Suicide is the leading cause of death in jails, with the suicide rate in jails from 9 to 14 times that of the general population. In contrast, suicide rates in prisons are only twice that of the general population which presumably relates to better screening of inmates and availability of services within these facilities.

Factors known to be associated with the high risk of suicide in jails include alcohol and drug intoxication with some studies showing that more than 60 percent of inmates were under the influence of drugs or alcohol when admitted to jail. A second factor is the high incidence of mental illness, often untreated, in this population.

There is much that can be done to address the problem of jail suicides, which seem to becoming endemic in Maine. First, staff needs to be aware that they are dealing with a high-risk population and be alert to signs of depression, suicidality or other signs of mental illness. This requires ongoing training of jail staff including all shifts and training them as to when a mental health consultation is indicated. All jails should have ready access to mental health consultation from crisis workers and psychiatrists. In addition, staffs need to have clear policies on monitoring and observing inmates and communicating their concerns with one another.

At another level, cells need to be updated so that they do not have projections from which sheets or articles of clothing can be attached for hanging. For instance, clothing hooks in the new Maine State Prison automatically release when a certain amount of weight is applied to them. Jails might also look into the feasibility of disposable paper sheets that would not support the weight of a hanging body.

We are dealing with a preventable problem. The Department of Corrections needs to take prompt action to provide better services to this high-risk population.

Diane H. Schetky, M.D.

Rockport