Suicide Behind Bars: Prediction and Prevention
David Lester, PhD and Bruce Danto, MD
The primary aim of this unique book is to provide practical knowledge about suicide and its prevention for those who work within the criminal justice system, particularly psychologists and correctional officers in jails, detention centers and prisons. The authors supply current and reliable information on legal responsibility, attempted suicide, self-mutilation, inmate screening and counseling, facility design, staff training and prevention programs. A widely read and welcomed addition to the scant literature on this subject, this book is used as a reference in hundreds of prisons, jails and detention centers in the US and around the world.
"The first half of this book offers a wealth of statistics and cited research articles...and the second half of the book...provides practical information concerning the assessment of potential suicide attempters, the training of staff and facility designs to prevent suicide, and the counseling of potential suicides. Correctional institution libraries should purchase Suicide Behind Bars. In addition, academic libraries with studies in psychology or corrections will also want to purchase this book for its excellent bibliography."
— Library Journal
"In this book a valid effort is made to examine and report on the factors, methods, preventative measures, and liability issues of prisoner suicide. The authors have met the challenge of presenting a wide spectrum of information in a highly reasonable and logical format, using case histories, citations of other published works, screening guidelines, management formats, and counseling recommendations. Contained in this work is information so critical that this book merits a chapter by chapter review.
Chapter 1: Spectrum of Inmate Suicide
Through the use of seven case histories, the authors examine successful suicide attempts in lockups and jails. A conclusion is afforded drawing common threads among all seven cases. Each individual had given direct or behavioral cues as to suicidal intent, was suspected of having been using alcohol or drugs, or had a previous psychiatric history, and died by his own hand shortly after booking. Officers’ negligence rests firmly in the failure to perceive that the prisoner was a danger to himself. This negligence establishes the tone and direction of the rest of the book.
Chapter 2: Inmate Suicide: How Common Is It?
The authors examine the suicide rates and percentages in jails and prisons and compare them to the rates for the entire population. Some revealing figures stare out at the reader. The authors report that about 20 percent of custody deaths are directly caused by suicide in prisons and jails. This compares to less than 2 percent in the entire population. The authors also reveal the extremely high rate of suicide of death-row inmates in spite of intensive death row supervision. Also examined is the higher rate of suicides in county jails as compared to state prisons. The authors attribute this to state prisons providing more complete policies and follow up. I feel that the authors missed the fact that most state prisoners are admitted to state prison out of the county jail. These prisoners have had an opportunity to adjust to confinement and probably had X opportunities to commit or attempt suicide if that was their choice.
Chapter 3: Which Inmates Commit Suicide?
Characteristics of suicidal inmates in jails, lockups, and prisons are the focus of this chapter. The authors develop material that points toward young, white, male prisoners with minor arrest charges and frequently intoxicated as the primary risk group. In jails, most suicides occur at night and within 24 to 72 hours of admission. A profile of persons likely to be at risk for jail suicides is not as reliable, but inmates who are incarcerated for violent crimes against persons seem at greater risk. The authors report that most all custodial suicide victims are male and that whites have a higher rate than black inmates. The authors offer no insight into this difference. In attempting to clarify this issue for myself, I spoke with the black control officer in our facility and proposed the question to him. His response was straightforward and concise. He advanced the idea that due to social constraints on blacks in our society, resulting in feelings of already being confined, a shift in location of that confinement makes little difference.
The book lists four primary types of suicidal prisoners:
“Morality Shock” – The inmate becomes suicidal after booking due to embarrassment and disgrace to himself and family. The crime may be violent, a publicized sex offense, or white collar.
“Chronic Despair” – This prisoner has been jailed for some time and feels isolated, dehumanized, or alone and without any possibility of change.
“Manipulator” – An antisocial individual who uses nonlethal attempts to gain attention or better housing assignment (i.e., hospital versus jail cell). Death can result from the miscalculation [by facility personnel] on the [level of] lethality of the suicide attempt.
“Self-Punishment” — This describes a person who mutilates himself to make life as humiliating, degrading, and painful as possible and may escalate into a full blown lethal attempt.
The book warns against using the suicide profile as the sole determining factor in assessing suicide risk. I feel that this warning is valuable. A better method is to look at the four types of suicidal prisoners the book lists and develop methods to screen for these individuals.
Chapter 4: Suicide Attempts and Self-Motivation
Nonlethal suicide attempts and self-mutilation are a serious problem and must be examined and treated. The authors believe that those who make nonlethal attempts and/or who self-mutilate are [perhaps not trying to end their lives as much as they are trying to bring attention to a problem and/or get help. For example, they may be exhibiting one or more of the following:
A Desire for reclassification to more secure housing
A cry for help, personal attention, or counseling
An escape from perceived intolerable conditions (in other words, guilt, prison, depression, etc.)
A desire for clemency from courts, officers, parole, etc.
Chapter 5: Theories of Inmate Suicide
Discussion of the relationship between childhood experience, physical abuse, psychological factors, and stressors involved in creation of a suicidal individual is presented in this highly informative chapter. Having been trained previously regarding signs and symptoms of suicide, I was pleased that the authors took some space to establish the emotional background and influences present in suicidal inmates. The authors draw a picture of a person already on the road to destructive behavior and then encountering the additional stressors of usual jail life including:
Bad news or no news from home
Unexpected jail sentence
Long term non-sentenced status
Feelings of guilt or depression
Chapter 6: Screening Inmates for Suicidal Risk
Several excellent screening documents are offered in this chapter. Intended to be used at the time of booking or transfer, prior to any actual suicidal act, the purpose of these documents is to screen prisoners for suicidal potential. According to their work, the authors set forth areas which must be addressed on any screening form, including signs of depression, history of mental problems, terminal illness (HIV included), poor occupational history, monetary problems, withdrawal from alcohol/drugs, history of suicide attempts by self or family members, rapid behavioral changes, and feelings of hopelessness. Methods of administration of such screening range from inmate aides to psychiatric nurses to corrections officers.
Chapter 7: Facility Design
Issues of levels of supervision and cell construction or modification are offered for examination. A management table for four different levels of suicide-prone inmates is presented. This approach, as presented, seems logical, well-developed, and usable by most facilities. Discussion of the negative effects of isolation on suicidal inmates as well as the planning and training needs for responding to an actual suicide attempt is right on target. This chapter also, quite effectively, stresses the need for immediate intervention by medical or psychiatric personnel as soon as the prisoner is identified as suicidal.
Chapter 8: Organization and Staff
An exploration into the need for staff training in such areas as screening skills, communications and interaction techniques, careful booking and classification procedures and emergency medical training is documented. Some examples in terms of staff training programs and of general content are also listed. I felt that the authors handled these subjects well but could have offered more extensive information regarding training directions, specifics, and training resources.
Chapter 9: Counseling the Suicidal Inmate
A five-step process in suicide intervention is given and seems suitable for initial intervention approaches from any quarter. Choice of who responds to any given suicidal crisis, be it inmate aides, correction officers, or medical or mental hygiene personnel, is usually determined by the resources of each facility. The authors present the case for using inmate counseling aides. As a 17-year practitioner in county corrections, I feel that this approach would work in state prisons or facilities where extended sentences are served, but not in facilities were the average stay is 30 days or less. The key issue here is that crisis in adequate follow-up response be provided.
Chapter 10: Institutional Programs for Suicide Prevention
In this chapter, the authors have provided all too brief descriptions of working suicide prevention programs in several jurisdictions. As a Suicide Prevention instructor for the NYS Commission of Correction, I was gratified to see the New York program described in this chapter. Implementation of this program in county jails across the state has resulted in a 90 percent decrease in inmate suicides since 1987. Programs from Mobile, Alabama, El Paso, Texas and Champaign, Illinois are also described here as potential models for use in program development.
Chapter 11: The Escalating Problem of Inmate Suicide
This chapter seemed out of place at the end of this otherwise comprehensive work. The problems of the deinstitutionalization of the mentally ill and the overcrowding of jails with drug users raised a call by the authors to place these persons in treatment facilities more commensurate with their needs. Although I agree with this idea, it is unlikely that this will happen. A more pressing question is: How we can keep up with the increasing numbers of mentally ill and chemical abusers in our custody? The book also makes it extremely brave stab at describing the liabilities involved in custodial suicides, which was not successful either in defining the parameters of the problem nor in proposing solutions. This passing comment on liability could have been developed more fully.
A final recommendation:
As a line supervisor who has witnessed 15 attempted suicides by inmates, and as a suicide trainer, reading this work not only validated my training and knowledge but expanded it. This book should be on the required reading list for suicide trainers, line supervisors, and facility managers."
— American Jails (Sergeant Larry S Fischer, Correctional Trainer, Broome County, New York, Sheriff’s Office)