Serious Suicide Attempts in a State Corrrectional System and Strategies to Prevent Suicide

Abstract

The characteristics of offenders who attempt suicide in prisons indicate that they are mostly white males, likely to be property offenders, serving less than ten years, suffer from depression and personality disorders, experience significant psychosocial stressors, often have a cellmate and use predominantly cutting and slashing. A significant percentage use lethal methods such as attempted hanging and overdose. Those who use lethal methods tend to be genuine in their intent and have many features common to those who commit suicide.

Comparison of those who used lethal methods with a cohort of inmates who committed suicide indicated no significant differences in gender, race, age, crime type, diagnosis, and prior or current psychiatric care. However, the suicide completers tended to have more psychiatric symptoms such as delusions, hallucinations, impulsivity and guilt feelings, as well as experience of conflicts, ridicule and/or rape immediately preceding the self harm acts. Furthermore, more completers experienced new convictions, medical conditions, psychosocial stressors, and had shown prior suicidal behaviors. They were likely to be held in maximum security prisons and in single cells. While hanging dominated the completed suicides, medication overdose was more common among the lethal attempters.

The authors discuss multiple strategies to deal with the identified group of suicide attempters in order to prevent subsequent serious attempts or suicides. They include comprehensive mental health (MH) services delivery, implementation of a suicide prevention policy, timely inpatient and involuntary treatment, watch take procedure for psychotropic medications, noncompliance management, suicide watch, therapy, use of liquid medications, elimination of Benzodiazepines and timely action by MH, correctional and medical staff.