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

Jennifer Crumlish Ph.D.
Published: September 10, 2019


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 CAMS-care

CAMS Framework is first and foremost a clinical philosophy of care. It is a therapeutic framework for suicide-specific assessment and treatment of a patient’s suicidal risk. It is a flexible approach that can be used across theoretical orientations and disciplines for a wide range of suicidal patients across treatment settings and different treatment modalities. The clinician and patient engage in a highly interactive assessment process and the patient is actively involved in the development of their own treatment plan.