Authors: Jennifer Crumlish Ph.D.

Dr. Jennifer Crumlish received her Ph.D. in clinical psychology at The Catholic University of America in 1996. She completed her pre-doctoral internship at St. Elizabeths in Washington, D.C., Her interest in research started while working in the Biological Psychiatry Branch in the NIMH at NIH during graduate school.

She has taught courses in the graduate psychology program at Catholic University in psychopathology and diagnostic assessment and supervised students in the psychotherapy practicum. From 2006 until 2017, Dr. Crumlish was a consultant to the D.C. Department of Human Services Adult Protective Services division and conducted capacity evaluations of adults throughout the city. Dr. Crumlish is currently an examiner for the Superior Court of D.C. Probate Division and has presented at several conferences on elder abuse in Washington, D.C.
 
Currently Dr. Crumlish is a partner in the Washington Psychological Center where she provides therapy to adolescents, adults and couples. In addition, she is the Assistant Director of the Suicide Prevention Lab at the Catholic University of America where she has been a consultant on several randomized controlled trials of CAMS. As a Senior Consultant with CAMS-care, LLC, Dr. Crumlish has provided training in CAMS to mental health providers at multiple military posts, a state correctional organization and local and state mental health suicide prevention organizations.

Suicidality in Correctional Facilities: Challenges in Assessing and Treating

With suicide rates rising dramatically over the past few years in both state prisons and local jails, the need for effective assessment and treatment of suicidal behavior as well as other forms of mental illness for inmates also increases. However, the nature of the correctional system and local and state facilities present unique challenges to the effort.

Below are four of the major challenges our correctional facilities face in their efforts to serve inmates experiencing suicidal ideation or other suicidal behaviors.

Challenge #1: Rising Mental Illness and Suicide Rates

The alarming trend of rising mental illness and suicide rates in correctional facilities is a major concern in the United States. The chart below visualizes the increase in the number of suicides in local jails and federal state prisons in the United States from 2000-2019.

Suicide and Mental Health Statistics for Incarcerated Individuals

  • The Bureau of Justice Statistics (BJS) has reported a staggering 30% increase in suicide rates in state prisons from 2013 to 2014, highlighting the dire state of mental health care in these facilities.
  • Suicide was also found to be the leading cause of death in 2014 in local jails, with a 13% increase from the previous year.
  • The rate of mental health issues in jails and prisons is three times higher than that of the general population.
    44% of jail inmates and 37% of prisoners report having been diagnosed with a mental health disorder prior to their incarceration.
  • The most common mental health disorder among both prisoners and jail inmates was major depressive disorder, which is known to be highly associated with suicidal thoughts and behaviors.

Challenge #2: Difficulty in Assessing “Secondary Gain” Behaviors

Occasionally, savvy inmates and prisoners may recognize opportunity in feigning suicidal thoughts or behavior in order to manipulate “the system”. This is called “Malingering.” Reference Here:

 

Malingering is falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among others.

 

In correctional facilities, presenting suicidal behavior can result in extra attention, trips to the hospital, special treatment, and more. It becomes difficult to discern between a genuine cry for help and those employing manipulative measures for their own gain or entertainment.

This presents a dilemma for administrators and health providers in correctional facilities, as they must balance the need to provide appropriate care with the risk of enabling manipulative or “secondary gain” behaviors. In some cases, the presence of these individuals can lead to a sense of suspicion or distrust, causing some administrators to become overly cautious in their approach to treatment. Unfortunately, this cautious approach can also result in underserving inmates who are genuinely struggling with mental health issues and suicidal ideation.

Challenge #3: Frequent Transfers and Short Terms

The issue of frequent transfers and short terms for inmates in correctional facilities poses a significant challenge for mental health professionals tasked with addressing suicidal behavior. In

some settings, clinicians and other mental health professionals may only have the opportunity to meet with a suicidal inmate for one or two sessions before the inmate is transferred or released.

This limited time frame makes it extremely difficult to accurately assess an inmate’s risk of suicide and to identify the underlying drivers of their suicidality. Without a comprehensive assessment and prevention program in place, mental health professionals may not have the tools or resources needed to quickly uncover an inmate’s true drivers of suicidal behavior.

As a result, accurate risk assessment and effective treatment become virtually impossible, and inmates may not receive the care and support they need to address their mental health issues. The root causes of their suicidal behavior may go unaddressed, leading to a continued risk of suicide even after their release.

Challenge #4: Most Correctional Policies Focus on Containment Instead of Treatment

The prevalence of mental illness in correctional facilities is a significant issue, and unfortunately, correctional officers are often more concerned with maintaining order and security within their facilities, and this can result in limited attention being given to caring for inmates with mental health disorders. Policies for addressing suicidality in particular tend to prioritize containment over treatment, especially when resources are scarce. In some facilities, the policies for managing a suicidal inmate may be inadvertently counterproductive and even punitive or demeaning, which can discourage inmates from seeking help and exacerbate their mental health issues.

Moreover, while some inmates may be screened for suicide, it can be challenging to provide follow-up screening and assessment or access the resources to provide treatment for suicidal inmates. This can result in inadequate care for inmates with mental health disorders, leaving them at risk of harming themselves or others.

A supporting example that offers insight into the containment vs treatment statement comes from a U.S. Department of Justice National Institute of Corrections training guide titled “Inmate Behavior Management: The Key to a Safe and Secure Jail”, (published in 2009):

 

The inmate behavior management plan consists of six essential elements:

  • Assessing the risks and needs of each inmate at various points during his or her detention.
  • Assigning inmates to housing.
  • Meeting inmates’ basic needs.
  • Defining and conveying expectations for inmate behavior.
  • Supervising inmates.
  • Keeping inmates occupied with productive activities.
For more information

For more information on this topic, read “The Challenges of Assessing and Treating Suicidalty in Correctional Facilities: A Possible Solution with CAMS-care” by Jennifer Crumlish, Ph.D.

About Jennifer Crumlish Ph.D.

Jennifer Crumlish Ph.D.
Dr. Jennifer Crumlish received her Ph.D. in clinical psychology at The Catholic University of America in 1996. She completed her pre-doctoral internship at St. Elizabeths in Washington, D.C., Her interest in research started while working in the Biological Psychiatry Branch in the NIMH at NIH during graduate school. She has taught courses in the graduate psychology program at Catholic University in psychopathology and diagnostic assessment and supervised students in the psychotherapy practicum. From 2006 until 2017, Dr. Crumlish was a consultant to the D.C. Department of Human Services Adult Protective Services division and conducted capacity evaluations of adults throughout the city. Dr. Crumlish is currently an examiner for the Superior Court of D.C. Probate Division and has presented at several conferences on elder abuse in Washington, D.C.   Currently Dr. Crumlish is a partner in the Washington Psychological Center where she provides therapy to adolescents, adults and couples. In addition, she is the Assistant Director of the Suicide Prevention Lab at the Catholic University of America where she has been a consultant on several randomized controlled trials of CAMS. As a Senior Consultant with CAMS-care, LLC, Dr. Crumlish has provided training in CAMS to mental health providers at multiple military posts, a state correctional organization and local and state mental health suicide prevention organizations.

The Challenges of Assessing and Treating Prison Suicidality: A Possible Solution with CAMS-care

The Challenges of Assessing and Treating Prison Suicidality: A Possible Solution with CAMS-care

Suicide Prevention in Jails

The correctional officers (COs) told their supervisor they had had it with Inmate Roy Jones (a fictional composite of real incarcerated individuals). During a busy change of shift, Roy told his CO that an hour earlier he had swallowed a razor blade and pieces of scavenged metal, and now was regretting that he had done so. Taken by a CO to the infirmary, the nurse on duty assessed Roy and noted his blood pressure was high, he looked pale, and he was spitting up blood. Due to a recent high-profile suicide in the facility that had brought unwanted publicity, pressure on staff to avert additional incidents increased tension among CO managers and mental health supervisors. As a result, being cautious, the nurse recommended that Roy be transported to the local hospital. After a 6-hour wait in the emergency department, diagnostic imaging conducted at the hospital revealed no evidence of a razor blade or metal, and Roy was transported back to the prison. Needless to say, the amount of time spent at the hospital and absence of the two COs accompanying him created more stress for the COs covering the shift.

Engaging in multiple suicide attempts as well as several incidences of reporting attempts that were revealed to be false, Roy was proving to be a major management issue for both the COs and the mental health team. Roy was just one of several inmates with escalating self-harming and suicidal behaviors since the death of the suicidal inmate. In addition to suicidal behaviors, Roy was combative, faced additional time for punching a CO, was often non-compliant with treatment, and committed many rule violations related to substance use, fighting with other inmates, and possession of contraband items. Each time Roy faced disciplinary action or was moved to a more restrictive placement, he either made another attempt or claimed he had made an attempt.

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About Jennifer Crumlish Ph.D.

Jennifer Crumlish Ph.D.
Dr. Jennifer Crumlish received her Ph.D. in clinical psychology at The Catholic University of America in 1996. She completed her pre-doctoral internship at St. Elizabeths in Washington, D.C., Her interest in research started while working in the Biological Psychiatry Branch in the NIMH at NIH during graduate school. She has taught courses in the graduate psychology program at Catholic University in psychopathology and diagnostic assessment and supervised students in the psychotherapy practicum. From 2006 until 2017, Dr. Crumlish was a consultant to the D.C. Department of Human Services Adult Protective Services division and conducted capacity evaluations of adults throughout the city. Dr. Crumlish is currently an examiner for the Superior Court of D.C. Probate Division and has presented at several conferences on elder abuse in Washington, D.C.   Currently Dr. Crumlish is a partner in the Washington Psychological Center where she provides therapy to adolescents, adults and couples. In addition, she is the Assistant Director of the Suicide Prevention Lab at the Catholic University of America where she has been a consultant on several randomized controlled trials of CAMS. As a Senior Consultant with CAMS-care, LLC, Dr. Crumlish has provided training in CAMS to mental health providers at multiple military posts, a state correctional organization and local and state mental health suicide prevention organizations.