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 sheer number of suicide attempts in correctional facilities – both state and local – is rising. According to the Bureau of Justice Statistics (BJS), suicide rates in US state prisons increased 30% from 2013 to 2014, and suicide was the leading cause of death in 2014 in local jails – an increase of 13% over the previous year.
Furthermore, the rate of mental health issues in jails and prisons is three times higher than that of the general population, with 44% of jail inmates and 37% of prisoners reporting mental health disorder diagnoses prior to becoming incarcerated. The most common disorder among both prisoners and jail inmates was major depressive disorder, 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”. 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.
Therefore, the presence of such attention-seekers and malingerers can cause some administrators and health providers to become especially wary of enabling manipulative or “secondary gain” behaviors. Unfortunately, those in serious need of treatment may inadvertently be underserved as a result.
Challenge #3: Frequent Transfers and Short Terms
We all know that there is no “magic bullet” in treating suicidal behavior, and change cannot be effected overnight. However, it’s common in some settings for clinicians and other mental health professionals to have the opportunity to meet with a suicidal inmate for only one or two sessions before the inmate is transferred or released.
Without the right tools or assessment and prevention program, it’s very difficult to quickly uncover an inmate’s true drivers regarding their unique suicidality – and without addressing the root cause(s) of the behavior, accurate risk assessment and effective treatment are virtually impossible.
Challenge #4: Most Correctional Policies Focus on Containment Instead of Treatment
Probably understandably, correctional officers are generally more concerned with keeping order at their facilities than caring for mental illness behaviors – and this priority becomes more prevalent when monetary and human resources are scarce.
Therefore, policies for addressing suicidality tend to focus on containment rather than treatment. For some facilities the policies for managing a suicidal inmate may often be inadvertently counter-productive – and in some cases even punitive or demeaning. In fact, suicidal inmates may feel pressured to deny being suicidal in order to be released back into the general population.
Though many inmates may be screened for suicide, it may be more challenging to provide follow-up screening and assessment, or for a facility to have access to the resources to provide treatment for suicidal inmates.
For the past three years, CAMS-care has trained mental health providers in a large state correctional organization to use CAMS with inmates in their mental health care systems. Implementation has revealed that CAMS provides a streamlined method to assess risk level, identify direct and indirect drivers of suicide, and collaboratively create a solid stabilization plan that inmates use with effective coping strategies to rely upon in the face of a suicidal crisis.
CAMS may be a successful approach to managing suicidal inmates in both short-term and long-term settings, and clearly meets the criteria for an effective suicide prevention approach in a range of correctional facilities.
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.