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Window on Correctional Practice: Suicide Intervention Drills
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Window on Correctional PracticeYou work in a jail. You probably assess risks every day. Hopefully you are doing fire drills at least quarterly in all facility areas. And yet, when you assess the risk, you might feel you have a higher risk of attempted or completed suicides, particularly with pretrial detainees, than with a significant fire occurring. Are you conducting suicide intervention drills? Have you thought about starting them?

A Short Story

I was helping a small jail once. Two staff on duty at night, one in a control area and one “roving”. The rover went into cell block 9 and found an inmate hanging.  He yelled “help, help” (mistake #1) and supported the inmate. Then the control area officer came running in with a fire extinguisher (mistake #2).  He immediately realized his error, threw it down, and ran back to control. He pulled open the drawer where the cut down tool was stored and pushed the cut down tool out of the way so he could look for the cut down tool (mistake #3). Obviously, he couldn't find it. Meanwhile, the roving staff managed to get the inmate down by literally tearing the sheet. 

The next day, the cut down tool was housed in control in a specially labeled box on the wall with a distinct red border around it (like most emergency equipment should be – distinctly housed and marked) and the administrator began designing a series of drills to practice interventions for various forms of suicide attempts.

The Problem

By their very nature, emergencies are unnatural and exceptional situations. Without some form of preparation, training, and forethought, people will tend to act unnaturally in an unnatural situation. By conducting training and performing realistic drills, the goal is to have staff perform as efficiently and effectively as possible given the unnatural situation. Part of the solution is training, but experiential drills, where staff get to practice the actual behaviors required, start to reduce the chances of errors, mistakes, and stress reactions. Hopefully, unexpected behavior by staff is constrained.

Thinking about the Drills

Design the drills just like you do with fire drills. Create drill scenarios that cover the major forms of suicide attempts: hanging, cutting, medications, etc. Use your mental health provider as a resource for ideas.  When you conduct the drills, make sure staff fulfill their roles to completion not just a simulation. If you want them to be able to cut down an inmate, you need to cut down something (obviously not an inmate) during the drill. If you expect medical services to arrive, they need to be part of the drill. If you expect mental health services as follow up, then plan that into the drill as well.

Once you have conducted a few “normal” suicide intervention drills, start to build problem-solving into the drill scenarios. Present staff with unexpected issues that they need to overcome: get them to start thinking while they are drilling. That will help when actual suicide attempts occur. Since there is probably no such thing as a “normal” suicide attempt, there probably should not be “normal” suicide drills after the first few.

Make sure you document the drills, and always do a debriefing with some form of report. Make sure staff are able to articulate what they have learned and what they would do differently. Get recommendations for changes in policy, procedure, and practice around suicide intervention. Video the drills if you can; you will see amazing things you probably missed by simply watching the drill, and these become valuable training tools.

Remember: Drills are only part of your Suicide Plan

Just like you have your fire prevention plan, drills are only one part of your suicide prevention/intervention plan. Good screening and identification, responsive mental health services and counseling, special supervision, and leadership by supporting a “zero tolerance” atmosphere around no successful suicides while in custody are all critical.  Make sure you collaborate with your mental health provider in your suicide prevention/intervention plan, and have a qualified mental health professional sign off on it. Given the high liability around suicides in custody, documentation (leaving “clear written footprints”) concerning your efforts are critical.

Some General Resources

National Study of Jail Suicide: 20 Years Later

National Study of Jail Suicides:  Seven Years Later

Basics and Beyond: Suicide Prevention in Jails

Prison Suicide:  An Overview and Guide to Prevention

Juvenile Suicide in Confinement:  A National Survey

Suicide Prevention in Juvenile Correction and Detention Facilities

Suicide Prevention in Custody (National Center for Institutions and  Alternatives)

Suicide Prevention in Custody Publications (NCIA)

As Always, NIC as a Resource

National Institute of Corrections

NIC Help Desk/Ask NIC

Posted Wed, Jul 17 2013 2:00 PM by Anonymous


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This blog is funded by a contract from the National Institute of Corrections, U.S. Department of Justice. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice.