Suicide is the number one cause of death not related to physical illness among individuals who are incarcerated in state and federal prisons. The rate of suicide is approximately twice as high in jails as in prisons. Correctional facilities have long recognized this risk and taken steps to address it. Still, suicide prevention is also critical for individuals who have been released from custody, which is a reality less extensively studied.
Multiple Risk Factors
Suicide is one of only three causes of death marked by a rate higher among adults who are incarcerated than among adults who are not involved with the criminal justice system. The nature of incarceration itself has been identified as a risk factor. For example, single-cell occupancy and lack of social visits are both associated with increased suicide risk. Isolation, even when warranted by safety concerns, can lead to suicidal ideations and behaviors.
Suicidal ideation during custody is the strongest of several clinical risk factors associated with suicide. Others include a previous suicide attempt, current psychiatric diagnosis, and alcohol misuse. Both institutional and clinical risk factors for suicide are considered dynamic, meaning they may change with appropriate interventions.
Certain characteristics, such as demographics, can be useful in tailoring suicide prevention strategies. Of note, two-thirds of adults in custody who died by suicide were between the ages of 25 and 44.
Additionally, alcohol use disorder and opioid use disorder are strongly associated with suicidal behavior. Withdrawal from certain substances is also associated with suicidal ideation, which can evolve rapidly during the withdrawal process.
Programming Within Corrections
Reflecting an “understanding of suicide as a multifaceted phenomenon,” authors of a meta-analysis of programs for preventing suicide in correctional facilities found that “multicomponent programs seem to be most effective in reducing suicide deaths.” Researchers suggest including evidence-based practices for the following:
- Screening individuals who are incarcerated (Figure 1)
- Training staff in CPR and crisis intervention
- Supervising individuals who are incarcerated and at risk for suicide
- Fostering communication between staff and incarcerated individuals
- Conducting post-suicide administrative reviews
- Debriefing staff
- Improving clinical procedures
- Ameliorating processes for suicide review
- Restricting access to lethal means
- Providing mental health treatment and support to individuals in custody
| Screening Tool Example |
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| The Columbia Suicide Severity Rating Scale (C-SSRS) comprises six “yes” or “no” plain-language questions. Responses to the questions determine next steps, such as additional assessment. Research demonstrates the effectiveness of C-SSRS for corrections populations. |
| For more information on screening and assessment instruments for suicide risk, see Screening and Assessment of Co-Occurring Disorders in the Justice System. |
Figure 1
To help corrections administrators establish relevant policy and procedures, national standards are available, such as those issued by the National Commission on Correctional Health Care.
The Bureau of Justice Assistance-funded policy brief Preventing Suicides of Incarcerated Individuals with Substance Use Disorders provides action steps for incorporating withdrawal management and substance use disorder treatment into jail and prison suicide prevention programming. The first of these steps is immediate screening for substance use disorder and state of intoxication upon entering jail and prison. Those who screen positive are considered at risk for suicide, regardless of the results of standard suicide risk assessments.
The Missing Piece
In the controlled setting of correctional facilities, properly conducted, comprehensive programming and behavioral health supports help maintain the safety of individuals. However, risk factors for suicide do not abate on the day of release.
- A study of incidents of suicides following jail release found rates higher for individuals who had returned to the community from jail than for those in jail custody.
- Among individuals in Washington who were previously in prison custody, the rate of suicide is nearly two times higher than that of the general public. Subsequent periods of incarceration increased this rate.
- Suicide rates among individuals released from North Carolina prisons were also approximately twice as high as the general public, even 3 years after release.
Individuals reentering the community face challenges related to relationships, housing, employment, and health care, all of which can lead to feelings of hopelessness. Severed ties with family and friends, for example, may result in feelings of isolation, previously discussed as a risk factor for suicide. Disproportionate rates of suicide among individuals who are homeless are well established, as are connections between economic hardship and suicide. Having no access to health insurance or appropriate supportive care may prevent individuals from managing mental and substance use disorders, thereby endangering their wellness and inhibiting their ability to avoid recidivism.
Increasing awareness of suicidal ideation and behaviors among individuals both in custody and post-release is the first step in saving lives. All correctional staff (i.e., frontline, leadership, treatment, and operations) must be trained to recognize the signs of suicidal ideation and resources for addressing it. Moreover, probation and parole officers, who work with individuals outside of the highly structured environment of correctional facilities, may benefit from using strategies such as Motivational Interviewing to discuss suicidal ideation with the individuals they serve.
Solutions for post-release crises, however, cannot fall exclusively on either jails and prisons or community corrections; community health, social services, and justice systems must collaborate for system-wide and lasting change that keeps people safe and out of custody. For consultation, training, and resources on suicide prevention, visit the Suicide Prevention Resource Center.