$$\frac{v_{2}}{v_{1}}$$ # Special Housing Unit Management Suicide Prevention SONY_00008554 EFTA00126016 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 5DNY_000001555 EFTA00126017 - Discuss management strategies for specific at risk inmates in this SHU - Review emergency response procedures SONY 95500000BBS EFTA00126018 SDNY_00008557 EFTA00126019 ## 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 SDNY 00008558 EFTA00126020 EFTA00126021 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 rescue opportunity SDNY_00008560 EFTA00126022 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 SDNY_000008561 EFTA00126023 ## High Risk Inmates Discuss local policies to ensure specific inmates are not single celled. These may include: - Special notation on Hot List - Special notation on cell door - Special notation on SHU boar - Other SDNY_00008562 EFTA00126024 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 SDNY_00008563 EFTA00126025 Good SHU Management is Good Suicide Prevention - Staff should wait for assistance prior to entering a SHU cell - 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 EFTA00126026 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! SDNY_000081565 EFTA00126027 - Don't allow negative perceptions or frustrations to impact your professional judgment - Manage through collaboration between departments 99580000_YNDS EFTA00126028 Working with Behavior Disordered Inmates - Manage with positive reinforcement - Catch them being good - Praise progress, not perfection - Address reasonable requests promptly - If a Suicide Risk Management Plan is in effect, follow it exactly 5DNY_000008567 EFTA00126029 - The Plan we will discuss today is not the same as the plan used by the institution when an inmate is in restraints - A Suicide Risk Management Plan is also NOT: - Punishment - Stricter rules - Extreme deprivation - Social isolation - Less work for staff SDNY_00008568 EFTA00126030 ## 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 $DNY_00000B569 EFTA00126031 - A Suicide Risk Management Plan IS: - Feedback: immediate and frequent - Reinforcement: of positive behaviors or neutral behaviors that replace harmful 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.) SONY_00008570 EFTA00126032 Creating a Suicide Risk Management Plan Psychology Services identifies key issues through observation of the inmate and input from staff: from staff: High risk behaviors - Elements of the environment that perpetuate dangerous behavior positive behavior -Reinforcers that may be used to reward SOD5YNN_00000571 EFTA00126033 - 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 SDNY_000008572 EFTA00126034 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 SONY_000008573 EFTA00126035 - Place PDS Photo Here Inmate's Name & Location List Risk Factors & Warning Signs Specific to the Inmate - Discuss Helpful Interventions: Especially Preventative Interventions 5DNY_000008574 EFTA00126036 Mentally III 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 SDNY_00008575 EFTA00126037 ## 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 SONY_00008576 EFTA00126038 - Place PDS Photo Here • Inmate’s Name & List Risk Factors & Warning Signs Specific to the Inmate - Discuss Helpful Interventions: Especially Preventative Interventions SDNY_000008577 EFTA00126039 ## 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 - Convey requests to speak to Psychology - Place in higher visibility cells SONY_00008578 EFTA00126040 ## Emergency Response - Always initiate life saving measures - Ensure the response reflects the emergent nature of the situation - All staff should carry personal protective ## gear EFTA00126041 SONY_000008580