Suicide Behind Bars
Exploring the difficulties of managing the suicidal inmate.
Posted Feb 11, 2019
Suicide has been on our collective mind recently. From high profile losses to the opiate epidemic, we’re more cognizant of people taking their own lives. In prison, the issue takes on a different hue.
It will come as no surprise that local jails, the initial level of incarceration and the entry point for most detainees in the correctional system, have the highest rate of suicidal behavior, especially in the first 24 hours. In the prisons, there is a similar period of acclimation where risk is elevated. Several issues complicate the identification and treatment of suicide for the incarcerated.
Firstly, deception casts a pall over self-report. The drama of the “sick cellmate” has played out in television and movies ad nauseam. Even the most compassionate corrections officer grows immune to threats of suicide, especially repeated claims by the same inmate. Secondly, jails and prisons can harden those who attend to inmates, prompting harsh judgments on those in their care. “Just desserts” sentiments permeate society; why shouldn’t they be more present where fatigue and work stress are significant factors?
Lastly, and more significantly among those incarcerated for lengthy sentences for severe crimes, there is a feeling that suicide is a reasonable reaction to such a fate. “I might do the same were I in his shoes.” While there are many who find meaning when faced with prolonged incarceration, depression and suicidality are common. Even when a noteworthy suicide is picked up by a vigilant media, these stories fade. The prison population engenders ongoing interest in but a dedicated few.
Every facility I worked for had numerous regulations governing how to manage a suicidal inmate. In one location, any inmate who’d shown a propensity for self-injury had his cell stripped of any material that could be used for strangulation. Clothes, sheets, and even the mattress were removed and the inmate was left with a strange looking foam garb to cover himself. An inmate with nothing but time on his hands was highly crafty: Some even climbed atop their metal sink and jumped head first.
After each novel attempt at self-injury, the oversight powers that be labor to respond by adding regulation. It provides layers of well-intended bureaucracy but ultimately cannot eliminate the most human of attributes: free will. Maintaining an inmate’s essential rights is pitted against the need to reduce bad outcomes. In our litigious world, dignity often must take a back seat.
Suicidal inmates can be moved to corrections hospitals for more treatment. At issue is the use of suicidal threats to get a respite from higher levels of security and the attendant secondary gain that engenders. However, most correctional facilities will err on the side of caution to avoid embarrassment. The savvy inmate knows this well.
I approached suicidal inmates with as much clarity and compassion as I could muster. Acknowledging true despair builds rapport and potential for treatment. I never saw value in subterfuge, that is, placating an inmate facing a lengthy sentence with bromides. But a genuine attempt to reach the inmate where he is and provide sympathetic care can provide a positive impact and lead to improvement.
Ironically, impulsivity can be easier to work with than the quiet, planned attempt. The louder the inmate’s appeal, the more they indicate a desire for attention and to be regarded. Still, the combination of hopelessness and impulsivity is deadly. Ultimately, we all do the best we can.