5-30/000.00 Suicide Prevention

PURPOSE OF ORDER

The purpose of this order is to establish procedures for the handling of suicidal inmates at the Inmate Reception Center (IRC), as well as to provide custody personnel information on the recognition of mentally ill inmates.

SCOPE OF ORDER:

This order shall apply to all personnel assigned to and/or working in any capacity at IRC.

ORDER:

All custody and civilian personnel assigned to IRC shall adhere to the following procedures with regard to the prevention of inmate suicides and the recognition of mentally ill inmates.  It is the responsibility of all personnel to recognize behavioral patterns which may indicate an inmate is in need of mental health care.  If staff determine an inmate is in need of mental healthcare or medical services, the appropriate referrals shall be made for an evaluation, assessment, and treatment.  

IRC custody personnel who encounter a potentially suicidal inmate shall make the proper notification to Correctional Health Services (CHS) staff.  For further information regarding the handling of suicidal inmates, refer to CDM section 5-01/050.00, “Handling of Suicidal Inmates.”

Inmates who were identified as suicidal by arresting or transportation officers prior to their arrival at IRC shall have an e-BOMHR or BOMHR completed prior to accepting custody of the inmate.  In addition, inmates who are identified as potentially suicidal by CHS during intake screening do not require an e-BOMHR.

In all other circumstances, personnel shall utilize the electronic Behavioral Observation and Mental Health Referral (e-BOHMR) available through the Custody Automated Reporting and Tracking System (CARTS).  Custody personnel shall complete the first five (5) sections of the e-BOHMR.

The printed BOHMR report (SH-J-407) shall only be utilized under circumstances when the use of the e-BOHMR is not possible (e.g. system failure, an emergency which significantly affects facility operations, etc.), in accordance with CDM section, 4-05/000.00, “Behavioral Observation and Mental Health Referral Reports.”

The following reports shall be written in the event of an attempted or completed suicide:

• Incident Report (SH-R-49);
• e-BOMHR Referral;
• Inmate Injury Report (SH-J-212)

When completing an Incident Report (SH-R-49) and all other required reports, custody personnel shall not refer to a suicide attempt as “feigned.”

IRC custody personnel shall also attempt to exchange clothing for any inmate who declares or is deemed to be suicidal for a Department approved risk precaution gown.  For additional information regarding procedures on the exchange, refer to IRC Unit Order 5-11/017.00, “Exchange of Inmate Clothing for Risk Precaution Gown.”

IRC custody personnel working in areas where inmates have access to telephones should exercise caution for the possibility of inmate hangings by use of telephone cords.  For additional information regarding telephone cord suicide risk, refer to CDM section 5-01/050.00, “Telephone Suicide Risk.”

POSSIBLE PRECURSORS OF SUICIDE AND ATTEMPTED SUICIDE

• Talking about dying, self-harm or any mention of dying
• Change in personality, sadness, withdrawn, irritable, anxious, tired, relief and apathetic
• Low self-esteem, feeling worthless, shame, overwhelming guilt, and/or self-hatred
• Giving away possessions or packaging belongings
• Losing interest in most activities such as not coming out of an assigned cell
• Not eating or the lack of interest in food
• Unusual/obscure interest in religion such as the sudden reciting of bible passages
• Feelings of losing self-control, statements of a mental breakdown or harming others
• Previous suicide attempts
• Bad news

(Rejection by family, sickness or death of a family member,
infidelity by a spouse)

• Sexual assault
• Confinement for a first time offender
• Harsh (or unexpected) sentence imposed by a court
• Guilt for having committed the crime
• Assault by an inmate or an altercation with staff
• Prolonged confinement in an un-sentenced status during the trial period

In the event of the discovery of an attempt or completed suicide personnel shall:

• Call for back up
• Notify Correctional Health Services staff/request paramedics (if necessary), sergeant, and watch commander
• Lockdown the immediate area
• Obtain the emergency response kit
• In the case of hanging, use the “cut down tool,” from the emergency response kit to immediately cut down the inmate (the preservation of life should be the primary consideration)
• Monitor the inmate’s airway, breathing, and circulation
• Render first aid and/or C.P.R. if necessary

The best preventative measure against a potential suicide attempt by an inmate is early detection.  Custody personnel who observe or are notified of an inmate who is exhibiting any of the previously listed warning signs of potential suicide shall immediately escort the inmate to the IRC clinic or IRC module 231 for evaluation by CHS staff.

Should the inmate die as a result of suicide, the procedures described in CDM section 4-10/050.00, “Inmate Death – Reporting and Review Process,” shall be followed.

EMERGENCY RESPONSE KITS

Each work station throughout IRC has been assigned an emergency response kit.  All areas shall maintain an emergency response kit.  The emergency response kit is contained in a white waterproof container with red stenciling on the sides labeled “EMERGNECY RESPONSE KIT.”  The emergency response kit shall only be removed from the work station to assist in suicide intervention or during suicide intervention drills. 

The emergency response kit contains the following items:

Item                                                                                                    Quantity

Craftsman Handi-Cut (cut down rescue tool)*                           1

Cardiopulmonary Resuscitation (CPR) Mask                            1

Bag valve mask (“Ambu bag”)                                                       1

High risk exam gloves                                                                     1 pair

NARCAN Nasal Spray (NALOXONE)                                          2 units

Towel                                                                                                 2

*Caution should be exercised whenever the emergency response kit is deployed.  The cut down tool is a security risk and should be accounted for at all times.

Personnel responsible for the work area shall inspect the emergency response kit at the beginning of their shift to ensure the tamper-resistant tape is intact.  This inspection shall be documented in the Uniform Daily Activity Log (e-UDAL).  If the tamper-resistant tape is broken or the kit appears to have been opened, notification to a supervisor shall be made.  When the emergency response kit has been deployed, or opened for any reason, the supervisor or designee shall contact the training unit.  The training unit shall inspect the container to ensure all of the above listed items are present and apply new tamper-resistant tape.  If items are missing from the kit, the training unit shall replace the items. 

IRC personnel shall receive ongoing training and recurrent briefings regarding suicide prevention.