Suicide Prevention:
AN ESSENTIAL ELEMENT OF CUSTODY AND CARE
Richard Forbus, CCHP, VP
Custody and care of incarcerated individuals is at the foundation of any correctional facility’s mission. Correctional facilities by their very nature are already a tough environment before any other human factor is considered. Preconceived notions of jail or prison tend to be a compounding factor in suicidal ideation, so we are already starting behind the curve when it comes to suicide if we do not have a culture in our facility that promotes suicide prevention.
We have no control over who comes into the doors to our facility and must always anticipate the unexpected. The moment an individual comes through the facility’s doors, we bear responsibility for their care, even if that individual does not care about their own safety and intends to self-harm. Suicide prevention in a correctional facility is a significant challenge, whether you are an officer, deputy, or a health care professional. We all must be completely invested in suicide prevention to make an impact.
When considering the prevalence of mental illness and substance abuse disorders, suicide prevention (and reducing all in-custody deaths) can seem to be an impossible challenge to overcome. The current trends in our industry seem to be showing an increase in suicides in custody. The statement “unresponsive inmate found in cell” is an ever-growing line in news story after news story, and this vague statement in many initial releases can stir up several images of what happened.
We are under a significant amount of pressure just by the nature of our profession, but when we consider additional factors seen during the pandemic, we face even more daily challenges: Increases in retirements and separations, challenges in hiring qualified candidates, staffing shortages, increasing numbers of arrests due to increases in crime, and delays in court dispositions due to pandemic-related backlogs still working through the system, delaying current cases. Those factors lead to overcrowding and create challenges to the proper supervision and care of offenders.
As the number of jail suicides and in-custody deaths continue to grow, there is growing public interest in these incidents and their outcomes, especially suicides. There is an unfair perception that someone in custody should never be able to commit suicide. The reality is we cannot constantly watch every single inmate, although we do our best to identify those at risk of self-harm to ensure they are being monitored more frequently and effectively. Even with our best efforts, suicides and suicide attempts may still occur.
Suicides and suicide attempts have always presented a significant challenge to mitigate or prevent in correctional facilities. Recent trends show suicidal ideation, suicide attempts, and suicides are on the rise. Is your facility ready to respond if an incident occurred today?
Suicide Prevention
Suicide prevention starts with culture. Decades ago, the mindset I experienced as a young officer was that we did not really have control over someone who wanted to self-harm, and we were told they would find a way, no matter what we did, by some experienced officers. This conflicted with our academy and in-service training. Some of those senior officers were also field training officers, who would tell us to forget what we learned in the academy, now we would “really learn the job.” This was not an unusual culture amongst officers then, and I am sure many agencies still have a culture like this today.
We had a Captain who was very adamant about changing that culture, due to her personal experience in having a son who struggled with mental health issues and substance use disorder. She was ahead of her time in recognizing and anticipating these issues, and 20 years later my former facility has a completely different culture and mindset when it comes to suicide prevention. Changing culture and mindset will not happen overnight, but staying the course has a significant impact over time. That captain’s impact is evident today because of her perseverance and knowing we could (and should) do better.
Changing culture and mindset will not happen overnight, but staying the course has a significant impact over time.
The reason I discuss culture first is no matter what policies you put in place, no matter what training you require, culture can counteract those efforts. Peter Drucker, an expert in organizational leadership, once stated “culture eats policy for breakfast.” If your agency has an underlying culture of negativity or dismissiveness regarding suicide prevention, it will manifest itself among staff.
Simply posting signs, mandating training, sending e-mails, and/or changing policy will not fix a culture issue overnight, but messaging is a necessary element in implementing and managing change over time. Engagement and buy-in by leadership are critical to the success of any cultural change, especially with line supervision. My former agency had a mantra of “inspect what you expect” to emphasize the leader’s role in ensuring directed changes have been made and policy matched practice, and it worked.
If a clear culture of suicide prevention has not already been established in your facility, it is a critical time to start doing so. There are a few broad areas of focus that should be
considered to guide this process while ensuring safety and security of our staff and facility, including, but not limited to, the following main areas:
• Assessment of Previous Suicides and Suicide Attempts—A thorough review of prior suicides and suicide attempts to ensure identified deficiencies were addressed and changes implemented.
• Physical Plant Assessment—A top-to-bottom assessment of the facility to identify weak points in suicide prevention efforts (e.g., tie off points, damage, blind spots, etc.)
• Procedural/Operational Assessment—A top-to-bottom review to identify gaps and weaknesses where opportunities to identify, prevent, intervene, or treat inmates have been, or could be, missed.
• Training—Initial training and mandatory, ongoing in-service training with testing to assess knowledge and understanding of content pertaining to the principles of suicide prevention.
• Policy—Clearly defined goals, expectations, response criteria, and training requirements. Some agencies incorporate the safety of staff and incarcerated individuals in their mission and vision statements.
• Emergency Drills—Regular assessments of staff response to critical incidents and an assessment of your equipment and resources to provide life-saving measures, when needed.
• Crisis Intervention Team (CIT) Program—A training curriculum to certify staff in response to incidents involving persons in crisis.
• Staff Reminders—Reminders of signs of suicide risk, such as posters, displays in staff areas, computer-based reminders, etc.
• Staff Wellness—An emphasis on the well-being and importance of all staff is critical and must be a part of the culture to be successful. We must care for ourselves to effectively care for others.
How Can NCCHC Help?
The National Commission on Correctional Health Care (NCCHC) has established guidelines that standardize suicide prevention and intervention techniques, suicide prevention program elements, and other training requirements that outline best practices for suicide prevention in a facility. NCCHC’s accreditation services are excellent, and health standards manuals are available online, whether a facility is accredited or not. The Suicide Prevention Resource guide is also available on NCCHC’s website.
Facilities seeking assistance in suicide prevention can receive technical assistance from the consulting subsidiary, NCCHC Resources, Inc. NCCHC Resources uses some of the best-known suicide prevention consultants in the field of corrections to ensure your needs are met, whether it is through training, program development, or a third-party objective assessment of your operation to identify gaps and needs.
Regardless of your facility’s size, location, or type, NCCHC is positioned to help your agency with its suicide prevention efforts. Contact the NCCHC today to discuss your facility’s needs and how we can assist you. Thank you and stay safe out here!
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Richard Forbus, CCHP, is the Vice President of Program Development for the National Commission on Correctional Health Care. A retired corrections captain and U.S. Marine Corps veteran, he has 27 years of corrections experience and is a graduate of the National Jail Leadership Command Academy. He holds a bachelor’s degree in Public Administration from Nevada State College and is currently pursuing his MBA in Health Care Management at Columbia Southern University. He can be reached at richardforbus@ncchc.org.