Inmates Suicide In Prison

Introduction

Suicide is the leading cause of death in correctional facilities. Approximately one suicide attempt occurs every three second and one completed suicide occurs every minute (World Health Organization, 2007). In 2013, 4,446 inmates died from suicide; an increase of 132 deaths since 2012 (Department of Justice, Bureau of Justice Statistics 2015).

Research suggests that vulnerable groups such as the elderly population, individuals with mental illness, and drug and alcohol abuse are at higher risk of committing suicide. Factors such as length of sentencing, isolation, and prison staff could also increase the likelihood of an inmate taking away their life. Given the scope of suicides occurring prisons, it has become a social problem. Social workers are in high demand in prisons; their primary task is to identify and target the social problem and stakeholders associated with the issue of prison suicides (Hatcher, 2009).

By researching the predictors of prison suicide, the accomplishment will be for prison staff including social workers to be able to identify an inmate that is displaying suicidal behaviors including depression and prevent them from completing the suicide. This will decrease the amount of suicides that inmates attempt during

incarceration.
The practical significance for methods of researching prison suicide prevention is to understand how the role of a social worker can impact inmates who are at risk of committing suicide. Social workers will be part of the prison staff that is trained to identify inmates who may be at risk of committing suicide. An ethical responsibility social workers have to their clients is to promote their well-being. For some inmates their well-being is at jeopardy because not all prison staff are adequately trained to work with the prison population. Working in a correctional setting can be difficult for a social worker because social workers adhere to the code of ethics and value dignity and worth of a person, self-determination, and social justice which are values and principles different from the ones in a correctional system.
The social policy significance of researching predictors of prison suicide is to reduce the amount of suicides that occur within a correctional facility. The lack of training prison staff receives on how to identify inmates who are suicidal increases the risk of unpreventable suicides. The Standards of Treatment on Prisoners are standards that were created to set rules to help correctional staff understand the general rules of imprisonment, the intake process, confinement, and personal safety of inmates. Every correctional system must have a prison standard that is followed in order to assure prison staff is providing inmates with the necessary treatment during their imprisonment yet there are 14 states that do not a prison standard for their facility (Tartaro &Ruddell 2006). Training is one of the standards required for staff who work with inmates in order to address their physical, social, and psychological needs but, 63% of facilities did not provide their staff with training on suicide prevention. Correctional facilities that are not following the protocol are increasing the likelihood of an inmate committing suicide.
Literature Review
According to the research conducted, suicides in prisons are preventable. Research has shown that there are predictors that can lead an inmate to consider suicide such as personal characteristics, environmental factors of the prison and illness. But, it has also been found that prison staff have a significant impact on inmates who have attempted suicide because staff are required to be trained in identifying inmates who are suicidal in order to prevent the inmate from completing self-harm. This literature review will cover the predictors that researchers have found that are connected to the risk of prison suicide and preventions to reduce the number of inmate who complete suicide.

Personal Characteristics
Age and length of sentencing are two personal characteristics that are frequently discussed throughout the literature as predictors that increase the risk of an inmate committing suicide.
Age
Some studies have found that younger inmates are at risk of suicide while others have found that older inmates are at greater risk. Daniel (2006), supports that younger inmates are at risk of suicide; inmates between 25 and 34 years old have committed more than half of the suicides in prisons. Aday (2003) cited in Tartaro and Ruddell (2006) supports that the elderly population 55 years and older are at higher risk of suicide because they suffer from higher levels of depression and suicidal ideations. Dillon (2013), agrees that inmates 55 and older are at a higher risk of committing suicide compared to inmates that are ages 18 through 24. He stated that the rate of suicide among the older population continues to rise steadily.
Length of sentencing
Studies have compared the length of sentencing and the risk of suicide and have found that both shorter and longer sentencing are factors of prison suicide.

Inmates who are serving a long sentencing, have been found to commit suicide within the early stages of prison confinement (Department of Justice, Bureau of Justice Statistics 2015). A study conducted by Fazel, Cartwright, Norman-Nott & Hawton (2016) found that inmates who were serving a sentence length greater than 18 months but not life were associated with increasing risk of suicide. World Health Organization (2007) argues that lifers are the highest population at risk for suicide because they have lost their freedom and fear the unknown of their future in

prison.
Environmental Factors
Two common themes of environmental factors found in the research that increase prison suicide are the prison staff that work with the inmates on a daily basis and solitary confinement which is a form of isolation.
Prison Staff
Researchers such as Daniel (2006) and Hautala (2015) have found that suicides occur frequently when staffing is low; between 7:00pm and 7:00am because of less supervision during the night and during weekends and holidays.
Prison staff have a moral and legal responsibility to do their best in preventing suicides among inmates (Tartaro & Ruddell, 2006). This can be difficult because as many researchers (Hatcher, 2009; Hautala, 2015 & Daniel, 2006) stated staff lack the appropriate training needed to identify inmates who are risk of committing suicide. Having adequate training is important for all prison staff that come into contact with inmates especially correctional staff who are often the only staff available in the facility 24 hours a day.
Solitary Confinement
Prison suicide is twice as likely to occur when an inmate is in a single cell (Dillon 2013). Solitary confinement can be used for a variety of reasons: as a form of punishment, inmate is at risk of harming himself or herself or voluntarily if an inmate chooses isolation in order to avoid harassment. Medical and psychological consequences that come with solitary confinement are self-harm, hallucinations, depression and anxiety (Steinbuch, 2014). According to Daniel and Fleming (2006) cited in Haynes (2010) the majority of inmates who commit suicide are housed in single cells or some type of administrative confinement.
Illness
Mental health was discussed in the majority of the research that was found on prison suicide. Both intoxication upon arrival to a correctional facility and receiving charges related to substance use have been linked to suicides that occur in prisons. Inmates with co-occurring mental health and substance disorder have increased rates of suicide (Hautala, 2015).
Mental Health
Inmates with mental health are more than five times more likely to attempt suicide (Hautala, 2015). According to Hatcher (2009) prisons did not seek to be the new mental health center but with the lack of funding for mental health care in communities, services placed victims with mental health illness in prisons. Due to limited impatient psychiatric resources jails are also responsible for housing inmates with mental health until a bed becomes available at a mental health hospital (Hautala, 2015).
This has forced prisons into a mental health provider role which staff are not properly prepared for. In the case of Sandra Bland, prior to committing suicide in her cell she informed a correctional staff of having a history of mental health and suicidal attempts; staff did not complete a high-fidelity mental health screening process or visual checks which are required by law. Bland was left out of sight for approximately two hours when she committed suicide. If staff had been given proper mental health and suicide prevention training the death of Sandra Bland could have been prevented (Hautala, 2015). Screening for mental health is a critical step in identifying inmates who are suicidal.
Substance Use
An inmate that is under the influence is at a higher risk of committing suicide (Daniel, 2006). 88% of inmates who have committed suicide were under the influence of drugs or alcohol upon arriving to prison (Felthous, 2011). One of the possible consequences of admitting an inmate who is intoxicated is that they may not process through harming themselves. Studies have also found that if an inmate is arrested on charges related to alcohol or drugs there is an increased risk of suicide (Felthous, 2011 & Haynes, 2010).
Although extensive research and studies have been conducted on the causes of prison suicide, there were some limitations found in the demographic characteristics of inmates. One of the limitations is that the majority of the research focused on male inmates who have committed suicide and did not incorporate females who have also committed suicide. Another limitation found was the lack of data of specific age groups that commit suicide in prisons.

Ethical Considerations
Inmates are members of a vulnerable population. If one completed suicide occurs every minute the universal human right of the inmate’s safety is being violated because everyone has the right to life, liberty and security of person (Nichols, 2012). It becomes an ethical responsibility for social workers to challenge social injustice and purse social change on behalf of the inmate population (NASW, 2016). In some prisons, solitary confinement is used as a tool to manage inmates who suffer from mental health. While in solitary confinement inmates who do not receive access to proper medical treatment (Steinbuch, 2014). Social workers must advocate for change in the policy of solitary confinement for inmates with mental health because according to research prisons are not providing inmates with the adequate services they are need of while placed in confinement.
Implications
In order to address the social problem of prison suicides, adequate training should be required for all staff that come in contact with inmates. According to Haynes (2010), 63.3% of facilities that had an inmate suicide did not provide prison staff with suicide-prevention training. Hautala (2015), agrees that if prison staff are not properly trained there will be an increase in the risk of an inmate to commit suicide. It is crucial for staff to understand their responsibilities during the intake process because 77% of suicide risk is identified during intake (Haynes, 2010).
Prison staff that come in contact with inmates, should receive eight hours of suicide-prevention training and a two-day refresher training each year (Haynes, 2010). Adequate for staff it must include the intake process, ways to identify high-risk offenders, signs and symptoms of mental illness, suicidal behaviors, factors of suicide and communication during intent (Daniel, 2006).

Research Statement and Hypothesis
Conducting a study to understand the predictors of suicide attempts within a correctional setting, would be beneficial for staff that work with inmates on daily basis and a prison social worker. The proposed research statement would be to examine the factors that lead to an inmate contemplating suicide and implementing preventions within the correctional facilities as a form of addressing the social problem. As presented in my literature review, providing staff with more training on how to identify an inmate might be suicidal and implementing prevention programs for the inmates are two approaches that can reduce the suicide that occurs in correctional facilities. If prison staff is provided with adequate training on the predictors that can lead an inmate to contemplate suicide then, prison suicides can be prevented.