Deal with jail suicide attempts

I am writing in response to the recent report of the suicide attempt in the Washington County Jail. It is important that the community and the correctional system have complete and accurate information about suicide and the issues related to mental illness and suicide risk in correctional facilities.

During the past year NAMI Maine (formerly The Alliance for the Mentally Ill of Maine) has provided training to correctional staff from seven of Maine’s 15 jails and to officers from the state prison system. Washington County is by no means alone in its struggle to prevent suicides in jail. Every local jail in Maine has its own stories of serious suicide attempts and completed suicides. It is repeatedly a grim and unfortunate duty of corrections offices to intervene with inmates following a suicide attempt.

Suicidal behavior in the criminal justice system is not a rare event. Nor is its prevalence a failure of any particular correctional facility. Suicide is currently the second leading cause of death in correctional facilities around the nation. It is the eighth leading cause of death nationwide. There are many factors that play into this statistic. These factors include, but are not limited to, the over representation of individuals with mental illness in the criminal justice system, the limited resources correctional facilities have to identify and treat people with mental illness and the inherent stress of being incarcerated.

There is a lot known about suicide in our culture and the suicides of individuals in corrections settings. We know that in 80 percent of all completed suicides the person did something to attempt to communicate their intent to die. This may have been a direct verbal statement or behaviors that have been closely linked with preparing to commit suicide. In corrections settings the initial 48 hours a person is incarcerated are an especially high-risk period. More than 50 percent of corrections suicides occur during this period. This is due to the acute stress of finding oneself incarcerated combined with the likelihood that alcohol or drugs may still be in the system of the inmate.

Other significant factors that come into play in suicide in jails and prisons include individuals arrested for the first time, those accused of especially heinous crimes and those who have recently been sentenced are at especially high risk. When an inmate presents with risk signs, correctional facilities need to be able to respond swiftly with skilled clinical staff to prevent suicide.

The largest risk factor for suicide in any setting is a diagnosis of mental illness. The over representation of individuals with mental illness places a significant burden on the criminal justice system and their duty to prevent suicide. Currently 3 percent to 5 percent of the general population has severe and persistent mental illness. Around the country 16 percent of corrections populations have severe and persistent mental illness. In Maine, estimates range from 20 percent to 35 percent.

The reality is that people with mental illness do commit crimes and are usually legally responsible for their actions. According to the Bazelon Center on Mental Health Law an individual with mental illness is 64 percent more likely to be arrested for an offense than a person who does not have mental illness who commits the same crime. Often this happens because police officers know the person needs help, but do not have access to appropriate resources to assist the individual.

The public system that has been put in place to support people with serious mental illness in the community and help them stay out of institutions is inadequate. Correctional facilities are now the safety net for this population. While Maine has made a significant investment in the community mental health system over the past 10 years, it is still insufficient and jails are paying the price. The Criminal Justice Committee of the Maine Legislature is putting a lot of effort into examining the best practices in diverting individuals with mental illness from the criminal justice system, both before and after they find themselves in jail. We know from other communities around the country what is effective in keeping people with mental illness out of the criminal justice system and helping them to get out and stay out of the system once they find themselves there.

The Crisis Intervention Team (CIT) model developed in Memphis is an excellent example of the best practices that can be implemented in Maine’s cities to help reduce the criminalization of the mentally ill. The Portland Police are involved in a collaborative effort with consumers of mental health services, family members and local mental health providers to implement this effective program. CIT is a model for police intervention with people who are mentally ill. It has been shown in Memphis and other parts of the country that CIT programs reduce the arrest rates of people with mental illness. Individuals that come to the attention of law enforcement who have a mental illness are more likely to be redirected to mental health resources. They are less likely to enter into the criminal justice system, and they are less likely to repeatedly use crisis mental health services. A program that diverts people from ever entering the system is ideal in reducing the burden on correctional facilities in preventing suicide.

For individuals who find themselves already in the criminal justice system the options are currently limited in Maine and across the United States. Even when a person has been identified as in need to mental health services the availability of treatment is limited. There are laws and systems in place that severely limit a persons access to psychiatric medications he or she have found helpful in the past. Despite the large number of people with mental illness in the corrections system, most jails in Maine do not have access to a psychiatrist who provides mental health evaluations and treatment. A recent survey of local jails in Maine found that in 50 percent of situations where an inmate needed hospital care for a psychiatric crisis no bed could be found. This obviously puts a huge burden on corrections staff that are untrained in mental health crisis intervention. The recidivism rate for people who have a mental illness is significantly higher than other corrections populations. This is due to the fact that people with mental illness are often discharged in worse condition than when they were incarcerated.

There is currently a bill before the Judicial Committee of the Maine State Legislature to study the feasibility of a Mental Health court in Maine and a pending federal appropriation of four million dollars to fund these programs. Lawmakers should give serious consideration to creating an opportunity for individuals with mental illness to successfully get out and stay out of the criminal justice system.

We should be shocked and dismayed when we hear about a serious suicide attempt in a local jail in Maine and we should do something about it. Failure to address this issue means more unfortunate and preventable deaths.

Melissa Gattine, MA, LCPC is the information and research coordinator for NAMI Maine.