SUICIDE PREVENTION

1. SUICIDE PREVENTION 2012 www.alabamacounties.org

2. WHY SUICIDE PREVENTION? • Detainees in jails and police lockups commit suicide at a rate that is several times greater than individuals in the general population. • When a detainee kills himself/herself, the consequences for jail officers and the county can be devastating. www.alabamacounties.org

3. CONSTITUTIONAL RESPONSIBILITY 8th AND 14th AMENDMENTS: DUTY TO PROTECT • When government assumes responsibility for a person, there is a duty to provide a reasonable degree of protection. • Incarceration limits a person’s ability to obtain essential care for themselves. • It requires that agencies take reasonable measures to guarantee the “safety of detainees” from assault, suicide, fire/life safety and preventable illness. www.alabamacounties.org

4. PREVENTION • To prevent these problems, all jail personnel should be properly trained to recognize potentially suicidal detainees. • When these signs and symptoms are observed, the arresting officers should inform booking officers that the new detainee may be a suicide risk. www.alabamacounties.org

5. SIGNS/SYMPTONS OF POTENTIAL SUICIDE • Writing a suicide note • Recent attempts or history of suicide attempts • Feelings of hopelessness • Major mood swings • Withdrawal and silence • Extreme tension • Obvious loss of self esteem www.alabamacounties.org

6. SIGNS/SYMPTONS CONTINUED • Expression of unusual concern over what significant others will say about the detainee’s offense • Unrealistic talk about getting out of jail “one way or another” • Excessive self-blame and inordinate guilt feelings • Particular difficulty in dealing with the present and a preoccupation with the past www.alabamacounties.org

7. SIGNS/SYMPTONS CONTINUED • Detainees who have been forced to submit to “same sex” rape or have been threatened • First time sexual assault offenders • Detainees in very poor health or who are terminally ill • Anyone under age 18, whether or not the offender has been waived to adult court www.alabamacounties.org

8. SIGNS/SYMPTONS CONTINUED • Overly emotional response to incarceration • Crying or tearful behavior • Experience of a sudden loss of a loved one, job or material possession • Receipt of unexpected legal or personal news • Displayed guilt, shame or embarrassment • Alcohol and/or drug withdrawal www.alabamacounties.org

9. WATCH OUT! • Detainees who talk about committing suicide should always be taken seriously, and those who have previously attempted suicide or who have a history of mental illness should be observed constantly. • Any potential weapons, clothes, shoe laces, bedding or any other item that may be used to harm the detainee should be removed from the cell. www.alabamacounties.org

10. THE JAIL ENVIRONMENT • Certain characteristics unique to jails make them ideal settings for suicide. • Jails are authoritarian by design • For many detainees, incarceration produces profound feelings of helplessness and hopelessness • Support from family and friends is sometimes restricted www.alabamacounties.org

11. THE JAIL ENVIRONMENT CONTINUED • Many persons, especially those who have never been arrested develop feelings of shame. • Viewed from the detainee’s perspective, confinement in even the best jail is dehumanizing. • Preconceived notions about jails, based on TV and movies, may heighten fears about other detainees and staff. www.alabamacounties.org

12. ADMISSION & BOOKING The booking officer should complete a screening form with questions like the following: • Does the arresting officer believe the detainee is a suicide risk? • Does the detainee lack close family or a friend in the community? www.alabamacounties.org

13. ADMISSION & BOOKING CONTINUED • Has the detainee experienced a major loss in the past six months? • Has the detainee expressed concern about problems other than his/her legal situation? (financial or family problems, medical condition, fear of losing job) • Has someone close to the detainee (family, spouse or friend) attempted or committed suicide? www.alabamacounties.org

14. ADMISSION & BOOKING CONTINUED • Does the detainee have a history of psychiatric treatment? • Does the detainee have a history of drug or alcohol abuse? • Does the detainee hold a position of respect in the community or is the alleged crime shocking in nature? • Is the detainee thinking of killing himself? www.alabamacounties.org

15. ADMISSION & BOOKING CONTINUED • Does the detainee feel there is nothing to look forward to? (hopelessness or helplessness) • Does the detainee show signs of depression? (i.e. crying or emotional flatness) • Does the detainee appear to be anxious, afraid or angry? • Does the detainee appear to be unusually embarrassed or ashamed? www.alabamacounties.org

16. ADMISSION & BOOKING CONTINUED Is the detainee acting or talking in a strange manner? (cannot focus attention or sees or hears things that are not there) Is the detainee under the influence of alcohol or drugs? Is this the detainee’s first arrest?

17. REPORTING A positive response to questions regarding a history of suicidal behavior or unusual behavior after questioning should immediately be brought to the attention of the supervisor.

18. Intake/Booking • One of the most critical operations of a jail is the intake or booking of detainees. • During intake or booking, the jail’s liability is most exposed and the staff safety is at risk. • Detainees behavior is the most unpredictable during this process. www.alabamacounties.org

19. REFERRALS Detainees who indicate they have a history of suicide attempts should be referred to: • Mental health authorities • mental health authorities or medical staff should conduct a face-to-face evaluation of the detainee as soon as possible • until evaluation is made, close observation should occur www.alabamacounties.org

20. FORESEEABILITY Definition: the ability to perceive, know in advance, or reasonably anticipate that damage or injury will probably ensue from acts or omissions. • Cases usually hinge on whether the suicide was foreseeable or not www.alabamacounties.org

21. DUTY OF STAFF • Bozeman v. Orum, 199 F. Supp. 2d 1216 (M.D. Ala. 2002) (Jail staff is not under a duty to be trained in diagnosing or treating mental illness) • Tessier v. Sheriff of Monroe County, FL, 402 F.3d 1092 (11th Cir. 2005) (detainee made two requests to see a psychiatrist but was never seen by a mental health professional before suicide. Raised triable issue of whether suicide was a foreseeable consequence of corrections center staff’s acts and omissions) www.alabamacounties.org

22. INCIDENT REPORTS • Any member of the staff who recognizes a detainee whose behavior indicates emotional instability should complete an incident report describing the behavior of the detainee. • Incident reports should be forwarded to the shift supervisor, jail administrator and the medical staff. • Also, communicate with other staff and shifts. www.alabamacounties.org

23. PLACEMENT WITH OTHER DETAINEES • If the detainee is not belligerent or hostile, the detainee may be placed in a cell with other detainees if the staff thinks it would benefit the detainee. • Many suicidal people are less likely to attempt suicide in front of other people. Also, other inmates would likely try to prevent a person from attempting suicide. www.alabamacounties.org

24. MONITORING • Detainee may then be placed into a single/holding cell with a 24-hour monitor. • A staff member should closely monitor all persons deemed to be suicide risks. • If appropriate, a trustee may be assigned to observe the detainee (does not relieve staff of obligation). www.alabamacounties.org

25. MONITORING CONTINUED • Video Monitoring is also key • Cagle v. Sutherland, 334 F.3d 980 (11th Cir. 2003) (jail staff not deliberately indifferent to detainee’s risk of suicide when they were alerted to suicide risk and placed detainee in video-monitored cell, which was checked every 15 minutes overnight even though the actual cell was not checked every hour). www.alabamacounties.org

26. OBSERVATION LOGS • Documentation of those who appear to be suicidal should be kept. • At a minimum, the detainee should be checked on an irregular schedule to average every fifteen minutes and the check should be noted in the observation log. www.alabamacounties.org

27. REQUIRED HOUSING • Single Housing: Detainee housed alone due to suicidal tendencies should have following removed from his/her cell: • Plastic cup • Glasses • Shoe laces • Bedding • Anything they may use to harm themselves www.alabamacounties.org

28. DELIBERATE INDIFFERENCE Definition: the conscious or reckless disregard of the consequences of one‘s acts or omissions. • Detention officials will be liable if deliberately indifferent to risk of suicide. • Troyanos v. Coats: in section 1983 actions, plaintiff must show detention officials displayed deliberate indifference to detainee’s taking of own life. www.alabamacounties.org

29. EVALUATIONS • Evaluations of detainee health/recovery: • Evaluations of the detainee’s health and/or recovery process should be made at the direction of the appropriate mental health care authority.  • Directions/Recommendations from medical staff: • All directions from medical staff concerning the behavior of a suicidal detainee should be followed by all of the detention center staff. www.alabamacounties.org

30. ACTIVE SUICIDE ATTEMPT • Report active suicide attempt immediately • Medical authorities, shift supervisor and jail administrator • Check scene for safety of self and others • Check for possible ruse, trap or set up • Use safety precautions and equipment, i.e., gloves, CPR mask, etc. • Secure site as soon as possible www.alabamacounties.org

31. ACTIVE SUICIDE ATTEMPT CONTINUED • Administer first aid • If hanging, lift to restore airway • Cut and remove item from detainee’s neck • Perform CPR until relieved by medical personnel • Debrief staff • Write incident report www.alabamacounties.org

32. ACTIVE SUICIDE ATTEMPT CONTINUED • Gather all documentation • Reports • Observations • Logs www.alabamacounties.org

33. WORDS OF WARNING! • Do not make any inappropriate statements • What you say can hurt you www.alabamacounties.org