Man Down! Suicide in Prison

Article by "K"

“Observers have noted that several recent developing trends suggest higher [inmate] suicide rates in future. These recent trends (mandatory sentencing laws, dramatic increases in life sentences, AIDS, and the graying of the inmate population) have instilled despair and hopelessness in inmates.”

 --from Prison Suicide: An Overview & Guide to Prevention, U.S. Dept. of Justice, NIC, 1995

Rapid response to inmate suicide makes all the difference in whether a prisoner lives or dies, especially since most people who do commit suicide in prison hang themselves. In most institutions, less experienced guards pull night and weekend shifts, times when suicides are more likely to be successful. How long will it be before back-up arrives? Will anyone cut down a hanging suicide within the four to six minutes required to save a prisoner’s brain function? Given the fear of AIDS, will CPR be attempted? Or, as in some prisons, is the hanging inmate treated as a crime scene with guards standing outside the locked cell, waiting for investigators, cameras, and medical personnel to arrive before they even attempt to cut the man down?

Given prison restrictions, one might think it would be hard to commit suicide in prison, yet suicide ranks 3rd as the cause of death in U.S. state prisons (after “natural causes” and HIV). By comparison, suicide ranks 9th as a leading cause of death in the U.S. as a whole. While no one counts the number of attempted suicides occurring in U.S. prisons, one of the few studies of the issue shows that for the period 1984-1993, the national rate of completed prison suicide averaged 20.6 deaths per 100,000 population, a figure virtually double the average rate of 11.4 suicides per 100,000 population in the US as a whole.

Suicide rates for prisons in the seven states served by the Western Prison Project were considerably higher than the national average for prison suicide and astronomically higher than suicide rates in the general U.S. population during this time period. In Western prisons, suicide rates (per 100,000) were as follows: Idaho (41.8); Montana (82.8); Nevada (42.0); Oregon (25.2); Utah (59.5); Washington (30.4); Wyoming (68.0). Only Alaska (87.2) and North Dakota (101.7) averaged higher rates of prison suicide (source: Prison Suicide: An Overview & Guide to Prevention).

Despite these alarming statistics, corrections departments throughout the country do not track suicides in their prisons. But thanks to the tireless advocacy work of Charles Sullivan from National CURE (Citizens United for the Rehabilitation of Errants), the Federal Deaths in Custody Reporting Act (Public Law No. 106-297), sponsored by Rep. Asa Hutchinson, became law in October, 2000. This law now requires that all deaths occurring in both state and federal correctional facilities be reported in detail to the federal government on a quarterly basis. Prison systems will be required to report: 1) the name, gender, race, ethnicity, and age of the deceased; 2) the date, time, and location of death; and 3) a brief description of the circumstances surrounding the death.

When the law was passed, U.S. Rep. Hutchinson commented. “In any other atmosphere, unnatural deaths under questionable circumstances would not only be reported but would raise serious concerns. State and local jails and lockups should be no different.” The law, while an improvement, still leaves large areas unexamined. It only requires counting “completed” suicides, not self-mutilation, not attempted suicides, not the “threats” of suicide so often contemptuously dismissed as “attention-seeking.” If we really want to lower the rate of prison suicides, these red flags must also be noted and a rational caring response initiated. When it comes to suicide, organized prevention is the only method that saves lives. But it takes attention, motivation, training, and on-going commitment.

With or without an official prison death count, effective suicide prevention programs depend upon priorities set by individual prison administrators. Warden C.M. Lensing (Elayn Hunt Correctional Center, St. Gabriel, LA) says of the program he initiated, “When you put suicide prevention kits in each housing unit, place social workers in the cell blocks to assess suicidal inmates each day, and schedule suicide prevention training every Friday, you symbolize to all staff the commitment we have to suicide prevention.”

Successful Prison Suicide Prevention Programs Include:

• Formal Identification of an inmate’s potential suicide risk both upon entrance and during “high risk” periods of incarceration, for example, after receiving bad news regarding self or family, or after suffering some type of humiliation or rejection. Long term prisoners may attempt suicide 5 years into their sentence; or with additional legal problems, or when all legal appeals are exhausted.
• Training must be provided for all staff members to recognize verbal and behavioral cues that may indicate the potential for suicide. 
• There must be assessment by a qualified mental health professional who can designate the level of risk.
• Staff must monitor an inmate at intervals appropriate to the level of assessed risk.
• A suicidal inmate should not be isolated (and isolation should not be substituted for monitoring). At minimum, the room or cell should be without protrusions of any kind, (loose vent plates, etc.) that would enable the inmate to hang him/herself since hanging is the usual means of suicide in prison. 
• Suicidal prisoners should be referred to mental health providers, and mental health and correctional personnel should share clear and current information regarding the continuing status of the inmate. Notification procedures need to be established for notifying prison administrators, outside authorities, and family members of potential, attempted or completed suicides.
• Documentation of activities with regard to potential and attempted suicides should be detailed, as well as completed suicides.
• A comprehensive plan should be developed that specifies procedures for medical and administrative review if suicides occur in order to identify causes and correct weaknesses.

Prison suicide sometimes seems fueled by conditions beyond the power of any individual. Conditions such as chronic noise and overcrowding, mandatory minimums, dramatic increases in life sentences, frustration/ exhaustion of all legal remedy, AIDS, Hep-C, jailing instead of treatment of the Mentally Ill, punitive Protective Custody/Ad Seg /Control Unit confinement, loss of outside relationships, marital difficulties, sexual assault or victimization all wear down coping skills and create intolerable, seemingly inescapable psychological pain.

Suicide as a process of deepening despair typically displays observable signs: loss of hope; feelings of shame or humiliation; all-or- nothing thinking; talk of suicide as the solution to “all this foolishness”; perhaps a previous suicide attempt or increasing mental problems; withdrawal, isolation, substance abuse or self medication; a suicide “plan” or demonstrated means of committing suicide.

If identified in time, suicide can be prevented. The acute period of danger is usually of short duration and if an inmate can be protected and talked through the crisis, the likelihood of a “successful” suicide is greatly reduced. The antidote for suicide is often as simple as competent, sympathetic attention during a time of acute personal distress, as simple as holding back the darkness for a fellow human being long enough for hope to renew itself in him tomorrow.

Suicide: What You Can Do to Help

Do you have a friend, cellmate or family member that may be suicidal? If so, there are things you can do to help. The following suggestions are taken from sources including San Francisco Suicide Prevention. They do not take the place of qualified mental health assistance – but since this can be hard to come by in prison, it may provide some guidance for self-help.

If you think someone is considering suicide, talk to them. Ask them if they are considering suicide. Raising the question of suicide shows that you are taking the person seriously and responding to the potential of her or his distress.

If The Answer Is: “Yes. I do think of suicide.” You must take it seriously And follow it through. 

Ask the following questions: “Have you thought how you’d do it?” “Have you decided when you would do it?” “Have you ever tried suicide before?” “What happened then?”

If the person has a definite plan, if the means are easily available, if the method is a lethal one and the time is set, the risk of suicide is very high.  

If you ascertain that the risk of suicide is high (i.e., a strong possibility exists that the person will commit suicide in the near future), try to make a verbal agreement with the person to talk to you before he or she follows through with suicidal intentions.

Pitfalls to Avoid:

• Avoid Moralizing (e.g. telling the suicidal person that suicide is a sin). The person already bears a heavy load of guilt. Moralizing will not help.
• Do Not Be Aggressive. Suicidal people can make us feel hopeless or powerless, and we may respond by being aggressively helpful. Listen, be compassionate, but don’t force yourself on the person.
• Do Not Try Too Hard to Reassure the Person. The suicidal person does not like her/himself at that moment. Telling her/him that they are a great person and that there is hope is worse than useless.

And finally, advocate for your friend or family member with prison staff, and try to get them adequate mental health care immediately.
 

This article originally appeared in the Fall 2001 issue of Justice Matters.