July 4 juillet 16:00 – 17:45
Room CMEL-102
Chair:
Stefan Frühwald
, University Hospital
of Psychiatry, Vienna
Discussants: Julio Arboleda-Flórez
, Queen’s
University
Brian
Mishara
,
Université du Québec
à Montréal
Offender populations have consistently been noted to be at high risk for suicidal behavior. Prevalence is high, as defined by prior histories (prior attempts) and incidents while incarcerated (attempts and completions). These are mental health and security concerns. To date, much of the empirical research has been retrospective in design and focussed on the identification of static predictors. The present study comprised an exploratory examination of the association between static and dynamic factors and suicidal behavior of offenders. Information was systematically retrieved at admission and proximal to the incident. Characteristics assessed included the lethality and intent of the act, mitigating factors and suspected precipitants, social competence, psychiatric and behavior problems, cognitive functioning, social support and substance abuse both, at admission and proximal to the suicidal behavior. These factors were investigated for 96 male federal offenders who had either attempted (n=48) or committed suicide (n=48). A matched (age, type of offense) comparison group of offenders (n=48) was also included. Key findings from this research are discussed with attention to differentiation of (1) Suicidal and Non-suicidal offenders; and (2) Completers and Attempters. Finally, the findings will be discussed in terms of theory and directions for future research.
The assessment and estimation of suicidal risk constitute a serious and difficult task for any mental health professional. If we add to this the challenges that may be presented by a specific population at higher risk, the task appears even more complicated. Since the beginning of the nineties a research group investigated the phenomenon of prison and jail suicide in Austria. In a case control study all suicides in all Austrian jails and prisons between 1975 and 1999 were investigated: all records of all suicides (n=250) were evaluated, plus records of the controls (n=500). The Viennese Instrument for Suicidality in Correctional Institutions presented here is based on the results of this case-control study and on research on literature examining suicide prevention in general and prison population in particular. As suicide rates in custody are higher than in the general population, and there is evidence, that these rates are increasing within the last 20 years, the screening of offenders newly admitted to prison for their propensity to suicide are necessary to understand this phenomenon, to give a valid estimation of the suicide risk and hopefully to stop further increase of suicide rates in jails and prisons.
That prisoners are more likely to kill themselves than
persons not held in confinement has been noted since the earliest 19th
century students of suicide began utilizing and theorizing from official
statistics. Well before Durkheim, observers of the phenomenon ascribed this
increased suicide mortality and morbidity in prisons to both the special
characteristics of places of confinement and to distinct characteristics of the
persons put there. To explain the elevated rates of prisoner
suicides and suicide attempts, some contemporary researchers have grouped
the causes into two similarly inspired broad categories, and they have borrowed
these categories from standard criminological texts on prisons: importation
variables and deprivation variables. This paper briefly reviews the intellectual
purchase of these transplanted categories for explaining the persistent problem
of suicidal behaviors in jails and prisons. The paper argues that
notwithstanding other virtues, standard criminological categories fail to
capture what is uniquely suicidogenic in the correctional idea and correctional
practice.
Accounting for nearly half of all deaths in penal
institutions, suicide is the primary cause of death among prisoners. However, it
is not easy to distinguish suicidal inmates from non-suicidal inmates. Many
inmates are possess traits that in a normal population would be indicative of an
increased suicide risk, including substance addiction, a psychiatric history and
a history of broken relations. Therefore, it was necessary to examine the
characteristics that distinguish inmates with a high suicide risk from ‘normal’ inmates.
This was done in a research project that consisted of a records study that
focused on the
characteristics, conditions of death and possible identifying signs occurring
prior to death of the 95 suicides that had been committed in detention centers,
prisons and TBS-institutions in the period 1987-1997. The research project also
consisted of interviewing 221 randomly selected non-suicidal inmates from the
regular population of inmates in all Dutch penal institutions. Comparison of the
characteristics of these two groups showed that it was possible to construct a
good screening device for suicide risk (consisting of eight questions). At a
demarcation value of 24 points, around 18% of all inmates and as many as 95% of
the suicide victims were placed in the high-risk of suicide group. The
presentation addresses the method of the study, risk factors for suicide and the
constructed screening instrument.
In 1994, the Scottish Prison Service (SPS), concerned at the rise in suicides in prison, commissioned a series of research studies that included, (a) a retrospective analysis of all suicides between 1976 and 1993; (b) an analysis, over a 12-month period, of 2841 inmates identified as at risk of suicidal behavior; and (c) and an assessment of the views of 200 inmates and 100 staff regarding the suicide prevention strategy as it then operated. On the basis of findings from the above, three main themes emerged that required attention. In particular: (a) Identification procedures regarding at risk inmates; (b) Communication procedures between staff regarding those inmates identified as at risk; and (c) the Care regime provided to those identified as at risk. In reply to these issues, the SPS introduced, in 1998, a revised suicide prevention strategy entitled Act to Care. The impact of this revised strategy is currently being assessed with regard to the number of prison suicides, number of inmates identified as at risk and the quality of care received. The proposed paper will provide a historical perspective in reviewing the impact of research on clinical practice and provide an update of the impact of the revised suicide prevention strategy Act to Care.
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