Suicide training

PLYMOUTH COUNTY DEPARTMENT PLYMOUTH COUNTY CORRECTIONAL FACILITY FIELD TRAINING COMPETENCY FORM MANAGEMENT PROGRAM (41) Trainee: Print Name Signature Training Officer: Print Name Signature Area: Date: Comments: 5 Satisfactory [j The confinement in a controlled, safe environment for the purpose of observing an inmate?s behavior and emotional state and to prevent destructive or self-destructive behavior, defines what term? At-Risk Management What is the policy number for At?Risk Management? PCCF 655 What is the term for a positive response to a suicide query on the Criminal Justice Information System (CJIS formerly known as Q-S Hit, calling for constant observation El Cell R114 in Booking Release will be used with the concurrence of the Medical Officer on- duty to temporarily house at-risk inmates for a period until cleared by mental health. True or False? True What form completed by Booking Officers indicates suicidal tendencies or prior attempts? The PCCF Initial Suicide Screening Guideline (ISSG) Who can identify an inmate as possibly being at risk ofsuicide? At any time during incarceration an inmate may be identified by correctionai, medical, or mental health staff as being possibly at?risk of suicide. Determination of an inmate being at? risk may or may not be a result of an actual suicide attempt. Identify at least 8 behavioral warning signs that may lead to thoughts of suicide. or Insomnia/sleeping all the time - Nightmares - Can?t concentrate 0 Changes in behavior 0 Recent weight loss 0 Giving away possessions - Direct/ indirect verbal statements 0 Changes in eating habits, sleeping patterns work behavior 0 Hopelessness/ isolation I Shame Crying When determined appropriate, at-risk inmates manifesting suicidal, self?mutilating, or other assaultive behaviors will be housed in an observation cell. Observation cells will provide: - Adequate lighting; 0 No exposed electrical outlets or fixtures on which an inmate can harm himself 0 An observation window through which an observer can see the entire room; - Adequate ventilation during warm weather, and adequate heat during cold weather; and - Toilet, hand washing and showering facilitiesin an immediately accessible or adjacent area. If an inmate attempts to commit suicide at our facility, what is the first priority? The first priority is to take whatever steps are necessary to ensure the life, safety and medical status of the inmate. Who must be notified in the event of a suicide attempt? An emergency referral to qualified mental health personnel must be made by notifying the Medical Officer on?duty and Shift Commander immediately. in the event that an inmate is injured and requires medical treatment, what procedure provides medical care for the inmate? The Shift Commander will implement ambulance procedures according to PCCF 604 How often will written documentation be made regarding inmates placed in observation ceils? Observation will be recorded on the Daily Observation Sheet at least every fifteen (15) minutes. What if an officer is providing constant observation to an at?risk inmate and needs to leave his/ her post? Officers will not leave their post for any reason unless properly relieved by another appropriately trained officer. At~Risk Management Program Page 2 of 3 When placed on suicide watch, inmates will be strip?searched and restricted to a padded safety smock. True or False? True May an inmate in an observation ceil have a rip-proof blanket and mattress? Mattresses and blankets are not authorized whiie an inmate is on suicide watch unless approved by Mental Health. If self-injurious behavior is apparent, food is restricted to neutral loaf or finger foods without utensils. True or False? True. I: How long may an inmate be secured in a soft cell? Only as long as necessary, but idealiy not more than 8 continuous hours unless continued confinement is ordered by Medicai staff, or other qualified medical or mentai health professionai How will an inmate on At?Risk status be released from that status? Qualified mental health staff will make written recommendations to the Booking Release Supervisor and Shift Commander and sign the Medical Report form. Will all staff who work with inmates be trained in the 655: At-Risk Management Program as well as verbal and behavioral clues that indicate potential suicide? Yes If you think an inmate is in crisis or suicidal, what should you do? 0 Create a calm atmosphere, non-judgmental and candid 0 Listen to the inmate?s response 0 Observe and Record in iog: time, date, place, etc. 0 Notify your supervisor, additional security and medical staff if necessary What form must be completed by mental health staff when an inmate has been released from atwrisk management and has been recommended for placement into a dormitory unit? The assessment for group living form Reviewing Authority: Training Division Signature 04/17 At-Risk Management Program Page 3 of 3 PLYMOUTH COUNTY DEPARTMENT PLYMOUTH COUNTY CORRECTIONAL FACILITY FIELD TRAINING COMPETENCY FORM Suicide Prevention Impact of Suicide on Staff (27) Trainee: Print Name Signature Training Officer: Print Name Signature Area: Date: Comments: S: Satisfactory What is stress? 0 Any internal or external event which causes changes in your body. I: What are some of the stress factors influencing suicides in custody? 0 First time arrests and/or incarceration - Under the influence of drugs or alcohol upon admission - Rejection of loved ones 0 Previously imprisoned, not wanting to go back 0 Has a terminal iliness or chronic medical condition What are some key signs of suicidal behavior? 0 Depression 0 Sleep Disturbances 0 Giving away possessions 0 Withdrawal - Recent weight ioss What is depression? 0 Depression can be a normal experience that passes after a short period of time ("the blues," "the blahs") a feeling, a mood, or an emotion, or a more serious clinical depression which carries a diagnosisof "Major Depression? If there is a suicide attempt or other emergency life threatening situation that the use of an AED becomes necessary, do you knowwhere the closest AED is to your present day workstation? indicate below where it is. What are some characteristics of Major Depression? - Deterioration of work and sociai relations - Deterioration of seif-care - Lasts at ieast two weeks, nearly every day Can depression be associated with other disorders? 0 Yes What are some stages of suicide? 0 Person experiences loss, loved one, self?esteem, self?worth 0 Anger and/or guilt (grieving process) denial, bargaining Succumbs to depression, threats, riskubehavior, abuse, detachment What are suicidal statements? 0 Direct and Indirect verbal cues about suicide El Identify some direct verbal cues for suicidal behavior. 0 lam going to kill myself 0 I want to die Identify some indirect verbal cues for suicidal behavior. 0 You can have my radio; I won?t be needing it anymore 0 Everything is okay now I: What shift is the highest risk for suicide, especially new commitments? 0 What is the most common method of attempting suicide in a correctional facility? 0 Hanging What should you do if you suspect an inmate is suicidal? 0 Question the inmate 0 Listen 0 Observe and Record 0 Notify your supervisor and medical staff according to poiicy Suicide Prevention/Impact of Suicide on Staff Page 2 What are the 4 key questions to ask a person you suspect is suicidal? - How are you going to do it? 0 When are you going to do it? 0 Where are you going to do it? 0 Do you have the tools or means to do it? Can you get them? What are some methods and tactics when dealing with an attempted suicide? 0 Create a calm atmosphere 0 Immediate assessment 0 Immediately gather back-up; additional security and/ or medical staff 0 Secure any weapons 0 Communications Why can suicide have a major negative impact on staff? 0 Can cause severe stress 0 Can cause decline in job performance, even job loss. What are some common stress reactions for a Correctional Officer following a suicide? - Constant thoughts of the suicide event 0 Tension 0 Reluctance to return to the suicide area 0 Inability to eat or sleep 0 Fatigue 0 Depression - lrritability Why would stress management heip you following an inmate?s suicide? 0 You wouid develop behaviors which enable you to manage or cope with stress. What actions can you take to minimize negative effects of stress following a suicide? 0 Recognize that stress is a normal reaction 0 Taking care of yourself; exercise is the best way to manage stress 0 Know the common signs of stress 0 Talk about your experience 0 Participate in a debriefing, if one is available toyou- 0 Seek assistance What is the purpose of debriefing? 0 To reduce the negative impact of stress resulting from a traumatic event suicide) Suicide Prevention/Impact of Suicide on Staff Page 3 I: When should a formal debriefing be initiated to be most effective? 0 Between 24?72 hours after a stressful event The goal of debriefing is to reduce the impact of the incident. True or False? True Reviewing Authority: Training Division Signature 09/16 Suicide Prevention/Impact of Suicide on Staff Page 4 PLYMOUTH COUNTY DEPARTMENT PLYMOUTH COUNTY CORRECTIONAL FACILITY FIELD TRAINING COMPETENCY FORM Suicide Watch/Observation (35) Trainee: Print Name Signature Training Officer: Print Name Signature Area: Date: Comments: S: Satisfactory What is the commonly used term for a positive response to a suicide query on the CJIS computer? Q-S Hit How often are inmates who are on suicide surveillance observed? Inmates are observed constantly - within view at all times; officers must remain within door access range at all times. Officers must be properly relieved in accordance with facility procedures before they leave the area. How often are observations recorded for inmates on suicide surveillance? Observations are recorded every fifteen (15) minutes - this does not mean 15 minute checks constant observation is to be maintained Where are these fifteen minute observations recorded? On the Daily Observation Sheet/15 Minute Medical Watch El What types of entries for this post will be recorded in the Log Book? The log book associated with this post will identify special instructions, visits from Supervisory, Medical or Mental health staff. (Examples: Meals shall be logged in the book, observation of inmate eating would be entered on this form, etc.) El Al! Officers must sign the acknowledgement of Post Order Form. True or False? True What is the responsibility of the Suicide Watch Officer if an inmate on suicide surveillance has contact with authorized staff? The Suicide Watch Of?cer must note it in the logbook indicating the name of staff, what was done, why he/she was there and the results of the visit. What precautions must be taken prior to the inmate being placed in an observation cell? Inmates will be strip searched and placed in a padded safety smock What is the procedure for handling the inmate?s clothing? The inmate?s clothing will be put in a plastic bag, tagged with inmate?s name and ID number and placed in the property area by a supervisor until the inmate is cleared to have his items returned to him. Who will give the instruction to use a paper Johnny when a Padded Safety Smock is not available and/or not authorized for a particular inmate? Shift Commander or higher authority with input from Mental Health and must be noted in the logbook. Who may identify an inmate as being possibly at-?risk of suicide? An inmate may be identified by correctional, medical, or mental health staff, and it must be documented in writing. How long will an inmate remain on suicide watch status? An inmate will remainon suicide watch status until removed on the recommendation of quali?ed mental health personnel. Inmates will be showered after 72 hours on a Mental Health Watch under the constant observation of an officer and after approval of the Shift Commander. True or False? True inmates on suicide surveillance will have no contact with other inmates or staff not authorized by the Superintendent (or his designee), Shift Commander, Medical or Mental Health. True or False?- True What type of meals will be given to inmates on suicide watch? Any inmate under suicide surveillance will be fed a bag lunch/meal. Suicide Watch/Observation Page 2 of 3 I: What is an inmate allowed to have in his cell while on suicide watch? Nothing no razor, clippers, canteen items or any other property is to be allowed. I: Where are attorney visits held for those inmates on Suicide Watch? in the line-up room when approved by the Shift Commander or higher authority What is the Suicide Watch Officer?s responsibility with regard to meals? All meais are to be searched for contraband speci?cally any item(s) that could be used to harm him and make an entry in the log of such search. At no time will an inmate be given trays, plastic cups, plastic eating utensils, etc. immediately after the inmate finishes his meal, the officer will remove and account for ali items given the inmate; paper bag, plastic-wrap/ bags. I: What should the Suicide Watch Of?cer do if the inmate on surveillance makes a claim, comment or threat? The Suicide Watch Officer should log the claim, comment or threat. Report it to Mental Health and/or the Medical Officer on duty. At all times, report it to the Shift Commander. El Who authorizes the use of a mattress and blanket for an inmate on suicide surveillance? Shift Commander after approval from Mental Health I: What type of blanket will be issued for an inmate on suicide surveillance? A padded safety blanket El Where are the padded safety smocks and padded safety blankets maintained? Property Room What must be done any time any item or activity authorized by Health Services Unit staff is removed or denied to an inmate on suicide watch? Such removal or denial wiil be documented in a written report to the Health Services Administrator and Shift Commander. Nothing will be given to the inmate without orders from Medical staff. True or False? True Reviewing Authority: Training Division Signature 09/16 Suicide Watch/ Observation Page 3 of 3 Name: KNOW YOUR INMATES- PREVENTING SUICIDES iN JAILS AND POLICE LOCKUPS 1) An arrestee told the patrol of?cer transporting him to the jail: ?Why don?t you just go ahead and shoot me and that will make everybody happy." Then the arrestee burst into tears. What shouid the patrol of?cer do? A. Tell the arrestee that shooting him is prohibited . by the department's rules and regulations and apologize for taking the poor guy to jail Find some valid axonse to shoot the arrestee Take the arrestee directly to the county hospital since he obviously has serious mental problems Tell the jail booking of?cer what the arrestee said and describe his emotional stress 2) One of the leading predisposing factors in an inmate's decision to commit suicide is: A. B. C. D. 3) The most crucial high risk period for suicide attempts Strange noises and odors in the jail Recent excessiVe drinking How the new inmate got along with his arresting officer and whether he thinks his arrest is legitimate The para-military regimentation of the During the booking process During the first 24 hours of incarceration immediately after arraignment immediately prior to release 4) Some key of depression include: 33.0 Crying, extreme tension and major mood swings Efferninate behavior and dress, withdrawal and sel?shness Loss of memory, bloodshot eyes and Vomiting Crying, DTs and severe shaking 5) The single best indicator of a potential suicide is: A. B. C. D. Dif?culty in concentrating or thinking Exoessive sleeping Severe depression insomnia AJA Job Bulletin 6) Many potentiai suicides can be detected during 8) Must be documented during the booking "Date: the booking/admissions process if: A. All arrestees are interviewed by a competent B. The jail has a receiving/screening form for the inmates to flit out C. Booking of?cers have been properly trained to ask arrestees the right questions and encourage the arrestees to respond truthfully D, The jail has a clearly written set of post orders for lhe booking area The presence or absence of physical and mental health in arrestees: A Wilt be apparent after the arrestee has been incarcerated for at least 24 hours B. Must be documented within a 48-hour period by competent medical personnei C. Must be documented by the arresting of?cer process, preferably by a trained booking of?cer or a quali?ed health care professional The recommended disposition at booking for an arrestee who is in alcohoi or drug withdrawal is: A House him in a single padded salt 8. House him with an inmate who is willing to watch him carefully and summon help if necessary C. Transport him to a medical facility or detoxification center prior to admittance to the jail . D. Refer him to mental health personnel as soon as possible, preferabiy within 48 hours Volume II Number 12 VOLUW II KNOW YOUR INMATES PREVENTING SUICIDES IN IAILS AND POLICE UMI BER 12 - 1. Jail Operations Bulletin #1142, Preventing Suicides in Jails and Police Lockups, is a programmed learning experience designed to teach jail officers how tqidentify potential suicide risks and the proper steps intake to present inmates from attempting suicide; . PERFORMANCE After bompleiing the study of this f0: Si. I .. factors .in jail environme??t i?li?l?iimete?s de?isiun?dedhlmit suicide. faci?xs eat-ii in?ue?zce a I 1 - - I ?as?i :??egpe?bds? Whigh risk ?91afiedst .sym?tbms suicide. how pote??ii?? ban the re?'eiv- pro?e?s . . .z IDENTIFYING RISK IN TAILS AND POLICE LOCKUPS Inmates in jails and police lockups commit suicide at a rater-tine times greater than individuals in the general population. HoweVer, officers who are aware of and alert to the signs and of potential suicide often can prevent inmates from attempting to take their oWn lives. When an inmate kills himself, the consequences for jail officers can be devastating. Of?cers responsible for the care of the inmate may suffer from severe emotional stress. In addition, there can be long-term legal conse- quences for both the jail and the offiCers, since families of inmates who commit suicide often file civil liability suits alleging negligence. To prayent thesc problems, all jail personnel must be properly trained to recognize potential suicidal inmates. For example, at arrest and while transporting an arrestee to jail, patrol of?cers and detectives are in a good position to observe the signs and of a potential suicide. Arrestees may make comments such as: "I?ll never be able to face my family again,? or "The best thing for me Would be to die.? Arrestees may cry or become severely agitated of depressed. When these signs and are observed, the arresting officcrs should inform booking officers that the new inmate may be a suicide risk. If this informa~ tion is not volunteered, booking of?cers should ask ar- resting of?cers whether the arrestee has exhibited any of the of potential suicide and, if necessary, give the officers a checklist of to review. Research into prisoner suicides has resulted in a body of knowledge which can be used effectively to identify and prevant suicide. While the focus of this Iail Operations Bulletin is on suicide prevontion in jails and police lockups, the signs and cited also are applicable to suicidal individuals in the community at large. {trains . use as: tlisz?-Fstimi? Went-st? sources in'gidentify? THE JAIL ENVIRONMENT Certain- characteristics unique to jails make them ideal settings for suicide. While the following character- istics appear to be a routing part of the normal jail environment for of?cers, these factors may induce seri; ous emotional consequences for civilians who do not haVe such everyday exposure to jails and lockups. For example: I Jails are authoritarian by design. People who are not accustomed to this para-military regimentation can encounter particular trauma. 0 For many inmates, incarceration produces profound feelings of helplessness and hopelessness. Such individuals may feel pOWerless and overwhelmed by their situation. - Supportnormally received from family and friends to overcome difficulties is restricted. - an}r inmates, particularly those who haVe never been arrested or who have limited arrest histories, may develop overwhelming feelings of shame. Studies also reveal that nearly three-fourths of jail suicides are com? mitted by individuals arrested for nonviolent offenses, such as traffic violations, disturbing the peace or other minor infractions. - Viewad from the inmate?s perspectiVe, confine? ment in exert the best jail is dehumanizing. Lack of privacy, association with hostile or mentallyvill inmates, the inability to make personal choices in the regulation of one?s life, together with strange noises and odors, can haVe a cumulatively devastating effect. These factors are enhanced in older substandard facilities where over? crowding may compound an already stressful situation. - PreconCeiVed notions about jails, based on televi? sion and movies, may also heighten fears about other inmates as well as the staff. -. Rule Nomi/23's? . Officers ivho are. aware. that the jail environment itself 'can? influence. a "decisi'on'=by an take thethecessar?yii precautionsto help save lives and "E?pireyent Ian'suitsi .. - - h. - 3.: - PREDISPOSING FACTORS There are a number of events'or situations which, under the right conditions, may make an individual more inclined to commit suicide. Recent eaccessive drinking is a leading predispos? ing factor. For some individuals, eyen a small amount of alcohol or drugs can home a depressing effect. in some cases depression sets in when the individual sobers up. However; some persons with blood alcohol levels in eicess of the legal limit commit suicide while still-intoxi? cated. H. .. .. .. "ENRule No.3 . Jail inmates who are "under the in- fluence? of alcohol are the most . - predisposed to commit suicide. In other cases, the loss of stabilizing resources can act as a catalyst toward suicide. Loss of one's spouse or another loved one {or for a juvenile, loss of a close friend or expulsion from school) may be particularly signifi- cant. The loss of one?s job, home, or business can also lead to a decision to commit suicide. 1 . Severe guilt or shame ovar the offense and its con~ sequences may come into play. The seriousness of the crime has less meaning than the way in which it is perceived by the offender. People of high status in the community or those who commit particularly shameful coma such as child molestation or sexual assault maybe particularly affected by personal shame and guilt. PERIODS FOR HIGH RISK OF SUICIDE Analyses of custodial suicides in seVeral jurisdic- tions revaai that there are certain periods when there is a high risk for suicide; these periods correlate with junctureis or events in an inmate?s incarceration and Passage through the criminal justice process. The most crucial period is during the first 24 hours of incarceration, specifically the first three hours. For the intoxicated inmate, seVere depression may set in when he begins to sober up. Therefore, heavily intoxis cated inmates always should be watched closely because it?s possible that they may unintentionally injure them~ selves or themselves on their own vomit. The sobering up period presents potential added risks if de~ litium tremens (DTs) occur; some alcoholic inmates cannot deal with the agony of alcohol withdrawal and thus con: template or attempt suicide. . Various st ages or steps in the criminal justice process can cause intensa anxiety or trustration which may trig~ ger a suicide attempt. For example, the periods inst prior to or following bond hearings, arraignment, or trial can be critical. Sentencing hearings also can be a breaking point for some inmates, as can impending release from a jail. While release may be regarded as a positive event, for some inmates the stigma offacing family, friends, and fellow workers may be too great a burden to bear. In addition, holidays can be particularly depressing for incarcerated persons, as can personal. dates of Big-- nificance such as a child?s or spouse's birthday. Officers shouldrwatch closely those inmates who receive bad neWs, such as a death notice, a legal docu? ment informing them that their spouse is ?ling for div vorce, or a letter from their employer telling them they haVe been fired. . Finally, suicide is a verprriVate act, and studies have indicated that there is a greater tendency for sui? cides to be committed during the hours of darkness. Un~ fortunately, this is the period when staff supervision of inmates is generally at its lowest point because of re? duced manpower. I . :Rule No. 4? The most crucial high risk period for suicide is the first 24 hours of incarceration, espe?cially the first three hours. OF POTENTIAL SUICIDE If any of the signs of a potential suicide are appar- ent to the arresting officer, it is essential that he inform the booking officer, who in turn should notify the shift supervisor. Any other agencies which may eVent-ually take custody of the inmate, such as a detoxification center, should also?be advised that the inmate may be a suicide risk. The single best indicator ofpotcntial suicide is de? pression. BetWeen 70 and 80 percent of all custodial suicides are committed by people who are sevarely and obviously depressed. Arresting, booking and onstodial officers can identify key of depression by talking with and ob? sewing suspects- These key include; Feelings ofhopelessness or helplessness, or an expressed inability to go on with life. Crying or extreme sadness Withdrawal and silence Major changes in appetite or Weight Sleeping problems such as insomnia or excessivo sleeping 6. Major mood swings 7. Extreme tension 8 9 new? . Slowing of movement . Obvious loss of sclf~esteem 10. Excessive self?blame and inordinate guilt feelings 11. Difficulty in concentrating or thinking me nuts? :2 3' Severe depression_is the indicator of a potential- suici?dei 131,-} ., . Agitation or aggressiVen ass also frequently precede a suicide. The agitated inmate has a high lEVel of tension, is extremely anxious, and displays strong feelings of guilt, rage, or an expressed desire for revenge. . 3' .. __Ru1e' No. 56 -. who talkabout c'dinmitting 'nwiisrbetgken' s?g rio?slyj and; thos?'ZEWho have 'previ?f ously attempted suicideor who. haveia history of. mentaliillness erred '5 ?Any'potential suicide Weaponsl?'; including clothes if "necessary; .should be removed ?from'them?igji'm Those inmates displaying signs of such as delusions or hallucinations should also be Watched care?v Fully. It is not unusual for suicide inmates to ?see? visions or "hear" voices that tell them to take their own lives. Such individuals also may be dangerous to others when such delusions cause them to act aggressively. Other signs and" of a potential suicide include: 1. Expressions of unusual concern over what signifi- cant others, such as a spousa, employer or parent, will say about the subject?s offense or incarcerah tion 2.Unrealistic talk about getting out of the jail "one way or another? 3.1ncreasing difficulty in relating to others 4.Particular dif?culty in dealing with the present and preoccupation with the past 5. The inmate unexpectedly begins packing or giving any his possessions 6.1nmates who have been forced to submit to "same sex? rape, or who have been physically threatened to submit to such acts 7. Those inmates who are in verypoor physical health or who are terminally ill, AIDS cases 8. Anyone under age 18, whether ornot the young of? fender has beenwaived to art-adult court. THE SCREENING PROCESS Preperly trained jail officers can effectiVeiy assess and identify inmates for potential suicide whether it be at booking or while the inmate is incarcerated. During admission, assassment for potential suicide should be part of an ovarall screening process for medi? cal and mental health problems. Most cases of potential suicide can be detected through a system of carefully screening all jail admissions.? -. Rule No. 7 Trained offi'ce?rs'can detect'many' v_ potentiallysuicidal inmates . dusts: s;_bos1ensarrosesa 1.the arrestee exhibits any serious health conditions evident to the booking officar, then a written medical or mental health clearance should be obtained from a phy? sician or mental health professional prior to admitting the arrestee to the jail. Undiagnosed and untreated health problems increase the potential for suicide Rule nos" A mental health clearance should. be sought for arrestees who appear to, be out of touch with reality or who Openly dealers or clearly evi~ dence suicide potential. Physical factors and mental health concerns should be evaluated by observing the arrestee and listening carefully to his responses to speci?c questions. Rule'No. 9 In all cases, it is essential that the-presence or absence and mental health be docu: - merited?fin writingf?at ?booking, preferably bye - trained booking: officer or litigi- qualified health care: . professional. A standardized form used for screening can help to assure uniformity and completeness. It also provides the very important Written record of the screening results. Asidefrom their immediate operational importance, such documents can prove essential ina jail?s attempt to esplaln the reasons for Specific actions taken at booking, particu- larly in cases where legal liability may be an issue. These and related documents should be completed prior to any dc?ision to assign an arrestec to cell space. Medical mental health screening up on a dmission is recs ommended, since suicides and deaths by other causes occur in holding areas and cells overnight. When an arrestee is admitted to the jail in the evening or at night, it is best to.conduct the medical and mentalhealth screen- ing then, not wait until the day shift cornes on the next day. The next morning maybe too late ifthe inmate is sew Iiously ill or suicidal. The screening process is extremely important, not only in detecting potential suicides, but also in identify- ing trauma, possible illness and infectious disasses, of drug and alcohol abuse and withdrawal, acute mental illness, and obvious needs for medication. All of these factors bear on a jail?s capabilities and re~ sponsibilities to safeguard the lives of those in custody. Questionnaires used to screen arrestees at booking. should be considered as a starting point for assessing arrestees in the aforementioned areas. Booking officers or others administeringsuch screening documents should ask follow?up questions as appropriate to gain a better understanding of important physical and mental health . issues. Police officers who must deal with the arrestee can aid in this effort by observing the arrestee?s actions, speech?, characteristics, and physical and by passing this information on to appropriate jail personnel. FACTORS When questioning arrestees about th eir physical and mental health status, officers should first explain in n'mple language why the questions are being asked For ex- ample, to remove the arrestee?s possibly feeling that he is being singled out for interrogation, the booking officer might say: am going to ask you some questions about your health which we ask all arrestees because we are concerned for your health and Welfare and want to ob- tain proper care for you if you need it.? . 7 Rule.No.=10 . . The newness: - upmust lac-explained in order. to secure; his. "cooperation. in [answering-g the questions I :Hffuthfullys . .H - la 52 ?7w! Questions should be posed in as private a Setting as possible?e factor which will encourage truthfulneSsLm and explained to the inmate in an unhorried, straightfor- ward manner. It may be helpful in some cases to use colloquial or ?street language" to ensure that the inmate understands the questions. A preperly conducted receiving/screeninginterview has a settling effect on many individuals following the trauma of arrest and inevitable incarceration, and has an overall positive effect on both the inmates and the staff. SAMPLE SCREENINGIDISPOSITION GUIDELINES FOR DETECTING POTENTEAL SUICIDES I. Under the In?uence of AlcoholfDI-ugs A. 1. Slurred speech 2. Unsteady walk 3. Confused, disoriented 4. Dilated pupils 5. Vomiting, sleepy or hyperactive 6. Red, bleedshot eyes B. Disposition: It is preferable not to admit the arrestee to the jail. Howover, this may be unrealistic. If your jail rules permit, transfer the inmate to a detox center. But if your jail policy requires that the inmate be admitted, then seek medical clearance and keep the inmate under constant sunteillance. II. Alcohol/Drug Withdrawal A. 1. Sweating 2. S?Vere shaking 3. Nausea, vomiting 4. Pinpoint pupils 5. Delirium tremens (DTs) 6. Hallucinations - 7. Serious breathing problems or reduced levels of consoiousness B. Disposition: Transport the arrestee to a medical facility or detox center prior to admission to the iail. Despondent/Severely Depressed (potential sui aide) A. l. l-ntenSe guilt, shame, remorse, self~cone damnation Bereavement Withdrawal silence Loss of appetite, later loss of weight Sleep problems Major mood Variations Lethargy 749912599!" B. Disposition: This inmate requires constant supervision. House him in a suicide-resise tent cell, if available, or with selected and trained inmates. Refer him to mental health services. IV. Irratiorlal BehaviorIMental Illness A. 1. Appears to be out of touch with reality 2. Hears voices that are not there 3. Hallucinations Ii. Withdrawal unco'mmunicative 5. Erratic/bizarre behavior B. Disposition: Follow thejail?s general order for dealing with the mentally ill; provide closesupervision. V. Assault Potential A. 1. Aggressive behavior during arrest or booking - 2. History of assaults 3. Threats of assault B. Disposition: 1. Use caution in handling 2. Consider safety in cell assignment 3. Consider behavior a possible - . oipotential suicide VI. Potential Male Rape Victim A. 1; Small/ frail 2. Weak appearance . 3. Naive, openly homosexual, or effemi hate Very frightened . Not the typical inmate, college student arrested on- a traffic offense or 'x?or shoplifting B. Disposition: 1. Orient him to the jail envimnment 2. House him in a single cell it possible 3. Provide close supervision in.? mum Name: Date: DEALING WITH INMATES AT RISK FOR SUICIDE 1) if a booking officer believes that an arrestee is suicidal, what is the best thing the officer can do? nnw> Try to talk the arrestee out of attempting suicide. Refer the arrestee to a mental facility. Place the arrestee in a vacant holding cell. Book the arrestee as usual, but keep a close watch on him. 2) If you?re not sure whether an inmate is suicidal, you should: A. Ask him, and accept his answer 8. Ask a mental health professional, and accept her answer. C. Ask other officers for their opinions, and accept the answer of the majority. D. Assume that the inmate is suicidal and take all appropriate precautions. 3) If checking on a suicidal inmate every 10 to 15 minutes is impractical, which of the following is an acceptable substitute? A. B. C. Watching the inmate on a closed-circuit TV monitor Asking other inmates to watch the inmate. Checking on the inmate every 20 to 25 minutes. None of the above. There is no acceptable substitute. 4) What is the most influential factor in preventing suicides in ajail? A. .0093 The ways in which officers deal with suicidal inmates. The physical layout of the jail. The capability ofthe jail?s mental health staff. The average length of time an inmate spends in the jail. AJA Job Bulletin 5) 5) 8) in your day?to-day dealings with inmates, how can you best reduce the general level of tension and anxiety? A. Decide which inmates are your favorites, and treat them better than the others. B. Answer inmates? questions directly and honestly. C. Avoid discussions with inmates about their personal problems. D. Let the inmates know ?who?s in charge? by giving as many orders as possible. Which of the following should an officer not do when talking to a suicidal inmate? A. Let the inmate know that there are people who care whether he lives or dies. Try to find out why the inmate wants to commit suicide. C. Say "Let?s see you really do it? as a way to shock the inmate into reality. D. Ask the inmate to describe how he intends to kill himself. The purpose of the modified jaw thrust procedure is: A. To prevent the inmate?s tongue from blocking the airway. To dislodge foreign matter from the airway. To protect the spinal column. To enhance blood circulation to the inmate?s brain. 53.0.03 if an inmate shows no vital signs, the appropriate response is to: A. Repeat the modified jaw thrust until the inmate begins breathing. Talk loudly to the inmate until he answers. Administer CPR until medical help arrives. Assume the inmate is dead. 9.0.00 Volume ill Number 1 Suicide Awareness and Prevention ff Suicide Awareness and Prevention - Importance of the suicide issue in jails] corrections - In jails! lock? ups, suicide is the number one (1) cause of DEATH Y'y' i SUICIDE AWARENESS PREVENTION - DEFINITION: An act or an instance of taking one?s own life. - Voluntarily or Intentionally To put one?s self to DEATH. SUICIDAL: reiating to the nature of suicide marked by impulse to commit SUICIDE. Suicide Awareness and Prevention The criminal justice system is becomingithe institution of last The place where many men and women with history of trauma, mental illness and substance abuse end up, because there is no place for them to go. SUICIDE AWARENESS PREVENTION What is the Incidence of Suicide? - In 2010, 38,364 Americans . Three ?mes of took their own lives . many males ?3?68? co lete suicide - In 2010, itwas the eight mp I leading cause of death ?lms as (33,687 in many females - 2?Dd leading cause of death attempt it. of age 15?24 How many here in class own a Firearm? . SUICIDE AWARENESS 0w many ere ass ave young Children? . ma . Suicide is under?reported; it is often listed as SUICIDE AWARENESS SUICIDE AWARENESS PREVENTION WPREVENTION High Risk Pogu'lations RISK FACTORS OF SUICIDE: Elderly Males Best Predictor: Past history of suicide Widowed Whites . attempts- Enforcement Alcoholism I Substance Abuse ALL INMATES MANY LAW ENFORCEMENT OFFICERS DIE BY THEIR OWN WEAPONS. SUICIDE AWARENESS SUICIDE AWARENESS PREVENTION WE RISK FACTORS OF SUICIDE: SIGNIFICANT FACTORS OF SUICIDE: - Guilt or Shame (due to crime committed) Mental Disorders (Depression- . Medical Problems Victim of Homosexual Rape Loss or Rejection (Death-Divorce?Job Loss) Lack of Institutional Programs I Change of Status (Up or Down) . Cenmate; I Manigulative I?ersonalig I Manipulator ?Mutilator LOSS OF STABILIZATION \Vbat?s happening in this person?s life Loss of loved one (family or peer) Job loss - School expulsion - Loss of residence or business Financial loss Custody or visitation of children - Prominence in Community ?the higher you are, the further you fall? Risk Factors In corrections, there is a great deal of BIZARRE behavior that staff must deal with every day. Seek the available professional help. Help for them Services) and Help for You SUICIDE AWARENESS PREVENTION The number of suicides are relativer stable, but the number of lawsuits are increasing. A proactive stance neutralizes liability, the ?Old School? ?Do Nothing? approach breeds LAW 7 I @x ., @5036} I SUICIDE AWARENESS PREVENTION PATTERNS OF SUICIDE: . Attempt to manipulate . Magical thinking (attempt to punish someonelbe in control) . Anniversary suicide (an-attempt to join a deceased love one; 13 are in?uenced by loss) . Accidental suicide unconscious death wish) . Drug abuse (largest number ofyoung people who commit suicide have bcen drug abusers-estimated to be as high as SUICIDE AWARENESS PREVENTION I: SIGNS OF SUICIDAL BEHAVIOR DON TAKE CHANCES - Everyone has ideas about some warning signs. SUICIDE AWARENESS PREVENTION WARNING SIGNS Current depression or paranoia Expresses/evidences strong guilt and/or shame over offenses Under the in?uence of drugs/alcohol Projects hopelessness/heipiessness Changes in eating patterns, sleeping patterns, work behavior SUICIDE AWARENESS PREVENTION WARNING Social Isolation - Begins packing up all belongings May try to HURT themselves (attention-getting gestures) Talks about or threatens suicide, even in ?jest? - Previous suicide attempts and/or history of mental illness Severe 0r AGGRESSIVENESS SUICIDE AWARENESS PREVENTION .3 4F DEPRESSION-ONE OF THE - MOST INIPORTANT CLUES: Prior hospitalization is very signi?cant Feeling of inability to go on Withdrawalorsilence - Pessimistic attitudes about the future M001) variations Worthless, helpless, shame SUICIDE AWARENESS PREVENTION DEPRESSION (Continued! Lethargy slowing of movements or non-reactive Excessive self?blaming Dif?culty concentrating/thinking Extreme sadness and crying Loss or increase of appetite/weight SUICIDE AWARENESS PREVENTION DEPRESSION (Continued) - Insomnia or awakening early - Excessive sleeping Loss of interest in people, appearance, or activities - Strong guilt feelings - Noticeable body language The better your knowledge and observation of inmates the better your security will be. SUICIDE AWARENESS PREVENTION WHAT ARE SUICIDAL DIRECT VERBAL CUES: - I AM GOING TO KILL MYSELF - I WANT TO SUICIDE AWARENESS PREVENTION VERBAL CUES: CAN HAVE MY BELONGINGS, I BE NEEDING THEM IS OKAY SUICIDE AWARENESS SUICIDE AWARENESS PREVENTION PREVENTION KEY QUESTIONS TO ASK: THERE IS 0 ONE - 1. HOW are you going to do it? BE ALERT - 2. WHEN are you going to do it? - 3. WHERE are you going to do it? - 4. Do you have the TOOLS 01? to do it? TAKE ALL SUICIDAL THREATS SERIOUSLY DO NOT. BE in RAID To ASK: ?Are you consxderlng killing yourself?? Be calm, non-judgmental and candid. SUICIDE AWARENESS PREVENTION SUICIDE AWARENESS PREVENTION ASSESSMENT TECHNIQUES FOR INMATES: - Ail suicide threats must be taken seriously Threats should not be i nored principle Scheme Available Means Lethality manipulation is the ?rst real threat. Determine impulsiveness the younger the inmate, the more impulsive. SUICIDE AWARENESS SUICIDE AWARENESS ., PREVENTION Explore the situation as far as possible: THERE ARE (3) MOST COMMON >Ask direct questions Explore plan for degree of risk HANGING The more detailed a plan, the higher DRUG OVERDOSE the success of death SUICIDE AWARENESS PREVENTION -. If access is available to implement the plan?! risk of suicide is HIGH. Despite the fact that this is a Correctional Facility, there are-innumerable it} tools available. SUICIDE AWARENESS PREVENTION Most common method of SUICIDE is: QEANGING). In hanging incidents, consider security issues if going into a cell alone: ASSUNIE spinal cord injury Keep airway open/modi?ed jaw thrust Cut down with assistance (1 holds body up) use CPR standard ?rst aid procedures SUICIDE AWARENESS PREVENTION WOUNDS: - Most common are slashed wrists Apply direct pressure to wound/injury DO NOT once applied. UNIVERSAL PRECAUTIONS: SUICIDE AWARENESS PREVENTION DRUG OVERDOSES: Identify type of drug(s), . quantity used, etc. Consider inmates to STOCK PILE Medications Look for needle, pills, _7 other items in cell areas . to ingest drugs. 3 AWARENESS PREVENTION WHAT DO I DO IF I SUSPECT AN INMATE IS 1.) Question the Inmate HOW-WHEN-WHERE-MEANS SUICIDE AWARENESS PREVENTION 2.) LISTEN to inmate?s responses 3.) OBSERVE RECORD LOG: 4.) NOTIFY other staff on site mm 5.) GET HELP emergency intervention SUICIDE AWARENESS PREVENTION 6.) WATCH vigilantiy! 7.) NEVER leave the inmate 8.) Provide 9.) Be HONEST and CONSISTENT SUICIDE AWARENESS PREVENTION SITUATIONAL RISK FACTORS OF SUICIDE IN INMATES: - 1" time offenders - Person with high status in community - Previously incarcerated/new charge/serious crime - Prior jail suicide or recent attempt Sex crimes - High Pro?le/Media - DETOXING SUICIDE AWARENESS PREVENTION MANAGING POTENTIALLY SUICIDAL INMATES - Exhibit fairness?show - Firm but fair no favoritism - Use autho my - Self-respect power constructively - Don?t put dowm yell breeds reSPeCt 01? SWEEP - No power trips SUICIDE AWARENESS PREVENTION Try to caim the inmate and relieve anxiety be calm, con?dent, ?rm, fair-and reasonable - The crisis is just temporary things can be worked out, as generaily happens SUICIDE AWARENESS PREVENTION BE PROFESSIONAL WORKING WITH THE PROPER BEHAVIORS, ATTITUDES, AND INTERACTIONS LEADS TO A SAFE, RESPONSIBLE MANAGEBIENT OF DIFFICULT SUICIDE AWARENESS PREVENTION OTHER MANAGERIENT TECHNIQUES THAT 1.) Encourage inmate to speak freely. 2.) Remove from scene of crisis when other persons are present. The goal in any potentially dangerous situation is to diffuse it from becoming more dif?cult than it already SUICIDE AWARENESS PREVENTION DO NOT BE SARCASTIC, LIE OR MAKE PROMISES THAT CANNOT BE KEPT. There can sometimes be a tendency to resort to a less than professional response. AVOID doing this at all COSTS. Methods Tactics COMMUNICATIONS: ?They tend to ramble initially wProne to emotional outbursts - Be prepared for this to happen It shouldn?t come as a surprise Try to keep person ?in the present? - Try to understand today?s problem - Try to identify precipitating factors Methods Tactics COMMUNICATIONS: ?Empathy,? not ?sympathy? - CARE, don?t - Understand what happened - Do not impose personal beliefs ~Anticipate distortions of reality Do NOT AGREE or DISAGREE - They are REAL to the person in crisis - Acknowledge their feelings of ?upset? - ocusron TRUE reality areas Methods Tactics COMMUNICATIONS: LIE - They?re ?in crisis,? don?t play them - All you have is your credibility trust - Don?t make false promises Communication is important to reduce risk! SUICIDE AWARENESS PREVENTION KEY POINTS IN EFFECTIVE HANDLING OF SUICIDAL INMATES 4% TRUST YOUR OWN JUDGEMENT, IF YOU BELIEVE SONIEONE IS IN DANGER OF SUICIDE, ACT ON YOUR BELIEFS. STAY A SUICIDAL PERSON. LEAVE THEM ALONE IF IN MMEDIATE DANGER. SUICIDE AWARENESS PREVENTION - Maintain contact and conversation express concern about that person - Negotiate assistance and mental health intervention ASAP REMEMBER: If you keep the individual talking or involved, he/she will probably not kill themselves Methods Tactics WEAPONS: ~Initial attempt to ASK person to put down any weapons - Abandon any attempt?to disarm person if they do not respond at ?rst - If they?re willing to put it down, they?ll do it when you ask ?Everybody loves a hero, especially a DEAD ONE \Vhat is referred to as a ?negative Methods Tactics - WEAPONS: (cont?d) ?Focus on the ?person,? NOT the WEAPON - Pay attention - But if ?you? focus on the person, then so will ?If you can establish a ?trust? - Then perhaps, you can help disarm them SUICIDE AWARENESS PREVENTION - POSSIBLE INSTITUTIONAL RESPONSES TO SUICIDE: - Maintain inmate under constant supervision - Examination of inmate by a mental health professional determine the level of SUICIDE RISK - Removal of inmate from Housing Unit SUICIDE AWARENESS PREVENTION Placing of inmate on (15) minute watch Removal of all inmate?s belongings sheets, piilow/mattress, clothing to eliminate means ofself?harm Placing an inmate on ?eye?ball to eye?bali? watch constant observation by a correction of?cer assigned solely to the inmate Placing inmate in restraints, if necessary SUICIDE AWARENESS PREVENTION RED Classic Lock-Up Suicide 15?30 years old new admission I within ?rst two weeks I ?rst time incarcerated for serious charge SUICIDE AWARENESS PREVENTION - Shift when - When inmate?s supervision is depression appears minimal: to be lifting, inmate 11 7 AM may have reached a - SHIFT CHANGES: decision to @n Staff are not on dayroom ?oor SUICIDE AWARENESS PREVENTION HIGH RISK SUICIDE PERIODS: IST 24 hours of con?nement Intoxication when sobering up Impending releases Darkness Holidays Bad news of any kind SUICIDE AWARENESS PREVENTION HIGH RISK SUICIDE Waiting for trial - Sentencing - Isolation - Decreased staff supervision - During illness/medical crisis SUICIDE AWARENESS PREVENTION CAN I BE HELD LEGALLY RESPONSIBLE FOR A Following each suicide, there is a autopsy. This autopsy is a thorough evaluation of everyone the deceased came in contact with prior to the event. Who?s Responsible? - Death in a Massachusetts Lock-up Ch 40 Sec 36A, 36B, 36C Civii Lawsuit Liability Who?s Responsible? Anyone who had contact with inmate. .. Regardless of time elapsed SUICIDE AWARENESS PREVENTION BASIC LEGAL ISSUES: Suicide must be proven I Proximate cause must exist Reasonable person standard NEVER delay or avoid consultation MONITOR inmates vigilantly 10 SUICIDE AWARENESS PREVENTION Staff may face CIVIL and/or CRIMINAL sanctions for failure to respond responsibly. Deliberate indifference federal suit I Eighth Amendment Statistically, it is now unusual for a lawsuit 139; to be ?led in the event of a suicide Wm SUICIDE AWARENESS PREVENTION 8th Amendment Claim COULD RESULT FROM MAKING A STATEMENT LIKE: - ?If you want to kill yourself, I?ll give you the rope.? ?If your going to cut yourself, do it right.? SUICIDE AWARENESS PREVENTION COMMON ABOUT SUICIDE 1. People who make suicidal statements or threatened suicide don?t commit suicide. - 2. Suicide happens suddenly and w/o warning. - 3. People who attempt suicide have gotten it out of their systems and won?t attempt it again. SUICIDE AWARENESS PREVENTION COMMON ABOUT SUICIDE 4. Suicidal people are intent upon dying. 5. You can?t stop someone who is reaily intent on committing suicide. 6. Asking about probing the inmate about suicidal thoughts or actions will cause him to kill themselves. 55 SUICIDE AWARENESS PREVENTION ABOUT SUICIDE 7. All suicidal individuals are mentally ill 8. Suicide happens less frequently in a jail setting. 56 SUICIDE AWARENESS PREVENTION 7 REALITIES ABOUT SUICIDE 1. Most people who commit suicide have made either direct or indirect statements which indicate?their suicidal intentions. 2. Most suicidal acts represent a carefully thought outstrategy for coping with personal problems. 3. Four out of ?vepersons who kill themselves have made at least One prior attempt and give out direct signs. 11 SUICIDE AWARENESS PREVENTION REALITIES ABOUT SUICIDE 4. Most suicidal people have mixed feelings about killing themselves, they are ambivalent about living, not intent on dying. 5. Most suicidal persons want to be rescued. 6. You cannot place suicidal thoughts into someone else?s mind when you show your interest in their welfare. 7. Although the suicidai person is extremely unhappy, he/she is not necessarily mentally ili. SUICIDE AWARENESS PREVENTION DEFINITIONS: Winn A personal, visual observation of each individuai inmate by a staff member responsible for the care custody ofsuch inmate to ensure the presence proper conduct ofall inmates (30-60) minute intervals, (24) hours per day (7)7days a week. SUICIDE AWARENESS PREVENTION G. ACTIVE SUPERVISION (Suicide watchD 2-3. ACTIVE observations to Zeb. The uninterrupted he conducted at (15) min of such staff member intervals, (24) per day, (7) to communicate orally with days a week, upon noti?cation and respond to each inmate. from the medical unit, or at any time that the Shift Commander feels appropriate. SUICIDE AWARENESS PREVENTION 3. CONSTANT SUPERVISION (Continuing Observation) The uninterrupted, personal, visual observation of inmates by facility staff members responsible for the care custody of such inmates. SUICIDE AWARENESS PREVENTION 1. DATE TIME OF OBSERVATION 2. ANY UNUSUAL EVENT, SIGNIFICANT PROBLEM, REQUEST, OR VISIT 3. TIME OF THE RESPONSE AND THE RESPONSE MADE 4. ANY OTHER RELEVANT INFORMATION SUICIDE AWARENESS PREVENTION Mg Correctional of?cers shall position themselves within the housing units so that the constant observation of the inmate population can be maintained. 12 SUICIDE AWARENESS PREVENTION Role of Law Enforcement: Preserve life property, whenever possible Respond w/professionalism compassion Understand suffering feelings of victim are very real SUICIDE AWARENESS PREVENTION SUI CIDAL PEOPLE MA COMMUNICATE THEIR INTENTIONS TO COMMIT SUICIDE 0 ONLY ONE OTHER THISPERSONMIGHTBE THE RAINED PROFESSIONAL . . .. WHA WILL Suicide Awareness and Prevention 13 Prevention of Suicide Examination The death or serious injury of a? person while in a Massachusetts lock-up could result in a civil law suit. A. True B. False Most suicidal persons give some warning or indication of their intent. A. True B. False A person who has never been arrested before is less likely to attempt suicide. A. True B. False The most common method of suicide attempted in a correctional facility is: A. Self?inflicted wounds C. Hanging B. Drug overdose D. Gunshot A person who threatens suicide should be: A. Ignored if you?re busy C. Given advice on successful methods B. Observed when time allows D. Not left alone A proper question to ask of a detainee whom you suspect of considering suicide is: A. Are you crazy? B. Are you considering killing yourself? C. Don?t you think things could be worse? D. Can I have some of your stuff? Depression can create feelings of: A. Worthlessness, helplessness, shame B. Euphoria inappropriate happiness C. A positive outlook towards the future D. All of the above Reviewed October 2016 10. "Prevention of Suicide Examination Which of the folloWing is NOT a about suicide? A. You can?t stop someone from committing suicide B. Suicide happens suddenly without warning C. All suicidal persons are mentain ill D. Most suicidal persons have made prior attempts It is the role of law enforcement to: A. Preserve life property, wherever possible B. Respond with professionalism compassion C. Understand that the victim?s suffering feelings are very real D- All of the above It is possible, if you are not careful, to place suicidal thoughts in another person?s mind. A. True B. False Reviewed October 2016 PREVENTION OF '?Suicide is a permanent solution to a temporary problem.? ?Most people don?t want to die, they just want the problem to go away 'Jails Prisons versus Community 'Higher rate of attempts success in Jails Prisons oHighest cause of unnatural death in confinement Key Signs 'Depression 40-80% of resultant suicides -P?rojection of hopelessness, extreme sadness, helplessness, crying, -No sense of the future, withdrawal, downcast eyes, lethargy, shame, ?Disturbed sleep, loss of appetite, loSs of activity interest, neglect of appearance oAttempts often made when appear to improve -Depression robs subject of energy and resolution to act forcefully 0Danger occurs when the ?will? and ?energy to act? return Methods Tactics 'Determine the probability of the act ~The scale -Specific plan oAvailable means OLethal means Olf not present, but threatening anyway: oAsk what their plans are? 0Attempt to understand the Method-s Tactics WEAPONS: 'Initial attempt to ASK person to put down any weapons 'Abandon any attempt to disarm person if they do not respond at first ?if they?re willing to put-it down, they?ll do it when you ask 'Focus on the ?person,? NOT the WEAPON 'Pay attention, if ?you? focus on the person, then so will ?they?? In-Service 2016 PREVENTION OF SUICIDE COMMUNICATIONS: 'Prone to emotional outbursts, be prepared for this to happen ?Keep person ?in the present,? understand today?s problem/precipitating factors '00 not impose personal beliefs, anticipate distortions of reality ~They are REAL to the person in crisis, acknowledge they?re ?upset? -Focus on TRUE reality areas til; all you have is your credibility trust ?Help re-estabiish logical structure, explore alternatives 'Offer options, don?t impose them, emphasize small steps 'lt won?t be solved immediately Influencing Suicides in Custody ?The attitude and awareness of Correctional Staff may either prevent, or enable attempted suicides by inmates. It is important that suicidal stress factors be identi?ed, and dealt with in a timely fashion. Death in a Massachusetts Lock?up Ch 40 Sec 36A, 36B, 360 'Civil Lawsuit Liability 'Anyone who had contact with regardless of time elapsed .BY HANGING it takes .a minimum of two people to properly lower a suicide/attempted suicide victim One person relieves the weight from the fixed knot by wrapping their arms around victim 8i lifting upwards 'The other person cuts the victim down by cutting below fixed knot, 'Cut or remove the ligature from throat (away from the knot) if possible UNTIE KNOTS if possible I'Knots are forensic evidence that can change a suicide to a homicide (If the knots are not tied the tied them?) ln?Service 2016 Signs of Suicidal Behavior Take All Suicidal Threats There Is No One Be RED Sleep disturbances Previous suicidal behavior Insomnia/sleeping all the time Depression Nightmares Hopelessness/isolation Can?t concentrate Lethargy Changes in behavior Withdrawn Recent weight loss Shame Giving away possessions Crying Direct/indirect verbal statements Seriousness of offense First time arrest and /or incarceration Within ?rst two weeks of incarceration Under the in?uence of drugs or alcohol upon admission 11pm?7am when supervision is minimal Rejection of loved ones Shift changes Previously imprisoned, not wanting to go back Holidays Has a terminal illness or chronic medical condition Bad news- of any kind Waiting for trial, sentencing Decreased staff supervision Changes in eating habits, sleeping patterns work behavior What Are Suicidal Statements? Direct Verbal Cues: Indirect Verbal Cues: am going to kill myself.? ?You can have my radio; I won?t be needing it anymore.? want to die.? ?Everything is okay now.? Stress and Depression Sn?ess is any internal or external event which causes changes in your body. Types of Stress Internal Stress External Stress ?Frames of mind? causing speci?c action Push individual?s level of deSpair to ?breaking point? Can be personal or situational Can greatly in?uence suicidal tendencies 5/04 Major Depression? Depression can be a normal experience that passes after a short period of time (?the blues,? ?the*b1ahs?) a feeling, a mood, or an emotion, or a more serious clinical depression which carries a diagnosis of ?Major Depression.? Characteristics of Major Depression: A marked deterioration in levels of functioning in areas of work, social relations, and self-care. are present for at least two weeks, nearly every day. can be exhibited in a variety of combinations. are a change from previous functioning. Possible Depressed mood or loss of interest in all or most activities. Signi?cant weight gain or loss. Increase in or. loss of sleep. Hyperactivity or lethargy (physically restless or slowed down). Fatigue or loss of energy. Feelings of guilt, worthlessness or hopelessness. Recurrent thoughts of suicide or death. Anxiety Crying or feeling extremely sad. Diminished ability to concentrate or indecisiveness. Hopelessness. Depression Can Be Associated With: 0 Other disorder, schiZOphrenia or alcoholism. 0 Physical disorders, i.e. HIV or endocrine disorder. 0 Often exists without other disturbances. Stages of Suicide Person experiences loss Loved one, self?esteem, self-worth Anger and/or guilt (grieving process) Denial, Anger, bargaining, Depression, Acceptance Succumbs to depression 5/04 Threats, risk-behaviors, abuse, detachment, resolution Suicide Intervention Methods Tactics The most common method of suicide attempt in acorrectional facility is hanging. Other forms of suicide include self?in?icted wounds and drug overdose. If you suspect an inmate may be suicidal take immediate assessment of the situation and use the following methods tactics. Do Not Be Afraid To Ask ?Do you feel bad enough to think of suicide?? If the inmate is thinking of suicide: Think Sz Speci?c plan Available means L: Lethal means Question the inmate use four questions: how/when/where/means 1. ?How are you going to do it?? 2. ?When are you going to do it?? 3. ?Where are you going to do it?? 4. ?Do you have the tools or means to do it? Can you get them?? 0 Create a calm atmosphere, non-judgmental and candid Listen to inmate?s response Observe and record in log: time, date, place, etc. Relieve any stress or anxiety possible Notify your supervisor, additional security and medical staff if necessary. Secure any weapons; shank, razor etc. Communications Watch vigilantly Never leave the inmate alone Provide support/ safety 0 Be honest and consistent Impact of Suicide on Staff An inmate suicide can have a negative impact on staff resulting in severe physical, cognitive, behavioral or emotional signs of stress, which can cause decline in job performance, even job loss. Staff involved with a suicide should be familiarized with the signs of stress. This should be done Within a short period following the suicide and before the end of the shift (usually within 3 hours of the event). This process is referred to as defusing. In defusing some discussion of the event occurs, but it does not address the strong emotional reactions. 5/04 Its primary purpose is to teach about stress reactions and what can be done to alleviate them. Stress reactions following a suicide are common and in fact are normal reactions to an abnormal event, making debrie?ng essential. The purpose of debrie?ng is to reduce the negative impact of stress resulting from a traumatic event g. suicide). Formal debrie?ng should occur within 24-72 hours. The goal of debrie?ng is to reduce the impact of the incident and to accelerate recovery. Debrie?ngs are conducted to allow ventilation of emotion; reaction to the critical event, provide peer support and stress management education. Debrie?ngs are not or treatment. Debrie?ngs should be administered by trained peers, with professional mental health support. A Debrie?ng is a structured method to assist personnel experiencing negative effects of stress after unusually stressful events. Common Stress Reactions Following a Suicide: Constant thoughts of the suicide event Tension Reluctance to return to the suicide area General numbness to surroundings Inability to eat or sleep 0 Constant fatigue - Apathy, depression 0 Irritability, outbursts of anger 0 Tardiness, absenteeism - Physical problems Stress Management helps you: 3" Develop behaviors which enable you to manage or cope with stress. Actions to take to minimize negative effects of stress following a suicide: Recognize that stress is a normal reaction. Accept that taking care of yourself is a strength and not a weakness. Talk about experience with a coworker, friend or family member. Participate in debrie?ngs or other professional service if available. Seek BAP assistance if stress persist. 0 Be familiar with the common signs of stress. Headaches Muscle aches Feeling out of control Sweating Irritable Tired all the time Anxiety Foot and/or ?nger tapping Increased heart rate Increased respiration 5/04