1 / 38

Suicide Prevention In the Division of Immigration Health Services

Suicide Prevention In the Division of Immigration Health Services. Guidelines for Screening, Referring & Intervening. Purpose.

jam
Download Presentation

Suicide Prevention In the Division of Immigration Health Services

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Suicide Prevention In the Division of Immigration Health Services Guidelines for Screening, Referring & Intervening

  2. Purpose • The Division of Immigration Health Services (DIHS) provides guidelines for the management of potentially suicidal detainees. While suicides cannot be totally eliminated, DIHS is responsible for monitoring the health and welfare of detainees and for ensuring that procedures are pursued to help preserve life.

  3. Objectives 1.Understand general information about suicide and its applicability to a correctional setting. 2. Recognize risk factors or situations that increase the risk for a potential suicide and document accordingly. 3. Understand guiding principles in suicide prevention. 4. Understand roles of each discipline and entity in suicide prevention and when on suicide watch. 5. Act to prevent suicides with appropriate sensitivity, supervision, and referral.

  4. Suicide Prevention • General Information on Suicide • Risk Factors for Suicide • Jail / Prison Suicide Research • Guiding Principles in Suicide Prevention • Process of suicide watch • Responsibilities of medical staff

  5. Suicide: General Information • 10th leading cause of death • 3rd leading cause of death individuals age 15-24, 4th leading cause individuals 25-44 • Approximately 32,000 – 33,000 completed suicides in USA each year • 250,000 – 600,000 nonfatal attempts/year • Each suicide leaves behind average of 6 survivors • 85% of all people who complete suicide are successful on the 1st or 2nd attempt!

  6. Suicide Facts • Women attempt suicide more often; men use more lethal means (63% of time men use guns, 39% for women) • For every successful suicide 8 -25 attempts • Hopelessness is most strongly related to suicidal intent for those who attempt suicide and those who constantly think about suicide

  7. Suicide Facts (II) • White men/women account for 90% of suicides • 70% of people who commit suicide are successful on the first attempt • Depression is the most common mental disorder for those who commit suicide • Suicide rates have not decreased with introduction of antidepressants

  8. Ten Commonalities of Suicide • The common purpose of suicide is to seek a solution. • The common goal is cessation of consciousness. • The common stimulus in suicide is intolerable pain. • The common stressor is frustrated psychological needs. • The common emotion is hopelessness – helplessness. • The common cognitive state is ambivalence. • The common perceptual state is constriction. • The common action is aggression. • The common interpersonal act is communication of intention. • The common consistency is with poor lifelong coping patterns

  9. Prediction of Suicide • Individual Suicides are difficult to predict, however, specific risk factors assist in predicting what individuals are athigherrisk. • And the risk factors are . . . .

  10. Risk Factors for Suicide 1.History of Psychiatric Disorder (85%) 4.75%-5% of psychiatric patients will commit suicide, 3X the national average. • A. Depression (clinical) is a factor in 35-75% of all suicide attempts; 70-90% of all successful suicides. • B. Schizophrenia: Approximately 10% of schizophrenics will commit suicide. The subgroup of schizophrenics who experience command hallucinations are at extremely high risk for suicide.

  11. Risk Factors for Suicide (II) • C.Personality Disorders (10%) Lifetime prevalence of suicide attempts in PD’s is: • -Antisocial P.D. – (11 – 72%) • -Borderline P.D. – (75 – 92%) • -Other P.D.’s – Histrionic 2. History of previous suicide attempts 3. History of substance abuse: in one study 1 of 5 were intoxicated at time of suicide

  12. Risk Factors (III) 4. Family history of suicide 5. History of head injury 6. Hopelessness 7. Major life losses & social isolation 8. Lethality of plan (Means + Access + Intent) 9. Impulsivity, Anger, & Aggression 10. Legal Difficulties, Marital Status, Age, Race, Gender

  13. Jail Suicide Research • #2 Cause of death in U.S. Jails • 600 – 700 jail suicides each year. • Suicide rate is 54/100,000 or 3 times the national average for men (18/100,000) • 51% of suicides occur within first 24 hours, 29% within first 3 hours • 60% are intoxicated • 2 out of 3 victims are in isolation at the time of suicide • 94% of suicides are by hanging • A Major Depressive Disorder is the key factor in most jail suicides

  14. Large Urban Jails • Most victims are arrested for a violent offense • Most kill themselves between 1 and 4 months of incarceration • Intoxication is normally not a factor • Majority of suicides are in Special Housing Units (Protective Custody, Disciplinary or Administrative Segregation)

  15. Prison Suicide Research • #3 leading cause of death • Majority of suicides are at larger specialized Bureau of Prison (BOP) facilities. • In BOP most suicides occur in SHU, after 72 hours or 60-90 days, usually due to inmate-related conflict. • Schizophrenia is the major mental illness precipitating suicide in prison. • SHU is primary site of suicides in prison

  16. Guiding Principles in Suicide Prevention 1. The assessment of suicide risk should not be viewed as a single event, but as an on-going process. 2. Intake screening should be viewed as similar to taking a temperature – it can identify a current fever, but not a future cold. 3.Prior risk of suicide is strongly related to future risk 4. Do not rely exclusively on the direct statements of a detainee denying suicidal ideation, when their behavior, actions, and/or history suggests otherwise.

  17. Guiding Principles (Continued) 5. Many preventable suicides result from poor communication amongst corrections, medical, and mental health staff. 6. Do not assume that inmates who appear manipulative are not suicidal. 7. A disproportionate number of inmate suicides occur in SHU. 8. A lack of inmates on suicide watch should not be interpreted to mean that there are currently no suicidal inmates in the facility.

  18. The Suicide Prevention Program of DIHS • The process of screening, identifying and referring a suicidal detainee • The suicide risk assessment and whom may conduct it • The process of placing a detainee on suicide watch • Location of suicide watch • Responsibilities of various medical staff

  19. Suicide Prevention begins with Screening & Identifying • All detainees will receive an initial mental health screening which will include an assessment of suicide risk. • This initial mental health screening will occur during intake and the results documented. • If no risk of suicide or other mental health concerns the detainee will be placed in general population. • Detainees threatening suicide, at any time and referred from any source, are considered priority and will require immediate attention.

  20. Identification of Suicidal Detainees • From intake screening • During sick call or other medical appointments • Referred by correctional or ICE staff • From other detainees

  21. Referral • A. During regular working hours staff shall immediately advise the Mental Health Provider (MHP) of any detainee who exhibits behavior suggesting suicide potential. In the absence of the MHP, the Clinical Director or a mid-level provider may be contacted. • B. If a detainee is deemed to be at risk for suicide during non-routine working hours the charge nurse may initiate a suicide watch. • C. The nurse will then contact the on-call provider, the MHP, CD, and HSA.

  22. Referral (Continued) • D. Once a suicide watch has been initiated, a face-to-face suicide risk assessment will be conducted at the earliest available time, usually the next business day. A watch may be not be terminated, under any circumstance, without the MHP or the CD performing a face-to-face evaluation. • E. If a suicide watch is commenced on a weekend or holiday, a brief suicide risk assessment will be conducted by the mid-level provider on the next duty day, usually within 24-48 hours. The mid-level providers will receive training in conducting a Suicide Risk Assessment by the MHP.

  23. Assessment/ Intervention • Detainees may engage in suicide gestures, threats, attempts, and other self-injurious behavior for a variety of reasons that may necessitate a variety of clinical interventions other than placing an inmate on suicide watch.

  24. Assessment • During normal working hours and ordinarily, suicide risk assessments will be conducted by the MHP. In the absence of the MHP, the suicide risk assessment may be conducted in the following order of precedence: Clinical Director, a physician, a mid-level provider.

  25. Interventions for Detainee with High Risk of Suicide • Once a detainee with high risk of suicide has been identified, ensure their safety. Maintain direct visual observation in a safe place. Do not allow them to go to the bathroom alone. • If during regular working hours, alert the appropriate staff to conduct a suicide risk assessment. • If during non routine working hours charge nurse will call the on-call provider, who may initiate a suicide watch.

  26. Suicide Watch 1. If it is determined that a detainee is to be placed on suicide watch, enter a note justifying the placement. 2. Nursing staff will carry out all orders and place the detainee in the area designated for suicide watch.

  27. Location of Suicide Watch(If suicide watch is warranted) 3. The suicide watch will be conducted in the clinic in an isolation room. If an isolation room is unavailable, a cell in SHU will be utilized. 4. The area (isolation room or SHU) will be searched prior to placement of the detainee in the room by correctional staff 5. All of the detainee’s clothes, including underwear, will be removed and he or she will be placed in the suicide smock or jumpsuit (for females). 6. All furniture, if possible, will be removed from the isolation room and the mattress will be placed on the floor

  28. Suicide Watch (Continued) 7. Detainee will be placed in observation area and a 24-hour visual observation will be initiated. This is a 1:1 visual observation. 8. Detainee will not leave the observation area for any reason. 9. The area will be shaken down on a random basis. (correctional staff) 10. Detainees property will be inventoried and stored. (correctional staff)

  29. Suicide Watch (Continued) 11. Nursing notes will be completed at least every 2 hours for patients on suicide watch. 12. Patients on suicide watch will receive sack lunches, finger food, or be allowed to use a plastic spoon with their meal. 13. All items will be inventoried upon entry and exit from the observation area.

  30. Who May Place a Detainee on Suicide Watch? • MHP • CD • Mid-level provider • Nurse (in some situations)

  31. Responsibilities of Nursing staff • Ensure the safety of patient • Nurse, in some situations, may initiate a suicide watch. • Carry out orders of provider & document all actions • Document detainee’s status every 8 hours

  32. Responsibilities of Mid-level Provider • Conduct suicide risk assessment, when appropriate • Place detainee on suicide watch • Consult with nursing staff during non-routine working hours • Contact CD, MHP, and HSA • Review patient’s status on holidays weekends • Consult with MHP & CD as appropriate

  33. Documentation • Once a detainee is placed on suicide watch or referred for potential suicide risk, a suicide risk assessment will be conducted and placed in the detainee’s EMR or medical record. • Detention officers will complete notes every 15 minutes on DIHS Form 835 or CCA form 13-69A.

  34. Documentation • All patients on suicide watch, regardless of the housing location, will be reviewed daily by the MHP or a physician. On weekends or holidays, or the absence of the MHP, the Clinical Director or designee (physician or NP/PA) will conduct the review and document the status of the detainee.

  35. Discontinuation of Suicide Watch • Only the MHP or CD may discontinue a suicide watch! • The clinical note in the EMR or medical record justifying will include the time suicide watch was discontinued, and any follow-up plan for treatment. Notify all appropriate staff.

  36. Follow-Up • No later than 1 week after release from suicide watch a detainee will be scheduled for a follow-up appointment with the MHP, CD, or CD’s designee. • Thereafter the detainee will be seen on a monthly basis for two consecutive months for follow-up.

  37. Remember! • Document ALL of your actions!!

  38. Many thanks to: CDR Dennis Slate, PsyD, for creating this slide presentation

More Related