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Article Excerpt
Suicide is a significant problem within jails and prisons. If self-harming inmates are labeled manipulative and therefore not treated, this may lead to their death, because research demonstrates that these "'manipulative" individuals are at risk of suicide and need treatment. Attention to the role of mental health counselors in jails and prisons is therefore necessary. This paper discusses that role and ways to identify, assess, treat, and prevent suicides in jails and prisons. It provides suggestions for research on suicide assessment with incarcerated individuals who are considered manipulative.
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The rate of suicide in United States jails and prisons is considerably higher than the suicide rate in the general U.S. population. In fact, according to Hayes (2003), within most jails suicide is the leading cause of death. The rate of suicide in jails is 47 deaths per 100,000 inmates (Mumola, 2005), roughly four times higher than the rate reported for the general population. The rate in prisons is lower than in jails because individuals in jail are often in crisis after being arrested, do not know how long they will be held in custody, and are often under the influence of drugs or alcohol when arrested. These factors place jail inmates at increased risk of suicide particularly within the first 24 hours of confinement (see Hayes, 1995, for a review).
In prisons, suicide ranks third for cause of death after natural causes and AIDS (Hayes, 2003). Hayes states that there are 200 completed suicides a year in prisons, which yields a rate of about 15 deaths per 100,000 inmates. This rate is slightly higher than the national rate for the general population, which is approximately 11 deaths per 100,000 (American Association of Suicidology [AAS], 2006). Additionally, some (e.g., Daniel, 2006) have argued that actual suicide rates in both jails and prisons may be higher because suicide in correctional facilities is often underreported.
Given the high rates, suicide and assessment of suicide have become major concerns for mental health counselors in correctional settings (Hayes, 2003). These counselors are often faced with unique challenges, particularly considering the differing expertise of various staff and the organizational structure. The purpose of this paper, therefore, is to raise awareness of suicide in jails and prisons by outlining some of the difficulties of treating self-harming individuals within a system that classifies some inmates as manipulative and therefore not suicidal; to discuss the role of counselors in these settings; to highlight ways to identify, assess, treat, and prevent suicides in jails and prisons; and to provide suggestions for research on suicide assessment with individuals who are considered manipulative.
SUICIDE AND PERCEPTIONS OF MALINGERING IN JAILS AND PRISONS
Suicide assessment is difficult in jails and prisons due to factors like lack of communication between counselors and correctional officers (Hayes, 2003) and perceptions that some self-harming inmates are malingering (Barr, 2001). DeClue (2002) posited that correctional officers may believe an inmate who is expressing suicidal ideation or gestures is malingering or "intentionally exaggerating or fabricating psychological problems or symptoms for the purpose of external gain" (p. 718). Barr suggested that this is a problem because correctional officers who believe an individual is faking suicidal gestures will often fail to refer the inmate to a mental health counselor. This can be detrimental to inmates because correctional officers, who often have minimal knowledge about mental health issues, may be making inappropriate professional decisions about who is malingering and who has a "genuine" concern (Kleinig, 2001).
Denying access to mental health services for an inmate who reports suicidal ideation or intent could be fatal. For example, an inmate considered to be malingering and not permitted access to mental health services may intensify self-harming behaviors and die accidentally in the process (Correia, 2000; Hayes, 1995; Winter, 2003). Further, despite the documented widespread use of isolation (see Correia, 2000; Hayes, 2003) when inmates are deemed to be suicidal or manipulative, research (Bonner, 2001; Correia, 2000; Hayes, 1995, 2003; Winter, 2003) has consistently demonstrated that most deaths occur when individuals are in isolation, where suicidal intent and behaviors are exacerbated. Indeed, Bonner (2006) recently demonstrated that inmates in segregation are significantly more likely to report higher levels of depression and suicidal ideation than inmates who were not segregated. To reduce the rate of self-harm and death within correctional institutions, it is therefore essential that mental health counselors find effective ways to collaborate and communicate with correctional officers so that individuals who are suicidal or are considered to be malingering are properly assessed and...
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