7 Week 623 Clinical Psychopharmacology In Correctional Settings This assignment has two parts. Part 1: Review the sample behavioral treatment plan provid

7 Week 623 Clinical Psychopharmacology In Correctional Settings This assignment has two parts.

Part 1:

Review the sample behavioral treatment plan provided in the textbook under Table 14.3.

Prepare a similar behavioral treatment plan based on the following individual:

Susan      Smithe is a 37-year-old female inmate who is incarcerated for armed      robbery. Susan suffers from mental illness. Susan is consistently verbally      abusive of prison staff, physically aggressive with other inmates, and      self-injures by battering her head, arms, and legs against walls and      floors. Her self-injuries often require medical attention. Susan suffers      from a fear of being alone and of insects.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, 

Part 2:

In 750 words, reflect on why your behavioral treatment plan will benefit Susan Smithe.

The reflection should provide a minimum of two to three peer-reviewed resources to support your explanations.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a scoring guide. Please review the scoring guide prior to beginning the assignment to become familiar with the expectations for successful completion.

Reading Assignment:

1.  Https://bibliu.com/app/#/view/books/9781452236315/epub/OEBPS/s9781544302805.i809.html#page_272

Treatment and Management

Read “Treatment and Management,” by Harris, Rice, Quinsey, & Cormier, from Violent Offenders: Appraising and Managing Risk (3rd ed.) (2015).

2. https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1752928X15001055

Clinical Practice: Prevention of Violence in Prison – The Role of Health Care Professionals

Read “Clinical Practice: Prevention of Violence in Prison – The Role of Health Care Professionals,” by Pont, Stöver, Gétaz, Casillas, & Wolff, from Journal of Forensic and Legal Medicine (2015).

3. http://dx.doi.org.lopes.idm.oclc.org/10.1080/13811118.2013.824830 

Management of Suicidal and Self-Harming Behaviors in Prisons: Systematic Literature Review of Evidence-Based Activities

Read “Management of Suicidal and Self-Harming Behaviors in Prisons: Systematic Literature Review of Evidence-Based Activities,” by Barker, Kõlves & De Leo, from Archives of Suicide Research (2014).

  

Grading Rubric

Design of plan part 1 definitions description and usability . 30 points

Discuss why Americans seemingly have such a desire for illegal narcotics. 22.5 points

Explanation of difference in treatment – disease vs. choice or behavior change (B)  30 points

Examine if the theories of psychopathology adequately explain substance use. 22.5 points

Criteria Description

Examine if the theories of psychopathology adequately explain substance use. 5. Excellent 22.5 points

Examination if the theories of psychopathology adequately explain substance use is clear, concise, and makes connections to current research. 4. Good 19.58 points

Examination if the theories of psychopathology adequately explain substance use is clear and makes some connections to research. 3. Satisfactory 17.78 points

Examination if the theories of psychopathology adequately explain substance use is present and clear.

2. Less than Satisfactory 16.65 points

Examination if the theories of psychopathology adequately explain substance use is vague and inconsistent. 1. Unsatisfactory 0 points Management of Suicidal
and Self-Harming
Behaviors in Prisons:
Systematic Literature
Review of Evidence-Based
Activities

Emma Barker, Kairi Kõlves, and Diego De Leo

The purpose of this study was to systematically analyze existing literature testing
the effectiveness of programs involving the management of suicidal and self-harming
behaviors in prisons. For the study, 545 English-language articles published in peer
reviewed journals were retrieved using the terms ‘‘suicid�,’’ ‘‘prevent�,’’ ‘‘prison,’’ or
‘‘correctional facility’’ in SCOPUS, MEDLINE, PROQUEST, and Web of
Knowledge. In total, 12 articles were relevant, with 6 involving multi-factored suicide
prevention programs, and 2 involving peer focused programs. Others included changes
to the referral and care of suicidal inmates, staff training, legislation changes, and a
suicide prevention program for inmates with Borderline Personality Disorder. Multi-
factored suicide prevention programs appear most effective in the prison environment.
Using trained inmates to provide social support to suicidal inmates is promising. Staff
attitudes toward training programs were generally positive.

Keywords best practice, inmates, prison, suicidal behavior

INTRODUCTION

Research has consistently shown higher
suicide rates in prisons and jails worldwide,
when compared to the general population
(Dooley, 1990; Hayes, 1994; Hayes &
Blaauw, 1997). The prison environment
presents many predictors of suicidal beha-
viors which are unique from the general

population. Risk factors of suicidal
behaviors in prisons could be divided into
four distinct categories:

. Demographic risk factors including
being a young male, having prior crimi-
nal history, low education level, White
race, and being of single marital status
(Daniel & Fleming, 2006).

. Clinical factors including personal and
family history of psychiatric problems,
and dysfunctional family lives including
parental substance abuse and violence
(Laishes, 1997), and Axis I and Axis II

Color versions of one or more of the figures in
the article can be found online at www.tandfonline.
com/usui.

Archives of Suicide Research, 18:227–240, 2014
Copyright # International Academy for Suicide Research
ISSN: 1381-1118 print=1543-6136 online
DOI: 10.1080/13811118.2013.824830

227

psychiatric disorders (Daniel & Fleming,
2006).

. Psychosocial factors such as poor cop-
ing methods, stressful life events, past
suicide attempts, receiving a new charge
or conviction, and experiencing shame
or guilt (Daniel & Fleming, 2006), and
family conflict (Laishes, 1997).

. Institutional factors such as overcrowded
conditions, bullying and harassment,
recent disciplinary action (Kovasznay,
Miraglia, Beer et al., 2004), being in a
new environment (Winkler, 1992),
sentences of life imprisonment, being
held on remand (Fazel, Cartwright,
Norman-Nott et al., 2008), lack of staff
supervision, isolation, and sensory depri-
vation of suicidal inmates (Daniel, 2006).

Rising prison suicide rates since the
1980’s have seen an increase in the study
of suicide in prisons (Daniel, 2006), and
the introduction of new suicide prevention
programs (SPP’s) and policies. For example,
the World Health Organization (WHO) in
collaboration with the International Associ-
ation for Suicide Prevention (IASP) released
the guideline ‘‘Preventing suicide. In Jails
and Prisons’’ in 1999. However, despite
the increased attention, there still seems to
be lack of evidence-based activities and
programs focusing on reducing suicidal
behaviors in prisons.

The aim of current review is to system-
atically analyze existing literature on suicide
prevention activities in prisons, which have
been tested for their effectiveness.

Methodology

A search was conducted of English-
language, peer reviewed articles published
between 1990 and 2012. The search
terms applied in SCOPUS, MEDLINE,
PROQUEST, and Web of Knowledge
were ‘‘suicid�,’’ ‘‘prevent�,’’ ‘‘prison,’’ or
‘‘correctional facility.’’ The initial search

of the databases returned a total of 538
articles, with another 7 articles being added
after checking the reference lists of the
articles retrieved by the search. These 545
articles were then limited to 99 after con-
sideration of the titles (Figure 1). The
abstracts of these 99 articles were then read
and reviewed according to the following
criteria:

Studies that present an overview of
suicide prevention activities in the
correctional setting, and include an
analysis of effectiveness measured in
incidence of suicidal behaviors or a
changing of staff=inmates attitudes.

Studies were excluded if they did not
appropriately test the impact of suicide
prevention activities (i.e., solely presenting
numbers of suicides occurring while the
suicide prevention program was in place
without any comparison to numbers before
program implementation), if they were too
outdated, were not focused specifically on
suicide prevention within prisons, or if
they simply provided an overall summary
of various suicide prevention recommen-
dations without any support of the effec-
tiveness of these recommendations.

RESULTS

A total of 12 articles fulfilled the selected
criteria and are presented here in more
detail (see Table 1 for a summary). Out
of the 12 studies, 7 were conducted in
the United States, 2 in the United Kingdom
and 1 in Canada, Austria, and Australia. Six
of these studies involved multi-factored
suicide prevention programs. Two of the
studies were peer focused suicide preven-
tion activities. The other four studies
included changes to the referral and care
of suicidal inmates in prison mental
health services, risk management skills
based training for prison staff, changes in

Managing Suicide and Self-Harm in Prisons

228 VOLUME 18 � NUMBER 3 � 2014

legislation and a specific suicide prevention
program targeted at inmates with Border-
line Personality Disorder.

Multi-Factored SPPs

In 1986, the Galveston County Jail in
the US implemented an SPP based on the

principles listed by Felthous (1994), includ-
ing screening new inmates, giving specific
attention to inmates during risky periods
such as the 3 days before and after a court
hearing, providing psychological support
for inmates, and avoiding the isolation of
suicidal inmates. The study also noted that
the use of trained inmates to provide com-
pany for inmates housed in isolation should

FIGURE 1. Flow chart of the identification, screening, eligibility assessment, and inclusion of articles.

E. Barker, K. Kõlves, and D. De Leo

ARCHIVES OF SUICIDE RESEARCH 229

T
A
B
L
E
1
.
S
u
ic
id
e
P
re
v
e
n
ti
o
n
P
ro
g
ra
m
s
in

P
ri
s
o
n
s
a
n
d
C
o
rr
e
c
ti
o
n
a
l
F
a
c
il
it
ie
s

A
u
th
o
r

C
o
u
n
tr
y
/

P
ri
s
o
n
a
n
d

p
e
ri
o
d

A
c
ti
v
it
y
/
In
te
rv
e
n
ti
o
n

E
v
a
lu
a
ti
o
n
m
e
a
s
u
re

M
a
in

fi
n
d
in
g
s

F
el
th
o
u
s,

1
9
9
4

U
n
it
ed

S
ta
te
s,

G
al
v
es
to
n

C
o
u
n
ty

Ja
il

1
9
8
6

1
9
9
4

S
u
ic
id
e
p
re
v
en
ti
o
n
p
ro
g
ra
m

w
as

im
p
le
m
en
te
d
w
h
ic
h
in
cl
u
d
ed

sc
re
en
in
g
o
f

in
m
at
es
,
p
sy
ch
o
lo
g
ic
al
su
p
p
o
rt
,

o
b
se
rv
at
io
n
an
d
d
is
b
ar
m
en
t
o
f
d
an
g
er
o
u
s

o
b
je
ct
s,
cl
ea
r
an
d
co
n
si
st
en
t
g
u
id
el
in
es

an
d
h
o
sp
it
al
iz
at
io
n
.

C
h
an
g
es

in
su
ic
id
e

n
u
m
b
er
s.

O
v
er

th
e
p
er
io
d
o
f
1
9
8
6

1
9
9
4
,
n
o

su
ic
id
es

o
cc
u
rr
ed

at
th
e
ja
il
.
T
h
is
is
a

re
d
u
ct
io
n
fr
o
m

7
su
ic
id
es

in
th
e
te
n

ye
ar

p
er
io
d
b
ef
o
re

th
e
p
ro
g
ra
m

w
as

im
p
le
m
en
te
d
.

H
ay
es
.
L
.,

1
9
9
5

L
o
u
is
ia
n
a,

U
n
it
ed

S
ta
te
s,

E
la
yn

H
u
n
t

C
o
rr
ec
ti
o
n
al

C
en
te
r

M
u
lt
i-
fa
ct
o
re
d
S
P
P
co
n
ta
in
in
g
si
x
m
ai
n

co
m
p
o
n
en
ts
in
cl
u
d
in
g
:
st
af
f
tr
ai
n
in
g
,

in
ta
k
e
sc
re
en
in
g
=
as
se
ss
m
en
t,
ap
p
ro
p
ri
at
e

h
o
u
si
n
g
o
f
su
ic
id
al
in
m
at
es
,
ap
p
ro
p
ri
at
e

su
p
er
v
is
io
n
d
ep
en
d
in
g
o
n
su
ic
id
e
ri
sk
,

in
te
rv
en
ti
o
n
p
ro
ce
d
u
re
s,
an
d

ad
m
in
is
tr
at
iv
e
re
v
ie
w

af
te
r
a
su
ic
id
e.

C
h
an
g
es

in
su
ic
id
e

n
u
m
b
er
s
in

E
la
yn

H
u
n
t

C
o
rr
ec
ti
o
n
al
C
en
te
r
an
d

su
ic
id
e
ra
te
s
ac
ro
ss

th
e

st
at
e.

O
n
ly
o
n
e
su
ic
id
e
at

th
e
fa
ci
li
ty

si
n
ce

p
ro
g
ra
m

im
p
le
m
en
ta
ti
o
n
,
si
g
n
if
ic
an
t

re
d
u
ct
io
n
in

st
at
e
su
ic
id
e
ra
te
s
fr
o
m

2
3
.1

p
er

1
0
0
,0
0
0
b
et
w
ee
n
1
9
8
4
an
d

1
9
9
2
to

1
2
.4

p
er

1
0
0
,0
0
0
in

1
9
9
3
.

C
o
x
&

M
o
rs
ch
au
se
r,

1
9
9
7

S
ta
te

o
f
N
ew

Y
o
rk
,
U
n
it
ed

S
ta
te
s,

1
9
8
5

1
9
9
6

S
P
P
u
si
n
g
co
-o
rd
in
at
io
n
st
ra
te
g
ie
s
an
d

ri
sk
-m

an
ag
em

en
t
co
m
p
o
n
en
ts
.
In
cl
u
d
ed

st
af
f
co
-o
p
er
at
io
n
,
st
ru
ct
u
re
d
sc
re
en
in
g
,

su
p
er
v
is
io
n
an
d
o
b
se
rv
at
io
n
o
f
at
-r
is
k

in
m
at
es
,
sp
ec
ia
l
sa
fe

ce
ll
s,
im
p
ro
v
ed

st
af
f

tr
ai
n
in
g
,
cr
is
is
in
te
rv
en
ti
o
n
m
en
ta
l
h
ea
lt
h

se
rv
ic
es
,
in
v
es
ti
g
at
io
n
o
f
su
ic
id
es

an
d
st
af
f

d
eb
ri
ef
in
g
.

C
h
an
g
es

in
su
ic
id
e

n
u
m
b
er
s.
F
ee
d
b
ac
k
fr
o
m

p
ar
ti
ci
p
an
ts
as

to
th
e

ch
an
g
e
in

n
at
u
re

o
f

re
la
ti
o
n
sh
ip
s
b
et
w
ee
n

p
ri
so
n
s
an
d
m
en
ta
l

h
ea
lt
h
ag
en
ci
es
.

S
in
ce

im
p
le
m
en
ta
ti
o
n
o
f
th
e
p
ro
g
ra
m

su
ic
id
e
n
u
m
b
er
s
d
ro
p
p
ed

fr
o
m

2
6
in

1
9
8
4
to

9
in

1
9
9
6
.
F
u
rt
h
er
m
o
re
,7
8
%

o
f
p
eo
p
le
w
h
o
re
sp
o
n
d
ed

to
a
su
rv
ey

co
n
d
u
ct
ed

af
te
r
im
p
le
m
en
ta
ti
o
n

re
p
o
rt
ed

im
p
ro
v
ed

co
n
n
ec
ti
o
n
s
w
it
h

m
en
ta
l
h
ea
lt
h
se
rv
ic
es
.

H
ay
es
,
L
.,

1
9
9
7

U
n
it
ed

S
ta
te
s,

C
o
u
n
ty

D
et
en
ti
o
n

C
en
te
r

S
P
P
im
p
le
m
en
te
d
w
h
ic
h
in
v
o
lv
ed

st
af
f

tr
ai
n
in
g
,
id
en
ti
fi
ca
ti
o
n
=
sc
re
en
in
g
o
f

su
ic
id
al
in
m
at
es
,
b
et
te
r
st
af
f

co
m
m
u
n
ic
at
io
n
,
im
p
ro
v
ed

su
p
er
v
is
io
n
,

im
p
ro
v
ed

sa
fe

h
o
u
si
n
g
an
d
ap
p
ro
p
ri
at
e

st
af
f
in
te
rv
en
ti
o
n
.

C
h
an
g
es

in
su
ic
id
e

n
u
m
b
er
s.

In
th
e
1
8
m
o
n
th
s
af
te
r
th
e

im
p
le
m
en
ta
ti
o
n
o
f
th
e
S
P
P
,
n
o
fu
rt
h
er

su
ic
id
es

w
er
e
re
co
rd
ed
.

230 VOLUME 18 � NUMBER 3 � 2014

F
ru
eh
w
al
d
,

F
ro
tt
ie
r,
E
h
er
,

R
it
te
r,
&

A
ig
n
er
,
2
0
0
0

A
u
st
ri
a,

1
9
4
7

1
9
9
6

C
h
an
g
es

in
le
g
is
la
ti
o
n
ai
m
ed

at
re
d
u
ci
n
g

p
ri
so
n
su
ic
id
es

sa
w

fe
w
er

lo
n
g
-t
er
m

se
n
te
n
ce
s,
m
o
re

fr
eq
u
en
t
re
le
as
es

o
n

p
ar
o
le
an
d
sp
ec
ia
l
m
an
ag
em

en
t
o
f

m
en
ta
ll
y
il
l
o
ff
en
d
er
s,
in
cl
u
d
in
g
in
cr
ea
se

in
m
en
ta
l
h
ea
lt
h
st
af
f.
R
ef
o
rm

s
p
ro
d
u
ce
d

a
lo
w
er
in
g
o
f
th
e
p
ri
so
n
p
o
p
u
la
ti
o
n
w
h
ic
h

w
as

ex
p
ec
te
d
to

lo
w
er

su
ic
id
e
ra
te
s.

C
h
an
g
es

in
su
ic
id
e
ra
te
s

B
et
w
ee
n
1
9
4
7
an
d
1
9
9
6
th
e
p
ri
so
n

su
ic
id
e
ra
te
s
in
cr
ea
se
d
fr
o
m

4
8
.6

p
er

1
0
0
,0
0
0
to

2
9
4
.4

p
er

1
0
0
,0
0
0
,
d
es
p
it
e

th
e
re
d
u
ct
io
n
in

p
ri
so
n
p
o
p
u
la
ti
o
n
an
d

in
cr
ea
se
d
m
en
ta
l
h
ea
lt
h
st
af
f.

F
re
em

an
&

A
la
im
o
,
2
0
0
1

U
n
it
ed

S
ta
te
s,

C
o
o
k
C
o
u
n
ty

D
ep
ar
tm

en
t

o
f

C
o
rr
ec
ti
o
n
s,

1
9
9
0

2
0
0
1
.

Im
p
le
m
en
te
d
m
u
lt
i-
fa
ct
o
re
d
S
P
P
in
cl
u
d
in
g

m
en
ta
l
h
ea
lt
h
sc
re
en
in
g
,
in
p
at
ie
n
t
ca
re

fo
r

su
ic
id
al
in
m
at
es
,
fo
ll
o
w
u
p
tr
ea
tm

en
t
o
n
ce

st
ab
il
iz
ed
,
re
lo
ca
ti
o
n
in
to

g
en
er
al

p
o
p
u
la
ti
o
n
,
co
m
m
u
n
it
y
li
n
k
ag
e
u
p
o
n

re
le
as
e,
st
af
f
tr
ai
n
in
g
.

C
h
an
g
es

in
su
ic
id
e
ra
te
s.

S
in
ce

im
p
le
m
en
ta
ti
o
n
su
ic
id
e
ra
te
s

d
ro
p
p
ed

to
fe
w
er

th
an

2
su
ic
id
es

fo
r

ev
er
y
1
0
0
,0
0
0
ad
m
is
si
o
n
s.

E
cc
le
st
o
n
&

S
o
rb
el
lo
,
2
0
0
2

A
u
st
ra
li
a

Im
p
le
m
en
ta
ti
o
n
o
f
S
P
P
ta
rg
et
ed

at
su
ic
id
al

in
d
iv
id
u
al
s
w
it
h
B
P
D
.
P
ro
g
ra
m

in
cl
u
d
ed

fo
u
r
m
o
d
u
le
s
w
h
ic
h
ai
m
ed

to
te
ac
h

o
ff
en
d
er
s
m
o
re

ad
ap
ti
v
e
co
p
in
g
sk
il
ls
,

re
d
u
ce

su
ic
id
e
an
d
se
lf
-h
ar
m

b
eh
av
io
r
an
d

ad
d
re
ss

u
n
d
er
ly
in
g
cr
im
in
o
g
en
ic
n
ee
d
s.

A
n
al
ys
is
o
f
B
P
D

sy
m
to
m
at
o
lo
g
y
b
ef
o
re

an
d
af
te
r
p
ar
ti
ci
p
at
io
n

th
ro
u
g
h
a
d
ep
re
ss
io
n
,

an
x
ie
ty

an
d
st
re
ss

sc
al
e

an
d
th
ro
u
g
h
q
u
al
it
at
iv
e

an
al
ys
is
o
f
th
er
ap
is
t

n
o
te
s.

M
o
st
p
ar
ti
ci
p
an
ts
ex
p
er
ie
n
ce
d
a
d
ec
li
n
e

in
B
P
D

sy
m
p
to
m
s
d
u
ri
n
g
th
e

p
ro
g
ra
m
,
h
o
w
ev
er

2
o
f
th
e
g
ro
u
p
s
(A

an
d
D
)
h
ad

le
ss

g
ro
u
p
ex
p
er
ie
n
ce

th
an

th
e
o
th
er
s
an
d
re
co
rd
ed

an
in
cr
ea
se

in

d
ep
re
ss
io
n
an
d
an
x
ie
ty

d
es
p
it
e
an

d
ec
ea
se

in
st
re
ss
.

H
al
l
&

G
ab
o
r,

2
0
0
4

C
an
ad
a,

S
o
u
th
er
n

A
lb
er
ta

P
en
al

In
st
it
u
ti
o
n
,

1
9
9
6

1
9
9
9
.

P
ee
r-
fo
cu
se
d
su
ic
id
e
p
re
v
en
ti
o
n
tr
ai
n
in
g

w
h
ic
h
fo
cu
se
d
o
n
tr
ai
n
in
g
in
m
at
es

in

li
st
en
in
g
sk
il
ls
,
su
ic
id
e
p
re
v
en
ti
o
n
,
ri
sk

as
se
ss
m
en
t
sk
il
ls
,
ef
fe
ct
iv
e
an
d
ac
ti
v
e

li
st
en
in
g
,
an
d
n
o
n
-v
er
b
al
co
m
m
u
n
ic
at
io
n

sk
il
ls
.

C
h
an
g
es

in
su
ic
id
e

n
u
m
b
er
s
o
v
er

th
e
p
er
io
d

o
f
th
e
p
ro
g
ra
m

an
d

as
se
ss
m
en
ts
fr
o
m

in
m
at
es

an
d
st
af
f
o
n

p
ro
g
ra
m

ef
fe
ct
iv
en
es
s.

S
u
ic
id
e
n
u
m
b
er
s
lo
w
er
ed

fr
o
m

4
in

th
e
5

ye
ar

p
er
io
d
b
ef
o
re

im
p
le
m
en
ta
ti
o
n
to

2
d
u
ri
n
g
th
e
5
ye
ar
p
er
io
d
o
f
th
e
st
u
d
y.

B
o
th

su
ic
id
al
in
m
at
es

an
d
v
o
lu
n
te
er
s

fo
u
n
d
th
e
p
ro
g
ra
m

to
b
e
v
er
y
u
se
fu
l.

C
o
rr
ec
ti
o
n
al
o
ff
ic
er
s
w
er
e
le
ss

p
o
si
ti
v
e,
h
o
w
ev
er
,
p
ro
fe
ss
io
n
al
st
af
f

co
n
si
d
er
ed

th
e
p
ro
g
ra
m

to
b
e

(C
on
ti
n
u
ed
)

ARCHIVES OF SUICIDE RESEARCH 231

T
A
B
L
E
1
.
C
o
n
ti
n
u
e
d

A
u
th
o
r

C
o
u
n
tr
y
/

P
ri
s
o
n
a
n
d

p
e
ri
o
d

A
c
ti
v
it
y
/
In
te
rv
e
n
ti
o
n

E
v
a
lu
a
ti
o
n
m
e
a
s
u
re

M
a
in

fi
n
d
in
g
s

ac
ce
ss
ib
le
an
d
h
el
p
fu
l.

K
o
v
as
z
n
ay
,

M
ir
ag
li
a,
B
ee
r,

&
W
ay
,
2
0
0
4

N
ew

Y
o
rk

P
ri
so
n
s.

Im
p
ro
v
ed

su
ic
id
e
p
re
v
en
ti
o
n
p
ro
ce
ss
es

in
cl
u
d
in
g
an

im
p
ro
v
ed

p
ro
ce
ss

fo
r
th
e

re
v
ie
w

o
f
su
ic
id
es
,
u
p
d
at
ed

cl
in
ic
al

p
o
li
ci
es

an
d
p
ro
ce
d
u
re
s,
im
p
ro
v
ed

o
b
se
rv
at
io
n
ce
ll
s
an
d
st
af
f
tr
ai
n
in
g
.

G
ra
d
u
al
ch
an
g
es

in
su
ic
id
e

ra
te
s.

A
u
th
o
r
n
o
te
s
th
at
su
ic
id
e
ra
te
s
h
av
e
b
ee
n

g
ra
d
u
al
ly
d
ec
re
as
in
g
th
ro
u
g
h
o
u
t
th
e

st
at
e
si
n
ce

m
ea
su
re
s
w
er
e

im
p
le
m
en
te
d
.
R
at
es

re
ac
h
ed

a
lo
w

p
o
in
t
o
f
1
0
.2

p
er

1
0
0
,0
0
0
in

2
0
0
1
.

Ju
n
k
er
,
B
ee
le
r,
&

B
at
es
,
2
0
0
5

U
n
it
ed

st
at
es
,

F
ed
er
al

B
u
re
au

o
f

P
ri
so
n
s

M
ed
ic
al

R
ef
er
ra
l
ce
n
te
r

S
P
P
u
si
n
g
in
m
at
e
o
b
se
rv
er
s
to

m
o
n
it
o
r

in
m
at
es

at
-r
is
k
o
f
su
ic
id
e.

A
n
al
ys
is
o
f
th
e
n
u
m
b
er

o
f

su
ic
id
e
w
at
ch
es

an
d
th
e

m
ea
n
h
o
u
rs

sp
en
t
o
n

su
ic
id
e
w
at
ch

b
ef
o
re

an
d

af
te
r
p
ro
g
ra
m

im
p
le
m
en
ta
ti
o
n
.

N
o
n
-s
ig
n
if
ic
an
t
d
ec
re
as
e
in

th
e
n
u
m
b
er

o
f
w
at
ch
es

re
q
u
es
te
d
o
v
er
th
e
p
ro
g
ra
m

co
u
rs
e.
M
ea
n
ti
m
e
sp
en
t
o
n
su
ic
id
e

w
at
ch

w
as

si
g
n
if
ic
an
tl
y
d
ec
re
as
ed
.

S
h
aw

&

H
u
m
b
er
,
2
0
0
7

U
n
it
ed

K
in
g
d
o
m
,

p
ri
so
n
s
m
en
ta
l

h
ea
lt
h

se
rv
ic
es
.

R
ec
en
tl
y
im
p
le
m
en
te
d
su
ic
id
e
p
re
v
en
ti
o
n

st
ra
te
g
ie
s
in
cl
u
d
in
g
th
e
A
ss
es
sm

en
t,
C
ar
e

in
C
u
st
o
d
y
an
d
T
ea
m
w
o
rk

A
p
p
ro
ac
h

(A
C
C
T
).
T
h
is
m
ea
n
s
th
at

an
y
st
af
f

m
em

b
er

ca
n
re
fe
r
an

in
m
at
e
to

re
ce
iv
e
an

as
se
ss
m
en
t
an
d
p
la
n
o
f
ca
re
.

C
h
an
g
es

in
su
ic
id
e
ra
te
s.

S
ig
n
if
ic
an
t
re
d
u
ct
io
n
in

su
ic
id
e
ra
te
s

fr
o
m

1
2
7
p
er

1
0
0
,0
0
0
in

2
0
0
4
to

9
0

p
er

1
0
0
,0
0
0
in

2
0
0
6
.

A
.
H
ay
es
,
S
h
aw

,

L
ev
er
-G

re
en
,

P
ar
k
er
,
&

G
as
k
,
2
0
0
8

E
n
g
la
n
d
an
d

W
al
es
,
5

p
ri
so
n
si
te
s.

R
is
k
M
an
ag
em

en
t
S
k
il
ls
B
as
ed

T
ra
in
in
g

p
ro
g
ra
m

w
as

ad
ap
te
d
to

fi
t
th
e
p
ri
so
n

en
v
ir
o
n
m
en
t
an
d
w
as

p
ro
v
id
ed

to
p
ri
so
n

st
af
f.
T
h
e
p
ro
g
ra
m

in
v
o
lv
ed

4
m
o
d
u
le
s

d
el
iv
er
ed

th
ro
u
g
h
le
ct
u
re
s,
v
id
eo
s,

v
id
eo
-t
ap
ed

ro
le
p
la
ys

an
d
fe
ed
b
ac
k
o
n

th
e
ro
le
p
la
ys
.

S
ta
ff
co
m
p
le
te
d

q
u
es
ti
o
n
n
ai
re
s
b
ef
o
re

an
d
af
te
r
tr
ai
n
in
g
,
an
d

ag
ai
n
at

a
6

8
m
o
n
th

fo
ll
o
w

u
p
.

T
h
e
p
ro
g
ra
m

re
su
lt
ed

in
im
p
ro
v
ed

st
af
f

at
ti
tu
d
es

to
w
ar
d
s
su
ic
id
e
p
re
v
en
ti
o
n
,

an
d
in
cr
ea
se
d
k
n
o
w
le
d
g
e
an
d

co
n
fi
d
en
ce

fo
r
ri
sk

id
en
ti
fi
ca
ti
o
n
.
T
h
e

v
id
eo
ta
p
in
g
o
f
ro
le
p
la
ys

w
as

n
o
te
d
as

th
e
le
as
t
h
el
p
fu
l
p
ar
t
o
f
th
e
p
ro
g
ra
m
.

232 VOLUME 18 � NUMBER 3 � 2014

not replace staff observation, and that
closed-circuit television (CCTV) should not
replace personal observation and interac-
tion at least every 15 minutes (Felthous,
1994). According to Felthous (1994)
inmates should be disarmed from poten-
tially dangerous items depending on suicide
risk, and suicide prevention procedures
should be applied consistently, with clear
outlines as to the responsibilities of invol-
ved persons (Felthous, 1994). Finally,
inmates who were psychotically disturbed
were provided access to psychiatric hospi-
talization when possible. Although the
author notes the empirical testing of prison
SPP’S is difficult to achieve, the impact of
the application of these principles can be
seen by the reduction in suicide deaths
(Felthous, 1994). During the period from
1986 (when the program was implemented)
to 1994 (when the article was published) no
suicide deaths occurred in the jail, com-
pared to seven suicides between 1976 and
1986 before the program began. This vast
reduction is despite the jail population
having more than doubled since 1986
(Felthous, 1994).

Similar to the previous study, Hayes
(1995) reported on the effectiveness of
the SPP at the Elayn Hunt Correctional
Centre (EHCC) in Louisiana, US. The
prison acts as both an intake and assess-
ment point for male offenders committed
to the Louisiana Department of Public
Safety and Corrections, and as a permanent
housing facility for sentenced prisoners.
The SPP tested at EHCC addressed the
six main components of a successful pro-
gram as listed by Hayes (1995), including
staff training, intake screening=assessment,
appropriate housing of suicidal inmates,
appropriate levels of supervision according
to active suicide risk, intervention proce-
dures in the event of an attempt (staff first
aid and availability of an ambulance for
transportation to hospital), and adminis-
trative review following a suicide. Between
the period of 1983 and 1994, 57,091

inmates were processed through the EHCC
adult reception and diagnostic center
(ARDC), only one of whom completed sui-
cide (Hayes, 1995). This was coupled with a
significant reduction in suicide in prisons
all across the state after the introduction
of a departmental suicide review committee
in 1992, to aid in coordinating suicide pre-
vention practices across the state’s 11
prison facilities and to supplement internal
investigations. Since the introduction of
this committee, Louisiana’s suicide rates
dropped from a rate of 23.1 per 100,000
between 1984 and 1992 to 12.4 per
100,000 inmates during 1993 (Hayes, 1995).

A large metropolitan County Deten-
tion Centre (CDC) in the US experienced
nine suicides within 24 months, a much
higher rate than the national average
(Hayes, 1997). Reasons for this high rate
were attributed to lack of staff supervision,
inadequate response time by medical staff,
hazardous cell conditions, and inadequate
staff training (Hayes, 1997). Following
these nine suicides, a comprehensive sui-
cide prevention program was implemented
to resolve these shortcomings, including
improved staff training through the intro-
duction of 8 hour suicide prevention train-
ing sessions as well as 2 hours of refresher
training each year, identification=screening
of all inmates on intake and for all inmates
identified as being suicidal during their
incarceration, improved communication
between staff, the availability of suicide
resistant housing, and appropriate staff
intervention and use of first aid and cardio-
pulmonary resuscitation (CPR) when sui-
cide attempts occur (Hayes, 1997). In the
18 months following the nine inmate sui-
cides and the implementation of the new
suicide prevention program, no further
suicides were recorded (Hayes, 1997).

Also in the US, Freeman and Alaimo
(2001) provided an outline of an effective
SPP applied in the Cook County Depart-
ment of Corrections (CCDOC), the third
largest pre-trial detention system in the

E. Barker, K. Kõlves, and D. De Leo

ARCHIVES OF SUICIDE RESEARCH 233

country. This program included the mental
health screening of all new detainees
(utilizing structured questionnaires, clinical
observation, and previous staff member
experience to detect high risk individuals),
staff member training, inpatient care and
monitoring of suicidal inmates, emergency
procedures such as close observation and
the use of medical restraints for highly sui-
cidal inmates, and follow up treatment
once inmates were stabilized (Freeman &
Alaimo, 2001). The care of inmates per-
sisted after they were released back into
the general prison population; with a crisis
team available at all times (Freeman &
Alaimo, 2001). Finally, the SPP introduced
new training procedures for correctional
officers with regards to better identification
of the mental health needs of the prison
population. One unique factor of this pro-
gram was the community linkage of detai-
nees who were suicidal. This involved the
petition to the court to have inmates who
remained suicidal on release, committed
to a state hospital for further treatment.
Since 1990, after the implementation of
the SPP at CCDOC, suicide rates were
reduced to less than 2 per 100,000 admis-
sions at the prison (Freeman & Alaimo,
2001). This low rate is impressive consider-
ing departments which hold pre-trial
inmates have been shown to generally have
higher incidences of suicide than those
which detain inmates on longer sentences
(Blaauw, Kerkhof, & Hayes, 2005). How-
ever, authors did not provide a baseline
rate for CCDOC, though it was noted that
suicide rates across New York State
showed an average of 42.2 suicides per
100,000 admissions between 1988 and
1997 (Freeman & Alaimo, 2001).

Two of the studies involved multi-
factored SPP’s implemented in prisons
across New York. The first, by Cox &
Morschauser (1997), focused on a multi-
factored SPP addressing increasing prison
suicide rates in New York Prisons between
1983 and 1984. The program was named

the ‘‘Local Forensic Suicide Prevention
Crisis Service Program’’ and was imple-
mented in 57 counties, with revisions made
in 1993 to keep the program up to date
(Cox & Morschauser, 1997). This program
included many components seen in previ-
ously mentioned programs such as inmate
screening, supervision of high risk inmates,
and staff training. In addition, it included
details of the review process after a suicide
occurs to prevent future incidents, and
staff debriefing to provide support for
staff involved in the incident (Cox &
Morshauser, 1997). Cox and Morschauser
(1997) report that the program had great
success across the state, with a decrease
in suicide numbers from 26 in 1984 to 9
in 1996, despite a doubling in the jail popu-
lation. Strengthened relationships between
prisons and mental health agencies were
also reported by 78% of respondents
(Cox & Morshauser, 1997).

The second, more recent, study from
New York focused on a program imple-
mented by NYS Department of Correc-
tional Services (DOCS), Bureau of
Forensic Services (BFS), and the Central
New York Psychiatric Centre (CNYPC).
Similar to other studies, measures included
an improved process for the review of
suicides, with each completed suicide
undergoing a psychological autopsy and a
special investigation, and quality assurance
reviews for both completed suicides and
serious non-fatal attempts (Kovasznay,
Miraglia, Beer et al., 2004). Clinical Policies
and procedures were improved through
changes to the inmate service level classi-
fication process, the admittance of inmates
into the observation unit, methods to
engage reluctant inmates with appropriate
treatment, and modification of observation
cells for enhanced safety (Kovasznay,
Miraglia, Beer et al., 2004). Despite fluctua-
tions, suicide showed an overall declining
trend (dropping from 15.8 per 100,000 in
1993 and 24.4 per 100,000 in 1994 to
10.2 per 100,000 in 2001, 19.4 per

Managing Suicide and Self-Harm in Prisons

234 VOLUME 18 � NUMBER 3 � 2014

100,000 in 2002). Kovasznay, Miraglia,
Beer et al. (2004) suggest that it is related
to these measures implemented as well as
quality assurance reviews, an increase in
mental health staff in prisons, and the col-
laboration between DOCS and mental
health agencies.

Peer Focused Prevention Activities

The potential for using other inmates
as suicide prevention has come to attention
due to suggestions that inmates are more
able to relate to the experiences of their
peers, therefore being more likely than staff
to gain the trust of other inmates (Laishes,
1997). The SAMS in the Pen, peer SPP was
implemented in a medium security facility
in Southern Alberta, Canada. The program
was created by collaboration between the
prison and the Samaritans of Southern
Alberta (SAMS; an inmate suicide preven-
tion group). Training was provided to
selected inmates covering topics such as
the concept of befriending, effective and
active listening, nonverbal communica-
tions, the nature of mental illness, suicide
prevention and intervention, and policies
and procedures of SAMS (Hall & Gabor,
2004). After participation in the program,
the general inmate population, as well as
SAMS volunteers, perceived the program
to be quite helpful, however correctional
staff were not as certain about the effec-
tiveness (Hall & Gabor, 2004). Professional
staff (parole officers, mental health work-
ers, chaplains) were more impressed than
correctional officers about the accessibility
of the program and its helpfulness (Hall
& Gabor, 2004). The program appeared
to have potential for suicide prevention,
with suicide deaths lowering from four
suicides in the 5-year period before
implementation, to two completed suicides
during the 5-year period of the program
(1995–2000). Unfortunately, due to low
absolute numbers it was not possible to

demonstrate effectiveness statistically.
However, Hall and Gabor (2004)
concluded that the comments from parti-
cipants and the low suicide rate over the
duration of the program indicated the pro-
grams potential for suicide prevention.

The Inmate Observer Program (IOP)
implemented at a Federal Bureau of
Prisons Medical Referral center, specifically
aimed to prevent the negative effects of
isolation through the use of inmate obser-
vers in the correctional setting (Junker,
Beeler, & Bates, 2005). During the 24-week
study period, 82 suicide watches were
initiated for 37 individuals who were placed
on suicide watch in an inpatient restricted
housing unit. These inmates were obser-
ved through direct observation by trained
inmate observers as well as staff obser-
vation through CCTV and rounds by staff
(Junker, Beeler, & Bates, 2005). The num-
bers of suicide watches in the 12-week per-
iod prior to the program were compared to
the 12 weeks following, with watches being
reduced from 48 to 33 (31.25% reduction),
however this reduction was not significant
(p ¼ 0.096) (Junker, Beeler, & Bates,
2005). Nevertheless, one group of inmates,
those with personality disorders had signifi-
cantly fewer watches than before program
implementation (p ¼ 0.033). The mean
hours on suicide watch was then analyzed
before and after initiation of the program.
Before implementation, inmates spent an
average of 108.88 hours on suicide watch,
which was reduced significantly to 64.5
hours after implementation (p ¼ 0.036)
(Junker, Beeler, & Bates, 2005).

Other Studies

In 1975, law reforms in Austria
imposing fewer long term sentences, more
suspended sentences, more frequent release
on parole, and special requirements for the
management of mentally ill offenders
(those not guilty by reason of insanity,

E. Barker, K. Kõlves, and D. De Leo

ARCHIVES OF SUICIDE RESEARCH 235

highly dangerous and mentally ill offenders,
and alcohol and drug addicted offenders)
were expected to lower prison suicide rates
(Fruehwald, Frottier, Eher et al., 2000). The
reform also saw an increase in staff, impro-
ved staff training, and better facilities to
treat mentally ill inmates. Fruehwald, Frot-
tier, Eher et al. (2000) analyzed the statisti-
cal reports from the Ministry of Justice
between 1947 and 1996 to get an overview
of annual suicide rates over this time per-
iod. It was found that despite the measures
implemented to reduce suicide and a lower-
ing of

Submit a Comment

Open chat