimately responsible for your prisoner. In this day of relentless litigation, failure to prevent suicide or respond appropriately to an attempted suicide will inevitably result in a lawsuit.
In-Custody Suicide Statistics
- Populous urban jails have higher suicide rates than non-urban jails.
- Most suicides occur in maximum security facilities.
- Most suicides occur when the inmate is in a single cell or isolation.
- Over 1/4 of all in-custody suicides occur within the first three hours of arrest.
- 94% of suicides are accomplished by hanging, either by bedding or clothing.
- Almost 75% of suicides are by white males under the age of 22 who were arrested for nonviolent offenses.
- Juvenile offenders placed in adult detention facilities have an eight times greater suicide rate than juveniles housed in juvenile detention facilities.
- Female inmates attempt suicide twice as often as male inmates.
- The highest prison suicide rate in is among death row inmates.
- Most jail suicide victims were intoxicated when arrested.
- The peak hours for jail suicides are between midnight and 3 am, when staffing is the lowest.
Other in-custody suicide methods include self-induced head injury, either by repeatedly hitting the head against the wall/floor or diving from a higher tier, or overdosing on hoarded medication.
In-Custody Suicide Risk Factors
The most common suicide risk factors include a history of mental illness and/or previous suicide attempts, alcohol intoxication or drug usage and/or withdrawal symptoms.
Additional high risk situation factors include:
- A young white male (ages 20-25)
- A highly publicized case, especially if the inmate was previously in a position of respect
- First time in custody
- Charges of spousal or child abuse, incest, or child molestation
- A harsh or surprising sentence
- Receiving upsetting news from the outside, especially from family
- Recent tragedy or personal disturbing events
- A newly diagnosed or debilitating medical condition
- A family history of completed suicides
- Identifying with a culture that considers suicide an honorable response to disgrace
- Being a victim of physical, sexual or emotional abuse by other inmates or facility staff
Any inmate, whether they have a history of mental illness or not, can become suicidal during their incarceration. Being locked up in a jail or prison comes with numerous inherent stresses. These stressors include shame and/or guilt, fear of the unknown, isolation from family, having no control of the future, losing outside relationships, legal frustration, dehumanizing factors, overcrowding of the housing unit, and increases in harsher and/or mandatory sentencing laws which include the death penalty and life sentences.
Profile of a new detainee at risk for suicide
Typically, the inmate will be intoxicated. He will have no prior criminal history. He may be a person of accomplishment, and for the most part be law-abiding. He will express very high levels of guilt and shame about the arrest and worry excessively about incarceration. He will show signs of depression such as crying and will verbalize feelings of hopelessness. He will probably have a history of mental illness, or will act unusually, and has made at least one previous suicide attempt. Additionally, he will have a very poor support network. He will admit to current suicidal thoughts and planning. If he attempts suicide, it will be within the first 24 hours of incarceration. A detainee may also be at risk around the time of his court appearance, especially if he anticipates a guilty verdict or severe sentencing.
Profile of a sentenced prisoner at risk for suicide
Sentenced inmates who commit suicide usually have been charged with violent crimes and are older. Peak risk times for suicide are within the first 30 days after sentencing, particularly during the first 3 days after court appearances, as well as prior to court. This is especially true if they have received an unexpected or harsh sentence. They have lost hope of release. Frequently, they have made previous suicide attempts and/or have a history of mental illness. Suicides increase on anniversaries related to their arrest, sentencing, holidays, or birthday.
Suicide Prevention and Intervention
All new detainees should be screened for suicidal thoughts or tendencies, previous attempts, and a history of mental illness. Ideally this screening for suicidality needs to be done immediately; remember 25% of all suicides are completed in the first three hours of detention. Either the correctional officer or screening nurse should ask a series of questions to determine if the detainee is suicidal. If the detainee states he does feel suicidal, ask about any plans he has. Inquire about previous suicide attempts; what situations precipitated the attempt(s); what was the method(s), and how lethal were these attempts. Check to see if he has injured himself in the past or recently. Take note if the detainee presents with any additional risk factors previously described. Document everything about the screening using quotes. If you identify an inmate as a high risk of suicide, request a more comprehensive evaluation by a mental health clinician, if your facility has such resources.
If a detainee verbalizes suicidal intent he should be promptly placed in a safety cell, especially if he is intoxicated. Initiate suicide watches per your facility's protocol the more frequent the observation the better. Inmates who have been identified as actively suicidal need constant supervision. Others who have been identified as at risk may require less frequent monitoring. Some facilities use cameras in lieu of visual checks by officers to supervise suicidal inmates. Typical safety cell protocol includes clothing and bedding restrictions, no access to any personal items or sharps (including pens and pencils), and providing only finger foods or foods that can be eaten with a Styrofoam spoon.
There are additional behaviors that indicate an inmate is a suicide risk. If an inmate is experiencing hallucinations or delusions, verbalizing depression, or if there h as been a sudden change in mood, recognize that these are signs that the inmate is at an elevated risk for suicide. Weight loss/gain, changes in appetite or sleep patterns, severe aggression or extreme restlessness can all indicate depression or other mental illness. Take note of any expression of feelings of hopelessness or helplessness. A suicidal inmate may give away all of his possessions, or place them into property. He may refuse medications, ask for an increased dosage or cheek the meds (to hoard for a suicidal overdose), or ask for an increased dose. He may write a will, write goodbye notes to family/friends, or start a diary. Any talk about suicide must be taken seriously. Sure there are manipulative threats and attempts, but treat these as the real deal anyway. Failure to do so could be costly: death to an inmate and litigation against you and/or your facility.
In-custody suicides can occur at any time during the inmate's incarceration. Sworn staff must diligently be alert to any new cues that an inmate has become suicidal. Talk with the inmate around the time of his sentencing or at any other anticipated critical or stressful period to identify suicidal intent. Any inmate who has a significant change in their legal circumstances or mental health status should be re-evaluated for suicidal thoughts/feelings.
If an inmate was on a suicide watch when he is released from custody by bail or bond, he will need to be placed on a 72-hour psychiatric application as a danger to themselves, and transported to a psychiatric hospital by a law enforcement officer.
What to do in an in-custody suicide attempt
Hopefully, you have prepared for this. You have made sure that all emergency rescue equipment has been tested, is in good working order, and readily available. Follow your facilities protocol. Call for internal or external emergency medical staff but don't wait for them to initiate CPR and/or first aid.
What to do if an in-custody suicide occurs
Suicide does happen, in-custody and not. It is crucial to debrief any in-custody suicide with correctional, supervisory, medical and mental health staff. In the debriefing, reconstruct the events, try to identify factors that may have led to the suicide, determine if something was missed, assess the emergency response, and discuss possible policy updates to improve any areas that were lacking. If an inmate completes suicide under your supervision, you may experience any number of emotions including anger, guilt, sadness, or resentment. Know that although these are typical reactions, and that they can be disturbing. It may help if you discuss your feelings with a support contact or a therapist.
Let's face it, in-custody suicide attempts or completions are problematic for jails and prisons. There is a very strong probability that the facility and/or correctional officer will face a lawsuit following any suicidal incident related to federal civil rights or a state wrongful death case filed by the victim's family. The premise of these lawsuits is that prisoners and detainees are under the exclusive control of the facility and its staff, who are ultimately responsible for the inmates' care. Inmates have lost their freedom do to incarceration, which includes the ability to obtain medical or psychological treatment themselves. Courts have found that it is the obligation of the facility and staff to assess for suicidal ideation and intervene appropriately. Since completed suicides result in death, and a liability is determined the settlement can be quite pricey. Failure to identify suicide risk factors or to take immediate and appropriate action in a suicide attempt is considered deliberate indifference.
In summary, it is prudent to exercise diligence in identifying suicidal detainees and sentenced prisoners from the time of arrest to release from custody. Doing so can save an inmate's life and prevent litigation.