Behavioral Healthcare Service Orientation Suicide Prevention/ Detection/Intervention CDR Grady MC,...

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Transcript of Behavioral Healthcare Service Orientation Suicide Prevention/ Detection/Intervention CDR Grady MC,...

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  • Behavioral Healthcare Service Orientation Suicide Prevention/ Detection/Intervention CDR Grady MC, USN Psychiatrist
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  • OPSEC Slides are unclassified All talks are CONFIDENTIAL
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  • Some U.S. Jail and Prison Statistics on Suicide 1989 jail survey: 1.07 per 1000 detainees, approximately 9-10 times the general population; has improved immensely over past 10 years with prevention most common method: hanging time: at night setting: segregation cell associated with: a setback
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  • Differences between Jails and Prisons Jails Point of initial incarceration following arrest Predominantly pre-trial detention, outcome/sentence is unknown Prisons Post-trial detention, sentence is known Mental Health issues usually identified and addressed
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  • Some U.S. Jail and Prison Mental Health Statistics Prevalence of severe mental illness: 6- 13% 1st psychotic breaks: 4% Self mutilation: 2-8% Prisoners referred for forensic eval: 33% feigning illness, most common is psychosis
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  • Suicide Risk Factor Categories Environmental Internal External
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  • Suicide Risk Factors Environmental Authoritarian Environment No Apparent Control Over the Future Isolation and Fears Shame of Incarceration Dehumanizing Aspects of Incarceration Insensitivity and Negative Attitudes of Staff
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  • Suicide Risk Factors Internal Current mental illness, especially depression Recent suicide attempts or suicidal ideation Impulsivity Prior suicide attempts or suicidal ideation History of mental illness, especially a hospitalization History of substance abuse Previously imprisoned Involvement in same sex rape Severe guilt or shame over the crime
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  • Suicide Risk Factors External First time detention Loss of family support Negative response by loved ones - letters History of suicide in the family Long sentences under adverse conditions Recent loss of stabilizing forces
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  • Factors that can Influence the Suicide Rate Idleness Boredom Inadequate monitoring Harsh emotional and physical conditions
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  • Suicide Profiles First incarceration Accused of heinous crime Past or current mental illness History of drug/alcohol abuse Significant behavioral or mood changes Unusual agitation High anxiety Prior suicide attempts or self injurious behavior Threats of suicide
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  • Signs of Suicidal Risk Looks Sad or Depressed Not Sleeping Withdrawn Period of Calm After Agitation Not Eating Suddenly Improves Unusually Agitated Looks Tired Refuses Treatment Draw Pictures with Sad or Death Themes Talks Like He is About to Get Out of the Camp Has Increasing Difficulty Relating to others Has No Sense of the Future Talking to Himself Looking Around As If Seeing or Hearing Something Noticeable Mood and/or Behavioral Changes Cutting or Burning Scars
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  • Symptoms of Suicidal Risks Feel Hopeless or Helpless Feel Worthless Paranoid Hallucinations or Delusions Command Hallucinations Threatens Suicide Reports Suicidal Thoughts Reports Depression Guilt/Shame Preoccupation About His Fate Reports History of Mental Health Treatment
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  • Times of Greatest Suicide Risks Within 24 Hours After Arrival Following a Set Back or Receipt of Bad News Just Prior to or During a Commission Immediately After Sentencing After Extended Detention Anniversary or Meaningful Dates When observation is Reduced: During Prayers While Performing Other Duties Such as Meals, Showers, Transports, IRFs Timing Between Scheduled Checks
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  • Detainees
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  • Suicide Intervention: Hanging/Asphyxiation Damage may occur to the Airway Spinal Cord Blood vessels Get the detainee down as quickly as possible protecting the head and neck Have another guard call DOC and request medical to respond to a Traumatic Medical Emergency Keep the head and neck stable Use the modified jaw lift method to maintain an open airway Do not leave the detainee alone
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  • Prisoner swallows rag to commit suicide 1July02 A prisoner in Japan committed suicide by swallowing a rag. The man had been under regular security checks in case he tried to take his own life. Prison staff claim they never expected him to use the standard-issue rag and say it has never happened before.
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  • Suicide Intervention: Cutting and Head Banging Respond to each cutting/head banging behavior even when it is a detainee who displays this frequently If a quart or more of blood is lost a person could go into shock. Death from bleeding can occur quickly. Direct Pressure to Extremity Wound Have another guard call DOC and request medical assistance Do not leave the detainee alone
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  • Suicide Prevention Summary Understand the role of human interaction and interpersonal communication Learn about Mental Health Disorders especially: Depression Psychosis Learn the signs and symptoms of suicide Respond to each suicidal threat from the detainee or his neighbors Dont be afraid to ask about plans of self-harm Make appropriate referral to Behavioral Healthcare Be familiar with times of increased suicide risk Know how to respond to hanging/cutting incidents