Preserving life: The importance of jail suicide prevention training

You are standing before a class of rookies … the “newbies” … the “greenhorns.” Today’s lesson is on preventing suicide in the inmate population. The learners sit up, prepare to listen attentively; they will be tested on this, and passing the academy is critical for them to stay employed.

Most suicide prevention curricula contain standard information written by experienced corrections personnel and trainers. In many cases, these lessons are used year after year with few changes. I am not saying the lesson plans have never been updated; usually, policy and standards require periodic reviews. This curriculum includes a list of reasons an inmate might kill (or attempt to kill) themselves. It describes the signs and symptoms, detailing what can staff do to protect offenders from themselves. Also, it explains the procedures for referring inmates to qualified mental health staff.

These are good training steps. Once the newbies graduate from the academy and complete their on-the-job training with a field training officer, they will be interacting with offenders who are thinking about suicide. Officers may come across deceased inmates who have cut their wrists, overdosed on medications or hanged themselves. Some corrections officers (COs) — especially those who have become somewhat jaded — may think suicide just comes with the territory. When it happens, they tell themselves, “The inmate was no good,” and inform their supervisors that they are OK to return to their posts. They don’t need to see a counselor. After all, aren’t correctional officers supposed to be tough and hold everything in?

Death is final, and so are the images of inmates who have hanged themselves, thrown themselves down stairwells or off a second-level unit catwalk, or have found or fashioned a ‘sharp’ and slit their wrists or necks open. Veteran corrections officers most certainly remember such incidents, as well as the inmates who have attempted suicide. They also remember the inmates they talked to — those they convinced that suicide is not the answer. In these situations, the officer may experience relief that the inmate did not act out their suicidal plan. When offenders give life another chance, a life is saved.

My goal here is simple, as there is no reason to reinvent the wheel. Virtually everyone in corrections has had suicide prevention training, both in basic training and in-service training. Let us look at the basics in a different, “outside of the box” perspective. By doing so, we can spark both interest and appreciation of the importance of this life-and-death topic.

The scope of the problem

Any jail suicide prevention training program should start with a look at the data: How many jail suicides have occurred, what times and locations, and so on. This gives staff a foundation. Statistics and data have a bottom line. Both the Bureau of Justice Statistics (BJS) and the National Center on Institutions and Alternatives (NCIA) provide good data.

From the BJS:

In 2019, there were a reported 355 deaths in local jails attributed to suicide. There were 553 deaths from illness.
From 2000 – 2019, 46.1% of jail suicides occurred in general housing areas, 20.6% in segregated areas, 25.8% in medical units, 1.9% in mental health units, 0.5% in transit and 5.2% elsewhere.
From 2000 – 2019, the highest number of suicides in local jails involved inmates between 25 and 34 years of age (1,960).
From 2000 – 2019, the number of deaths by suicide among male local jail inmates was 5,627, compared to 589 female inmates.
From 2000 – 2019, suicides of convicted inmates totaled 1,109, while the number of suicides of unconvicted inmates was 5,084.

From the NCIA:

History of mental illness among jail suicide victims: 38%
History of suicidal behavior among jail suicide victims: 34%
Rates of suicide occurring close to court dates: 35%; 80% within two days of court date.
Rates of suicides occurring close to date of phone call or visit: 22%; 67% within one day of phone call or visit.
Suicide methods used: Hanging comprised 93% of suicides; 66% used bedding, 30% used bed or bunk as an anchor.
Housing of suicide victims: 38% were housed in isolation.

Let’s look at the bottom line. According to the BJS, jail suicides can occur in general population areas as well as in segregation. Suicides even happen in medical areas. Many more male offenders kill themselves than females, and the suicide rate is higher for unconvicted inmates than convicted. The NCIA data indicates mental illness is a significant factor. Court dates and visits are critical times that must be considered when monitoring inmates for suicide risk.

Let’s have a frank dialogue about suicide prevention training. At the conclusion of this discussion, I hope the reader comes away with some ideas to enhance the training and convey the importance of it. A jail suicide prevention program should include the viewpoint that inmates are people and people have problems. In their struggle about making the decision to die, many will look for a lifeline. And the correctional officer is the lifeline they’re hoping for.

Signs and symptoms

In addition to the data, trainers must include the signs and symptoms of suicidal inmates. In basic officer training, these indicators are discussed at length. However, in-service training in suicide prevention must be offered — or mandated in some venues — such as online training, roll call or day-long classes. It is always important to list the signs and discuss them. A few of the many signs include sadness, crying, withdrawing from social activities, talking about not being around for court, not eating, not sleeping, refusing treatment, giving possessions away, and writing a note about what to do after they die.

Other warning signs include a history of suicide in the family, being the victim of or fearing same-sex rape, health problems, talking about dying and substance abuse. Combine these with severe guilt or shame over the offense, receiving (or the possibility of receiving) a long sentence, and being agitated or aggressive, and you get a clearer idea that these offenders are in crisis. If they have been incarcerated before, suicidal behavior, attempts and ideation are probably in their records.

Do not overlook the possibility that an offender has suffered a recent loss, including relationships, job, home or the death of a loved one. Upon incarceration, these “anchors” are suddenly gone.

Officers must engage in ongoing, vigilant observations. While it is impossible to get to know all the inmates in your institution, you should frequently check in with them, interact with them and look out for any changes in behavior. Talk to other inmates. In other words, get up from the desk, interact with inmates and see how they are doing. Fear can be a factor. Imagine yourself as a newly admitted inmate in your local jail. All you know about jail is what you’ve seen in the news, movies or reality shows.

In my in-service classes, I often ask when members of the news media visit the jail. The typical answer is when something goes wrong: the death in custody of an inmate, a staff member getting hurt or killed, staff sexual misconduct, escapes, gang activity, contraband being smuggled in, or an officer posting something stupid — yes, stupid — on social media. Media folks may pay particular attention to special population inmates such as transgender people, the mentally ill, pregnant females and so on. Of course, there are exceptions, such as when a news outlet covers an innovative jail program or speaks to inmates who have gotten sober. Not all media coverage is negative.

So, imagine yourself in jail, where you’ve never been before. You’re sitting in a holding area, listening to the screams of mentally ill inmates, arguments among inmates, violent inmates being subdued by officers, and angry inmates pounding on the door. If you are in population and have received bad news from your lawyer or family, or are just depressed and tired, you may think that ending your life is the only possible option.

Protection from self-harm

In any corrections setting, steps must be taken to protect all inmates from harm, regardless of whether that harm comes from others or from themselves. This includes removing items that could be fashioned into nooses, such as such as clothing or bed linens, or makeshift cutting implements, which includes anything that could be sharpened. Suicide prevention smocks, which are resistant to tearing, are a great innovation, but most inmates find them uncomfortable and humiliating, which is unlikely to improve their state of mind. In addition, we must closely observe inmates and be quick to react to other methods of self-harm, as some inmates have jumped from second-floor tiers in units or thrown themselves down stairwells.

Officers must check suicidal inmates very frequently, such as every 15 minutes. But in my experience, there are inmates who are so self-destructive that they must be checked more frequently, every few minutes, and placed in direct line of sight of staff. Suicide is a private act, so placing suicidal inmates with other suicidal inmates near an officer post can be an effective detriment.

Protection includes frequent interaction with staff, ranging from officers on post, medical staff and mental health personnel. Go into the cell, see how the inmate is doing, and don’t forget to search! Are they fashioning a noose or sharpening something? Is there a suicide note? Are they in contact with family? Has the chaplain visited the inmate? If inmates wish to speak to certain staff members because they have a positive rapport with them, can that be arranged?

When it comes to preventing suicide, everyone on staff must be a team player. Protection means both observation and concern. To put this into action, the mantra that “corrections is a people profession” must be instilled from basic training through in-service training and beyond. While COs are on the front line, all sworn and civilian staff should be familiar with the problem of inmate suicide. Even if a CO is assigned to records, commissary or programs, they can still take time to glance into a cell housing an inmate on suicide watch. Civilians who deliver commissary or conduct programs should realize the importance of notifying post COs or their staff liaisons if they observe an inmate displaying depression or sadness or talking about dying. Training for contractors, professional and support employees having regular inmate contact should include suicide precautions and signs of suicide risk.

This level of observation requires an open, respectful, two-way dialogue between sworn and non-sworn staff. If you are a CO and the GED teacher tells you an inmate in her class was crying and talking about death, act on it. Notify your supervisor, put the inmate on suicide watch and observe closely. You may not like programs — in fact, you might think they are a waste of time — but all staff members are responsible for the well-being of every inmate. If you are a supervisor and the COs under you show disrespect for programs staff, take immediate steps to resolve this problem. Full cooperation is required to help save inmate lives.

In suicide prevention, complacency can be dangerous. Consider the example in which two California jail deputies lost their claim of qualified immunity in a lawsuit stemming from an inmate’s suicide. Court records indicate they saw a rope hanging from a ceiling-mounted light fixture in an inmate’s cell. This fact was verified by other inmates. The next morning, the inmate used the rope to hang himself.

Remember that liability can be assigned based on deliberate indifference. The deputies knew the rope was there, yet did nothing. If your observations and interactions with an inmate indicate the possibility of suicide, your instincts should tell you that if you fail to act, it will not go well for you in a civil lawsuit.

Response

Response to a suicide attempt or an inmate acting in a suicidal manner is important. How quickly is the staff responding to administer medical care or put the inmate on high observation? How fast can you access cutting tools in case of a hanging? Can mental health staff intervene quickly? What resources are available to interact with the inmate, such as the chaplain, mental health providers, and so on?

These questions and their proper responses should be included in all suicide prevention programs, from online to roll call to in-service. Training also must address staff attitudes. All personnel must show care and concern — no matter what they think of the inmate, their behavior or charges. Documentation is important, from incident reports to logs showing services and care provided to the inmate on suicide watch. Do not forget to pass on intel about potential suicide risks to other shifts. The more those other shifts know, the better their observations will be. Also, pass-on information should be written, and not just verbal.

Things to remember about jail suicide prevention

First, training is important. All staff, sworn and non-sworn, should realize that corrections is a people profession, similar to health care or social services. The clients are markedly different; they are accused of or convicted of breaking the law. Regardless of why they are incarcerated, though, we all have a stake in addressing their problems and keeping them safe from themselves. True, some are manipulators, trying to elicit sympathy from staff. But we must treat all suicidal behavior by inmates as the real thing and let qualified mental health professionals sort it out.

Second, staff must get to know the inmates in their areas. While it is impossible to know the whole life history and back story of every inmate, staff should be familiar with how they act and notice changes. For example, an inmate has always seemed friendly, cooperative and upbeat. Now they are quiet, appear sad and aren’t sleeping well. Ask them if something is wrong … and then listen to the answer. I tell my classes: “If inmates are talking, they are breathing. And if they are breathing, they are not dead.” Stay with an inmate in crisis — as long as possible. Good supervisors will act quickly, putting the inmate on suicide watch, referring them to mental health and medical staff. Good supervisors will arrange relief, as much as possible, from your other assignments so you can talk to the inmate. It’s critically important to stay with an at-risk inmate as long as possible until mental health staff arrives.

Third, treat all signs, symptoms and remarks about suicide as the real thing. True, an inmate may be faking, trying to manipulate staff to elicit sympathy. But we must err on the side of caution and take all suicidal behavior at face value. Let the trained mental health professionals do their jobs, evaluate inmates and confer with supervisors. And don’t get complacent about inmates who come back to the jail again and again. Even though they may have never shown signs of suicidal behavior in the past, that doesn’t preclude them from becoming a suicide risk this time. It’s important to always remember that every inmate — young and old, first timer or “frequent flier,” felon or misdemeanant, convicted or not — is potentially a suicide risk.

Finally, a CO trying to prevent an inmate suicide is similar to throwing a lifeline to a drowning person. In my trainings, I show a PowerPoint slide depicting several people (both famous and infamous) who have died by suicide, from Ernest Hemingway to Adolf Hitler to Robin Williams. I ask the class, “Why do you think these people killed themselves?” All these people, I tell my students, had problems that seemed insolvable. Ernest Hemingway suffered from mental illness, made worse by his alcoholism. Adolf Hitler was losing the war and feared capture by the Russians. Robin Williams had a debilitating disease. But it’s not just famous people who kill themselves; people from all walks of life and all layers of society are susceptible to death by suicide. Everyone — including jail inmates — has problems. Some think suicide will solve them. As jail correctional officers, you must throw the lifeline. Ending a life solves nothing, and regardless of how determined an inmate might be, it’s always possible you can convince them otherwise. Death is final.

Inmates are people. Throw the lifeline.

References

Carson E A. Mortality in Local Jails, 2000-2019 — Statistical Tables. Washington, D.C.: Bureau of Justice Statistics, 12/2021. Accessed 8/15/2024 at https://bjs.ojp.gov/content/pub/pdf/mlj0019st.pdf
Chamberlain M. 10 warnings of suicidal inmates. Corrections1, 7/23/2019. Accessed 8/15/2024 at https://www.corrections1.com/correctional-healthcare/articles/10-warning-signs-of-suicidal-inmates-LXhSVsYQPflZQM07/
Cohen F. San Diego Deputies Fail to Respond to Rope Hanging Down in Decedent’s Cell: QI Claim Rejected. Correctional Law Reporter, Civic Research Institute, XXXII, No. 5, 2-3/2021: 76.
Cornelius, Gary F. The Correctional Officer: A Practical Guide, Third Edition. Carolina Academic Press, 2017.
Cornelius, Gary F. Suicide Prevention in Jails. In-Service Power Point training presentation. 2023.
Hayes, Lindsey. National Study of Jail Suicides: 20 Years Later. National Center of Institutions and Alternatives. 4/2010. Accessed 8/15/2024 at https://nicic.gov/resources/nic-library/all-library-items/national-study-jail-suicide-20-years-later
Performance-Based Standards for Adult Local Detention Facilities, Fourth Edition. American Correctional Association, 2004.