EFTA00117553 10/10/2018 ## Objectives - Understand suicide risk associated with locked units and single cells - Identify high risk groups - behavior disordered inmates - sex offender and protective custody inmates ## Objectives - Discuss management strategies for specific at risk inmates in this SHU - Review emergency response procedures 1 EFTA00117554 10/10/2018 ## Locked Units - Locked units include SHUs, SMUs, ADX, Seclusion, Extended lock down units, etc. - Every year between 30 and 80% of inmate suicides occur on a locked unit - Single Cells in locked units are especially risky for high-risk inmates 2 EFTA00117555 10/10/2018 ## Single Cells It is recommended that all SHU inmates be double-celled unless there is a compelling reason not to do so. Reduces isolation - Reduces privacy - - Provides distraction - Provides rescue opportunity ## Single Cells When an inmate cannot be double celled: – Place at-risk inmates in higher visibility cells Reduce or eliminate tie-off points - Increased monitoring of property - Additional out of cell contacts with Psychology, Health Services, Unit Team, Recreation, Education, and Religious Services ## High Risk Inmates Discuss local policies to ensure specific inmates are not single celled. These may include: - Psychology Advisory List (TRU-SCOPE) - Special notation on cell door - Special notation on SHU board - SHU Program - Other Do Net Cell Alone 3 EFTA00117556 10/10/2018 ## Good SHU Management is Good Suicide Prevention - Complete SHU rounds as directed by policy and document them accurately - Observe inmates & report concerns to the SHU Lieutenant, Psychology Services, and/or the next shift, as appropriate - Respond to inmate concerns and accommodate reasonable requests promptly ## Good SHU Management is Good Suicide Prevention - Prior to entering a SHU cell to provide assistance staff should ensure their safety which may include waiting for assistance - Cut down tools should never be used for any purpose other than responding to a suicide emergency - Know the location of the AED and how to use it ## Behavior Disordered Inmates - 30% suicides are committed by behaviorally disordered inmates in SHU - At risk for suicide AND accidental death - Must be assessed by psychology EVERY time they make a new threat of self-harm - Must be taken seriously! 4 EFTA00117557 a a a a a a a ! a 10/10/2018 ## Working with Behavior Disordered Inmates - Negative perceptions or frustrations may impact your professional judgment and need to be monitored - Manage through collaboration between departments - A group approach is indicated for the most demanding cases ## Working with Behavior Disordered Inmates - Manage with positive reinforcement — Catch them being good *Praise progress, not perfection – "small steps"* - Address reasonable requests promptly - Set one goal that is guaranteed to occur - If a Suicide Risk Management Plan is in effect. follow it exactly ## What is a Suicide Risk Management Plan? - The Plan we will discuss today is not the same as the plan used by the institution when an inmate is in restraints - Punishment - A Suicide Risk Management Plan is also NOT: - Stricter rules - Extreme deprivation - Social isolation Less work for staff 5 EFTA00117558 âL¥♦!!‡♥â 10/10/2018 ## Suicide Risk Management Plan The goal of a Suicide Risk Management Plan is to increase inmate safety by decreasing behaviors that create risk for suicide or accidental death when the inmate cannot be engaged in positive change behaviors ## Suicide Risk Management Plan - A Suicide Risk Management Plan IS: – Feedback: immediate and frequent Reinforcement of positive behaviors or neutral behaviors that replace harmful behaviors - Collaboration: between psychology, custody, other departments, and executive staff - Targeted: self-harm behaviors and other behaviors that place the inmate in danger (cutting, cell fires, etc.) ## Creating a ## Suicide Risk Management Plan Psychology Services identifies key issues through observation of the inmate and input from staff: - High risk behaviors -Elements of the environment that perpetuate dangerous behavior Reinforcers that may be used to reward positive behavior 6 EFTA00117559 âL¥♦!!❤â 10/10/2018 ## Creating a ## Suicide Risk Management Plan - These are combined into a brief, individualized plan that indicates: – Management strategies - When reinforcers will be provided - What harmful behaviors will trigger more intensive risk management strategies ## Enacting a ## Suicide Risk Management Plan - Present the plan to the inmate; this is usually done collaboratively by the Captain and Chief Psychologist - Be prepared: Behaviors usually get worse before they get better - All staff need to adhere to the plan - Discuss concerns and issues along the way to ensure staff members are being consistent ## Behavior Disordered Inmates • Place PDS Photo Here - Inmate's Name & Location - List Risk Factors & Warning Signs Specific to the Inmate - Discuss Helpful Interventions: Especially Preventative Interventions 7 EFTA00117560 10/10/2018 ## Mentally Ill Inmates - Approximately 30 to 60% of BOP suicides are completed by mentally ill inmates - Disorders most frequently include Depression, Bipolar Disorder, and Schizophrenia - Symptoms may include psychosis, poor hygiene, lack of energy, poor appetite, insomnia, agitation, and lack of interest in things that were once of interest ## Mentally Ill Inmates - Monitor these inmates closely; look for changes in mood and behavior and report them to Psychology - Build positive rapport with these inmates to assist them with problem solving and meeting their needs - During shake downs, ensure medications are not being hoarded and property has not been modified to allow self-harm ## Mentally Ill Inmates • Place PDS Photo Here - Inmate's Name & Location - List Risk Factors & Warning Signs Specific to the Inmate - Discuss Helpful Interventions: Especially Preventative Interventions 8 EFTA00117561 ♭♭♭◎♭♭8♫ 10/10/2018 ## Sex Offenders and Protective Custody - Both of these groups are at heightened risk for suicide - - Both groups may be fearful of other inmates - Both groups may be experiencing shame - Double-cell all inmates whenever possible - Convey requests to speak to Psychology immediately - Place in higher visibility cells ## Emergency Response - Always initiate life saving measures - Ensure the response reflects the emergent nature of the situation - All staff should carry personal protective gear ___ ## Lesson Learned ## From Local Mock Drills 9 EFTA00117562 ±♡♥⊙♥!!♥7ü▲¶‡©ú§♥♥!!♥4a▲¶‡√ú§♥♥ä:♥3ä▲¶‡©ú§♥●ä<♥1a▲¶‡©ú§♥●ä>♥0ç▲§ 10/10/2018 ## Psychology Advisory List • The Advisory List - identifies inmates with mental health conditions who may become dangerous, self-destructive, or suicidal when placed into the SHU. ## PSY Alert - PSY Alert is an enhanced tracking and monitoring system to ensure: - Special psychological needs are reviewed and considered by Psychology Services - Safety and security concerns are highlighted for non-psychology staff ## Phone a Friend - You are required to refer an inmate to Psychology Services if you observe behaviors that indicate she or he may be at risk for suicide - Call to collaborate in managing high risk inmates - Call to discuss small problems before they get big 10 EFTA00117563 ## Review of Objectives - Understand suicide risk associated with locked units and single cells - Identify high risk groups - mentally ill inmates - behavior disordered inmates - sex offender and protective custody inmates - Discuss management strategies for specific at risk inmates in this SHU - Review emergency response procedures ## QUESTIONS? 11 EFTA00117564