“Suicide is a huge, but largely preventable, public health problem, causing almost half of all violent death in the world, resulting in almost one million fatalities every year and economic costs in the billions of dollars, according to the World Health Organization” (quoted in Pompili & Lester & Innamorati & Casale & Girardi, 2009,1155). According to Kupers (quoted in Heuy & Mculty, 2005, 490) “in the United States, suicide rates among prison inmates are higher than in the general population and suicide accounts for more than half of all deaths in custody”.
The “rates of suicide…within prisoner populations have generally increased over the past few decades” (Perry & Olason, 2009, 385). Unfortunately, “there is not just more suicidality within the institutions but more people who are imprisoned show suicidal thoughts and behavior throughout the course of their lives”, according to Jenkins ( quoted in Konrad&, Daigle&, Daniel & Dear & Frottier, 2007,114 ).
Identifying key risk factors and proper assessment of high-risk offenders will contribute to the “Understanding [of] the process by which certain prisoners, under certain circumstances, contemplate, plan, and decide to end their lives [which] is critical to suicide prevention” (Bonner, 2006, 250).
Improving prison conditions along with “increasing the provision and participation of inmates in rehabilitation, education, and work skills training programs” (Heuy & Mculty, 2005, 508) will aid the United States toward decreasing prison suicide rates and bettering the health of inmates.
Summarization of Article A qualitative study was conducted throughout six state prison facilities in Oregon with the purpose “to study dynamic variables by examining the experiences of 24 inmates who attempted suicide in prison” (Suto & Arnaut, 2010, 1).
By focusing on these “dynamic variables”, this study differentiates from “existing research on prison suicides [which] has been criticized for focusing on static variables such as demographics” (Suto & Arnaut, 2010, 1).
Aiming to provide understanding of the participants, interviews were conducted to project the experience of the inmate and to further “contribute to the knowledge base about factors associated with suicide in prison” (Suto & Arnaut, 2010, 290). After analyzing the interviews using Lieblich’s holistic-content perspective (quoted in Suto & Arnaut, 2010, 293), “three categories with several themes and subthemes emerged in the study of reasons leading up to the suicide attempts: mental health issues, relationship issues, and prison factors (Suto & Arnaut, 2010, 293).
Within the category of mental health issues, “depressive symptoms [were] consistently reported across almost all participants” (Suto & Arnaut, 2010, 302-303). Included in the theme of depressive symptoms, “5 subthemes were identified” (Suto & Arnaut, 2010, 294). “Low mood” and depressive thoughts were expressed by the participants prior to their suicide attempts (Suto & Arnaut, 2010, 295). “Several participants reported feelings of loneliness were a significant factor in their suicide attempts” (Suto & Arnaut, 2010, 296) along with “feelings of hopelessness”, was also experienced by a large number of participants (Suto & Arnaut, 2010, 295).
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Lastly, “feelings of guilt and shame related to crime… haunted them so badly that it contributed to their suicidal ideation” (Suto & Arnaut, 2010, 296). Along with depressive symptoms, inmates conveyed “symptoms of anxiety” (Suto & Arnaut, 2010, 296) and “hallucination and/or paranoid ideation” (Suto & Arnaut, 2010, 296) that contributed to their suicide attempts. Impulsivity and religious beliefs were recognized across participants as a role in their suicide attempts as well (Suto & Arnaut, 2010, 297).
Failures and problems of relationships with people outside of the prison like their family and/or partners were identified by many participants that contributed to their depression and therefore their desire to attempt suicide (Suto & Arnaut, 2010, 299). Relationship problems within the prison, such as the “inability to fit in with other inmates… threats from inmates…physical fights…relationship problems with staff ” (Suto & Arnaut, 2010,299- 301), all “further added to the stress level of the inmates who later attempted suicide” (Suto & Arnaut, 2010, 300).
The last category, “Prison factors” (Suto & Arnaut, 2010, 301), indicates issues like, “Moves within the prison” (Suto & Arnaut, 2010, 301) which “led to feelings of depression and reported that it was a contributing factor to their suicidality” (Suto & Arnaut, 2010, 301), especially placement in DSU (isolation) which inmates “had a particularly hard time adjusting to the new conditions” (Suto & Arnaut, 2010, 302). “Employment/activity-related difficulties” (Suto & Arnaut, 2010, 301), such as having a stressful job or in contrast, unemployment, contributed to some inmates suicide desire (Suto & Arnaut, 2010, 302).
When looking at all these factors overall, it is concluded that “these inmates were in distress at the time of their suicide attempts” (Suto & Arnaut, 2010, 307). “The decisions to attempt suicide were preceded by a series of difficulties that drained the inmates’ ability to cope. Inmates overwhelmingly indicated that they wanted to talk about their problems” (Suto & Arnaut, 2010, 307). All these findings lead to the conclusion “that nonmedical solutions that boost inmates’ coping abilities also need to be implemented in any effective suicide prevention program” (Suto & Arnaut, 2010, 307).
Research Literature in Support Many of the categories and their themes, identified as risk factors of suicidal ideation, previously discussed are supported by multiple other research studies of suicide in prison. As stated, “Some participants indicated that their feelings of depression were connected to a lack of psychotropic medications or of consistency in taking them” (Suto & Arnaut, 2010, 297). This concept is common across many inmates across the country. This “lack of psychotropic medications” (Suto & Arnaut, 2010, 297) has been such a significant role in numerous suicides in prison that it has reached the U. S. Supreme Court. “Deliberate indifference occurs when an inmate faces the possibility of serious harm and an official disregards the obvious risk of such serious harm. The U. S. Supreme Court asserted in Estelle v. Gamble (1976) that this disregard violates the Constitution’s Eighth Amendment protection against cruel and unusual punishment” (Daniel, 2009, 20). A participant in the study, Suicide in Prison: A Qualitative Study, stated, “That’s the mode I went into on [date].
I’ve told them I felt suicidal and I was given a 5 on suicidality, and I needed help” (Suto & Arnaut, 2010, 301). From a legal approach, this participant did not, “receive health care that meets minimum standards” (Daniel, 2009, 20), which contributed to his suicide attempt. Impulsivity was supported through research literature as a risk factor according to Polvi (quoted in Tripodi & Bender, 2007, 43), “Inmates who describe suicidal impulses with anxiety and/or determination should be noted, as well as inmates who demonstrate problems with impulse control”.
Relationships of inmates were identified by Correia (quoted in Tripodi & Bender, 2007, 44), “[A] lack of social support has been shown to place inmates further at risk. Inmates with social networks in the facility may reduce their sense of hopelessness or fear, thereby reducing suicide risk, whereas inmates with familial social support outside the facility may be more open to prevention efforts”.
Potentially being one of the most key risk factors supported, placement in DSU, or isolation, “was more likely to produce suicide and other forms of violence rather than prevent them” (Dye, 2010, 804). Due to the fact of “Potentially facing many years of isolation and in fear for one’s safety [it] does not inspire much of a sense of hope” (White & Schimmel & Frickey, 2002, 340) which therefore, according to other studies by Ivanaoff, Jang and Smith (quoted in Suto & Arnaut, 2010, 303) “hopelessness and suicidal behavior [are] associated”.
In basic terms, “Many inmates are simply ill-equipped to handle the common stresses of confinement” (Hayes & Blaauw, 1997, 147). Along with the goal of treating psychiatric disorders, “The implications of these findings are that nonmedical solutions that boost inmates’ coping abilities also need to be implemented in any effective suicide prevention program” (Suto & Arnaut, 2010, 307). Research Literature Not Supported
Despite the support throughout multiple research studies for most of the risk factors identified in the study, Suicide in Prison: A Qualitative Study, additional risk factors, not yet mentioned, have surfaced in similar research literature. For instance, the “pivotal factor” (Heuy & Mculty, 2005, 507) of overcrowding “is a critical feature of prison environments that dramatically raises the risk of prison suicide” (Heuy & Mculty, 2005, 507) has not yet been identified despite of it being “a strong predictor of heightened suicide” (Heuy & Mculty, 2005, 508).
An individual risk factor that has not yet been mentioned, high-risk groups, has “been consistently identified…[as] pretrial inmates and penitentiary inmates with longer sentences…[which] appear to have emerged as the highest risk group, with a rate of suicide over three times that of other federal inmates” (White & Schimmel & Frickey, 2002, 339). Although Suto and Arnaut included “feelings of guilt and shame related to crime” (Suto & Arnaut, 2010, 296), they had failed to investigate the relationship of suicidal ideation to the extent of the crime committed. Offenders with a history of violence were most at risk… [And] had rates much higher than average” (Tripodi & Bender, 2007, 42). Therefore, according to Way (quoted in Tripodi & Bender, 2007, 42), the “type of offense is related to suicide rates, with inmates convicted of violent crimes demonstrating higher suicide risk than nonviolent offenders”. In addition, substance abuse was briefly mentioned by Suto and Arnaut, but was not identified in their study by any of the participants.
Despite this lack of evidence in their study, it has been identified in other research literature as a risk factor. Stated by Rowan and Hayes (quoted in Tripodi & Bender, 2007, 43) “Inmates that are currently under the influence of substances and/or have severe addiction problems have an increased risk of suicide. In fact, because inmates sometimes smuggle drugs into correctional facilities, substances can affect inmates long after entrance into a facility”.
Alongside risk factors contributing to suicidal ideation, a motive for suicide has been identified for the first time, “a motive of escape coincides with at least moderate suicidal intent and is more likely to involve highly lethal self-harm behavior” (Dear & Thomson & Hills, 2000, 172). Analysis of existing or proposed programmatic and policy interventions: The correctional system was developed to protect society from evildoers and reduce their potential for social harm by “confine, manage, and provide rehabilitative programs for those convicted of crime, all within a safe, secure, and humane environment” (Siegel & Bartollas, 2011, 4).
In order to run a successful system, with the focus on inmate suicide prevention, key factors should “include an emphasis on relevant staff training, the proper identification and assessment of high-risk inmates, the continuous monitoring of inmates who are considered to present an immediate suicidal threat, and the review of every completed suicide using structured psychological autopsies to further understand risk factors” (White & Schimmel & Frickey, 2002, 339).
To properly asses an inmate, Rowan and Hayes (quoted in Tripodi & Bender, 2007, 42) state, “Professionals should assess individual responses to determine how the sentence may be affecting the inmate’s self-esteem, family and interpersonal relationships, and employment” as well as “review inmates with several suicide attempts or patterns of increasing suicidal threats for severity of current risk” (Tripodi & Bender, 2007, 43).
From a legal approach, “aside from ethical and altruistic concerns, the competence of custodial staff to detect inmates who are at risk for suicide is important due to the threat of civil lawsuits” (Hanser, 2002, 459). With that in mind, a valid assessment is an “Understanding [of] the process by which certain prisoners, under certain circumstances, contemplate, plan, and decide to end their lives is critical to suicide prevention” (Bonner, 2006, 250).
When a high risk offender is properly assessed, “providing increased sensitivity to the stresses and uncertainties of inmates in this situation may help them through a particularly difficult period” (White & Schimmel & Frickey, 2002, 339-340) and the offender “should obviously be seen by mental health staff as soon as practicable after a placement in special housing” (White & Schimmel & Frickey, 2002, 340) to ensure their safety.
As identified previously, placement in DSU (isolation) “was more likely to produce suicide and other forms of violence rather than prevent them” (Dye, 2010, 804) and therefore, the main goal would be to “drastically decrease or completely eliminate the use of ‘supermax’ prison conditions whenever possible” (Dye, 2010, 804). Although this idea is not entirely realistic, “the implementation of a more careful classification system would better differentiate offenders in need of placement in maximum security and those that could serve sentences under minimum/medium security conditions” (Dye, 2010, 804).
When placement in isolation cannot be avoided due to the high risk or mental health issues of the offender, “increased involvement of staff to monitor and report signs of suicide or worsened mental health is recommended” (Dye, 2010, 804) due to the fact that “33% of all the suicides [occur] within 72 hours of the inmate’s placement in that status” (White & Schimmel & Frickey, 2002, 340). Therefore “this 72-hour window may provide some chance for staff to identify an inmate at high risk and to assist that person through a crisis” (White & Schimmel & Frickey, 2002, 340).
To aid suicide prevention, “[improving] prison conditions in general will go far to reduce suicide behind bars” (Dye, 2010, 804). This includes “relying more on community based programming rather than imprisonment” (Dye, 2010, 804) as well as “providing opportunities behind bars and in the community for rehabilitation and reintegration” (Dye, 2010, 804). In conclusion, “the best practices for preventing suicides in jail and prison settings should include the following lements: training programs [for staff], screening procedures [of offenders], communication between staff, documentation, internal resources, and debriefing after a suicide (Pompili & Lester & Innamorati & Casale & Girardi, 2009,1155) along with “increasing the provision and participation of inmates in rehabilitation, education, and work skills training programs” (Heuy & Mculty, 2005, 508) to aid in prevention of suicide and to essentially, reintegrate the offenders.
Conclusion Suicide in prison is an alarming occurrence. Preventive procedures should be fully implemented at every level by trained professionals of corrections; which should have an extensive training course that identifies all risk factors along with the ability to react quickly and proper in the matter of an emergency.
In order to successfully prevent suicide, the entire prison system must be operating at its fullest potential. The main goal of incarceration should be to punish as deserved while rehabilitating the offender to become an upstanding citizen that holds no threat to themselves or others. Once that is achieved, the offender will eventually reach the main goal of reintegration back into the community.