Best practices for suicide prevention and response for correctional systems exist, and a growing body of research establishes the essential components of an effective suicide prevention program in jails.

1. Initial and ongoing training.

Nearly half of the suicides in jail settings between 2015–2019 (48 percent) occurred between 6:00 p.m. and 6:00 a.m. Because correctional officers are often the only staff available 24 hours a day, they are considered the front line of defense in preventing suicides. Therefore, officer training around suicide risk detection is crucial for prevention efforts. Correctional staff must be trained to understand the risk factors present that increase the chance of suicide and high-risk periods for suicide, which include the following: the first 2 to 14 days of incarceration; periods of withdrawal from drugs or alcohol; waiting periods before trial, sentencing, or release; holidays or personal anniversary dates; after admittance to restrictive housing or single-cell housing; after the receipt of bad news regarding self or family; and periods when there is less staff present for supervisions (e.g., weekends, nights, and holidays).

2. Systematic screening at intake and follow-up assessment.

Screening during jail intake provides a critical opportunity to identify the mental health needs of individuals being booked into the jail. Jails frequently elect to train correctional officers to administer brief, validated screening tools and/or a set of structured questions and record the answers to a brief list of questions about an individual’s physical and mental state at intake. Timely identification of mental health needs, including heightened risk of suicidal ideation is essential as the median time served before suicide in past studies is nine days. Individuals with a positive screen for serious mental health needs or suicidal ideation should be assessed as soon as possible, ideally within two hours of intake. This information is vital for determining treatment plans and ensuring that individuals are properly monitored. View screening instruments here.

3. Monitoring after initial screening.

Ongoing screening is necessary to ensure proper treatment and placement of the incarcerated person, as their conditions (e.g., worsening of symptoms) may change during incarceration. Custody staff are vital in conducting ongoing screening due to frequent contact and knowledge of the person’s behavior. If the incarcerated person’s behaviors or patterns are observed as changing, a referral for assessment may be warranted.

Though screening instruments for suicide risk inform staff of individuals at elevated risk of attempting suicide during incarceration, these screenings do not predict when an attempt will occur. Jails should use the least restrictive housing necessary to ensure everyone’s safety and avoid restrictive housing for those with serious mental illness. In situations where individuals are placed in administrative restrictive housing or similar specialized housing assignments (e.g., single-celled), they may have difficulty coping with the isolation and be at increased risk of suicide. Historically, a disproportionate number of suicides in specialized housing units have occurred. Forty-six percent (46 percent) of suicides during 2000–19 occurred in the jail’s general housing areas, and 21 percent occurred in restrictive housing units. If restrictive housing is the only option for housing a suicidal person, constant observation should be provided.

4. Effective communication procedures.

Incarcerated decedents, individuals who died in custody, often disclose suicidal intent to family, other incarcerated people, the arresting/transporting officer, and/or correctional staff. Educating family members, fellow incarcerated people, and correctional staff on reporting suicidal disclosures and developing mechanisms to ensure notifications are relayed to appropriate facility personnel may reduce suicide of the incarcerated population. All jail personnel must be trained to relay their observations about detained individuals. These open channels of communication keep staff informed and promote basic safety standards. In addition, some correctional facilities have implemented peer-to-peer programming among incarcerated individuals to enhance social support and prevent suicide.

5. Continuity of care upon reentry.

The American Psychiatric Association’s (APA’s) Psychiatric Services in Jails and Prisons notes that “timely and effective mental health discharge planning is essential to continuity of care and an integral part of adequate mental health treatment.” APA has indicated that essential elements of discharge planning include arranging follow-up appointments for individuals with serious mental illnesses, transferring their treatment records to the referral entity, and arranging to have prescriptions renewed or reevaluated.

Suspended or delayed access to insurance coverage may result in delayed scheduling of behavioral health care appointments and lapses in access to medication. The best practice is to provide an adequate supply of medication upon release to bridge the gap until the individual can receive care from a community-based provider.

In-reach care coordination, a practice through which case managers or social workers come into correctional facilities and provide in-person assistance, is becoming more common. These staff may provide transitional support information to the individual or may personally transport and introduce the released individual to a mental health or substance use counselor, a coordinator of a local Forensic Assertive Community Treatment (FACT) team, or a community resource caseworker. These “warm hand-offs” ensure that, upon reentry, individuals have timely access to people and support.

Suicide Prevention Resource Guide: National Response Plan for Suicide Prevention in Correction Settings 2019

https://www.ncchc.org/suicide-prevention-plan

The National Commission on Correctional Health Care and the American Foundation for Suicide Prevention developed this guide that focuses on three areas key to suicide prevention in corrections: assessment, intervention and treatment, and training. The aim is to educate the field on how to better identify and help incarcerated individuals at risk for suicide, safely manage those identified as at high risk, and provide consistent, comprehensive training to all involved personnel.

Justice and Mental Health Collaboration Program (JMHCP)

https://bja.ojp.gov/program/justice-and-mental-health-collaboration-program-jmhcp/overview

From first contact to reentry, the Justice and Mental Health Collaboration Program (JMHCP) supports criminal justice and behavioral health systems nationwide as they safely divert people from the justice system and increase access to mental health treatment, innovative crisis services, housing support, and more.