Webinar presenter Dr. John Peters answered a number of your questions after his presentation, Suicide Identification, Prevention, and Policy Failure. Here are just a few of his responses.
Audience Question: Are there studies you can share that confirm that a prior history of suicide increases the likelihood of suicide within a detention facility?
Dr. John Peters: Yes. That’s been fairly well established. On the top of my head, I can’t direct you to a specific one but there are several out there. I would suggest, probably the quickest way to do it is just to do a Google search or go to Google Scholar and type that information in on the search bar. Many times, plaintiff’s lawyers will have that information and use it against the organization saying I tried to say to you on the way in he had three prior attempts, what did you do? Nothing. That type of thing. Yes, that is out there.
Audience Question: If a person’s parents’ have died by suicide are they at higher risk? Again are there particular studies you might be able to cite or should we look at Google?
Dr. John Peters: That’s a good question. I personally don’t know of any studies that correlate or associate apparent suicide because it can be so diverse. If the parent had a mental illness that caused suicide, the genetic disposition of also developing a mental illness may be at a higher risk. That doesn’t necessarily translate into the suicide ideology. We do know that if a person is an alcoholic, genetically that may pass on to their children or in some cases it’ll skip a generation and it will the grandchildren. I will probably seek some answers on Google Scholar on that. I am not aware of any definitive research to associate that.
Audience Question: When they are available, do suicide notes typically provide sufficient information to understand motivations?
Dr. John Peters: It depends. As you can imagine a note is as different as the individual who wrote them. Many times there will be an indication that I can’t bear this anymore. In other cases, it’s a blame game. You made me do this. We can get some insights but again if the deceased wrote this prior to his death or her death blaming a wife or a spouse or the correctional officer, something else. We cannot just take that at face value in some cases. In other cases, it may be what the person actually thought. Again, that’s something that is evidentiary. That’s certainly something that you can pass on to your psychologist who may be assisting in the psychological autopsy. He or she may be able to extract more information from that given the totality of the circumstances surrounding that suicide. I would look at it on a case by case basis.
Audience Question: Would you consider the utilization of closed circuit monitoring the same as direct supervision?
Dr. John Peters: Generally, no. The reason for that is people who, institutions that are set up to have monitors, the person doing the monitoring never is dedicated to solely watch that monitor. Usually, at the desk, the person has five or six other things doing at the same time, people come up and talk to them. Generally speaking, unless the person is dedicated to only watch that monitor, that is not direct supervision. That usually is a problem. There have been instances where people have died in their cell where that monitor has been on somebody’s desk and because they are busy doing other things, they are not dedicated to that and they miss it.
Audience Question: Got it. When you talk about watching a monitor, you mean one monitor with one inmate. Is that correct?
Dr. John Peters: Correct.
Audience Question: If you don’t have the staff to do constant suicide supervision then what do you recommend?
Dr. John Peters: If you don’t have the staff to do constant supervision of inmates, there may be other issues at play. Correctional standards violation, policy violations, what have you. In those situations, you might be able to relocate the inmate and put that inmate in a position where he or she can be monitored maybe not one-on-one but maybe put out in an area where you have many correctional officers or put that person into a suicide-proof cell where the person literally can’t do anything to harm him or herself. You’re still going to need some type of monitoring of that person. If we don’t have the personnel to put one on one and I don’t know this person’s facility at all but I would consider relocating that inmate either to put them in a position where they are at the center of attention and can be watched on a very regular basis or put them at a room or a cell that’s suicide-proof.
Audience Question: When there’s a suicide in a cell block, do you recommend that facilities work with the other inmates within that cell block? If so, what is the best follow up mechanism?
Dr. John Peters: I think you have to work with inmates in that cell block. They have to be interviewed as well. I think the other inmates, many times, have information. I just reviewed an investigation last week of a suicide in a jail where the inmates were interviewed and they were told right up front we’re not going to use this information against you in any way. It’s just that we have to get this information from you. What did you hear? What did you see? What did the person say? That type of things. As part of your investigation, take a look at that.
Audience Question: I think Ann was referring to in terms of mitigating the risk that other prisoners in a cell block might, in turn, commit a suicide?
Dr. John Peters: Like some sort of a copycat viewpoint? If there’s a contagion suicide or copycat suicide, there’s always a risk of that. I think it’s important that if you have a situation like that in a cell, on a tier or on the floor or out in the yard. Whatever happens, I think it’s very very important to talk to the other inmates kind of do a debriefing as much as you legally can and find out if anybody else is depressed. I think the thing that’s often missed in these cases where you have other inmates and maybe an inmate was really good friends with this inmate who’s now gone maybe can get depressed over it. These folks are under your care, custody, and control. It’s not like being a private citizen. They just can’t go outside and go to the doctor. They can’t go see a psychiatrist. They can’t just go and talk to somebody. It’s incumbent upon all of us who work in this business to make sure that we offer some type of debriefing to these folks and if you can identify one or two other people who are depressed or saying yeah, he really did the right thing, I wouldn’t mind doing that too. Okay, there we go. Put them under watch. you won’t know that unless you talk to them.
Audience Question: She was actually talking about taking one step further. They want to create a video for inmates so they can help to monitor some of their other fellow inmates and look for the sights of suicidal ideation. Are there some significant symptoms you could recommend or would you just refer to the list of symptoms from the presentation?
Dr. John Peters: I would refer to the list of symptoms from the presentation. I would also look at that article you made available to them. Attorney (Heinble?) and I authored that article for corrections managers’ magazine. We have a lot of behavioral science in there. I would also go to Youtube and see what’s available on Youtube on suicide identification behaviors or something like that. There’s a lot of resources out there. I would also go to your local suicide prevention group and ask them what they have. They may have written materials. They may have videos. It may save you reinventing the wheel for sure. The other thing to keep in mind if you produce something like that is it’s always discoverable. You may have to turn it over in the process of litigation. Make sure it is done professionally and done well. It can also act as a buffer at times to say look we tried this is what we did to be proactive. It may actually turn out to be very very good. I’d check your local resources, Youtube and refer to that article.
Aaron: Art in the audience just messaged and he said there are recent studies which suggest a strong correlation to genetic-based suicidality. The one that he’s linking out is from the May 2018 article in molecular psychiatry which talks about this correlation. Then he talks about the second book called The Neurological Basis of Suicide which also supports a strong correlation. That goes back to the question asked by Richard if the parents have died by suicide is there a higher tendency? These articles would indicate yes.
Dr. John Peters: Just to remind everybody, correlation is not cause-and-effect. Correlation just means there’s a relationship between two or more variables. It can point in the direction of causation and certainly getting this information will be helpful to everyone. I would encourage you to get it and read it and incorporate it into your training.
Audience Question: How often, if you know, has a person who committed suicide has been a victim of prison sexual assault?
Dr. John Peters: I don’t have the specific statistic on that. I’m sure it’s available but I couldn’t give you a direct answer on that. I know there is, again, an association and there’s a correlation but how strong that is, I don’t know.
Audience Question: What constitutes a suicide-proof cell? Are there standards? Are there specifications we can look to that identify what a suicide-proof cell is especially as given in your example, no cell is truly suicide-proof?
Dr. John Peters: I have actually been in cells that have been suicide-proof as far as it’s really hard for the inmate to cause any injuries in him or herself. We’re talking about not having bars in the cell at all. We’re talking for the most part having a rubber or a matted room, all the walls are mat. There’s no toilet in that cell. If the inmate has to go to the bathroom, he or she has to request to go. Basically, it’s like a rubber room. There’s really nothing in that room that can be harmful. Some of your larger facilities may have that. Some of your smaller ones may not have that. I would certainly look at some of the facilities out there that have it. You may want to go back either through Youtube or Google. Just type in the search bar suicide-proof room. You may find this in hospitals. You may find them in other institutions as well. Jails do certainly have those. Not everybody has them obviously. There’s nothing in that room that will be harmful to that individual. Somebody can say they can keep ramming their head into the wall or doing whatever. There’s always that possibility. Remember I said if somebody really wants to kill them there’s that possibility. It could be that they take the suicide smock and try to eat it or hold their breath. There are always those possibilities. That’s why you monitor these people as well. You don’t put them in a room like that and just let them go. You still have to monitor these individuals. Again, they are under your care, custody, and control. You’re responsible for their well-being.
Aaron: We had another person submit another comment. Charles Rose. There’s an article by Lindsay Hayes Checklist for the Suicide Resistant Design of Correctional Facilities. I don’t know how widely available that is but thank you very much for sharing that.
Audience Question: The person is asking whether or not two inmates in the same cell keeps people — keeps them from suicide has been shown as helpful keeping them from suicide?
Dr. John Peters: Generally speaking, that would be correct. If the person tries to do something the other cellmate will be able to try to stop it, prevent it or at least notify the correctional officers. It doesn’t always happen because people do sleep. If the inmate is asleep, the person who is dedicated to committing suicide may do it while the individual is asleep. It’s not a hundred percent guarantee but it does minimize the associated risk with that. If I might, Lindsay Hayes is probably the foremost expert on suicide research on jails in the country. Most of her research was done under federal grant and you can get that through the either the Department of Justice or the National Institute possibly of Correction or other government agencies and download all those reports including that checklist.
Click Here to Watch a Recording of Suicide Identification, Prevention, and Policy Failure.