BJOC 2.6 - Abnormal Behavior and Suicide Prevention

Terminal Performance Objective (TPO):

BJOC 2.6 - Abnormal Behavior and Suicide Prevention

Enabling Objectives (EO’s):

As a result of this instruction, the student will be able to:

2.6.1        Describe the legal rights inmates have to receive basic mental health care.

2.6.2        State the responsibilities of the jail officer in responding to inmates (1) exhibiting abnormal behavior, (2) are disturbed or violent, or (3) are experiencing substance abuse withdrawal.

2.6.3        Describe the symptoms of a person with Schizophrenia, Depression, and Bipolar Disorder.

2.6.4        Identify characteristics of substance abuse withdrawal.

2.6.5        Describe the characteristics of a potential suicide situation.

2.6.6        List steps taken by jail staff in attempts to prevent a suicide.

2.6.7        List the steps taken by jail staff in response to a suicide attempt.

2.6.8        Identify the benefits of ethical, and the consequences of unethical, decision making and behavior as related to abnormal behavior and suicide prevention.

 In the late 1950s and early 1960s with the development of mental health medications, elected officials and mental health professionals felt that long term mental health consumers, who for years had been housed in large psychiatric facilities like Georgia’s Central State Hospital, could be moved back to their communities and receive services through community based services.  Although the idea was well intended, funding and management never met the needs of the consumers.  Consumers did and still, often become homeless, with little or no access to any mental health care.  Many due to their illness become involved with the criminal justice system, with jails becoming the major treatment provider by default.

In 1976 the U.S. Supreme Court ruled in the case Estelle vs. Gamble an inmate has the right to basic health care while incarcerated. 

Name 3 symptoms a person with schizophrenia may experience.

§  Delusions – Delusions are false beliefs strongly held in spite of invalidating evidence, especially as a symptom of mental illness.  For example:

§  Paranoid delusions believe that people are “out to get” you.

§  Somatic delusions believe that one has a terrible physical illness.

§  Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities.

§  Hallucinations - Hallucinations can take a number of different forms such as:

§  Visual  {seeing things that are not there}

§  Auditory {hearing voices that other people can’t}

§  Tactile {feeling things or something touching your skin that isn’t there}

§  Olfactory {smelling things that other people cannot smell}

§  Gustatory experiences {tasting things that aren’t there}

§  Social isolation – This person spends most of the day alone.

§  Disorganized speech – There is no order to speech pattern.

§  Disorganized thoughts – Thoughts have no organized pattern.

§  Flat affect – This person has little or no emotion or facial expression.

Name the 5 types of hallucinations a person with schizophrenia may experience.

§  Visual  {seeing things that are not there}

§  Auditory {hearing voices that other people can’t}

§  Tactile {feeling things or something touching your skin that isn’t there}

§  Olfactory {smelling things that other people cannot smell}

§  Gustatory experiences {tasting things that aren’t there}

Name 3 symptoms of depression.

§  Constant sadness

§  Irritability

§  Hopelessness

§  Trouble sleeping

§  Low energy or fatigue

§  Feeling worthless or guilty for no reason

§  Significant weight change

§  Difficulty concentrating

§  Loss of interest in favorite activities

§  Thoughts of suicide or self injury.

When identifying an inmate in a suicidal crisis the jail professional should immediately secure the area and advise medical personnel and their supervisor.  If the inmate has already made the suicide attempt, call for backup, survey the situation for security, provide CPR and any required first aid as needed.  The officer should also attempt to preserve, as much as possible, any evidence that will be used in the ensuing investigation.  Furthermore, the officer should document all actions following the end of the situation.

This bipolar disorder consists of time limited episodes of depression, mania, and normal mood.  Mood changes may occur over a few days or be more widely spread.

 1) Difficult to communicate, 2) understand directions, 3) follow rules, 4) remember, and 5) be self sufficient without support.

List 3 symptoms of alcohol withdrawal (2.6.6)

§  Feeling of jumpiness or nervousness

§  Feeling of shakiness

§  Anxiety

§  Irritability or easily excited

§  Emotional volatility, rapid emotional changes

§  Depression

§  Fatigue

§  Difficulty thinking clearly

§  Bad dreams

List 2 reasons inmates are at risk for suicide in a jail setting.

·        Recent excessive drug or alcohol use

·        Recent loss of stabilizing resources (loss of job, loss of family support)

·        Severe guilt or shame over the offense

·        Fear of same sex rape

·        Mental illness

·        Poor physical health or terminal illness

·        First arrest

List 2 risk factors that could lead to suicidal behavior.

·        Recent excessive drug or alcohol use

·        Recent loss of stabilizing resources (loss of job, loss of family support)

·        Severe guilt or shame over the offense

·        Fear of same sex rape

·        Mental illness

·        Poor physical health or terminal illness

·        First arrest

List 2 high risk time periods for suicide.

·        First 24 hrs of incarceration

·        Intoxication / Withdrawal

·        After receiving a lengthy sentence

·        Impending release

·        Times when staffing is lowest

·        Weekends and holidays

·        Receiving bad news from home

List 5 guidelines for handling disturbed or violent inmates.

§  Try to calm the inmate through communication.  Talk to the inmate and encourage him/her to talk to you.

§  Use open-ended questions to get the inmate to express his feelings.  Remember, the more he can express with words, the less he has to express through behavior.

§  Avoid “why” questions.  They can lead to defensiveness.

§  As the inmate shows signs of willingness to comply, ask closed-ended questions to obtain commitment like, “Will you go back to your cell?”

§  Don’t argue, use sarcasm, or speak more loudly than necessary.

§  Always be honest with the inmate, even about the negative consequences of their behavior.

§  If the inmate complies and goes into restraints, do not be unnecessarily rough while applying the restraints.

Attempt to establish meaningful communication with suicidal inmates. How can you accomplish this?

·        Trust your judgment – if you believe an inmate is in danger of suicide, act on it.

·        Listen patiently – encourage suicidal inmates to talk and express feelings.

·        Maintain contact through verbalization, eye contact, and body language.

·        Emphasize a positive future.

·        Stay with the suicidal inmate. If you believe he is a danger to himself, stay until assistance arrives. 

·        Take all threats seriously and make immediate referrals.  It is not your responsibility to interpret sincerity of a suicide threat.

·        Don’t offer solutions or give advice.  You are not a social worker.

·        Don’t become angry or threatening to the inmate.

·        Don’t be sarcastic or make jokes about the situation.

·        Don’t challenge the inmate to make good on his threat.  Don’t tell him to “go ahead and do it.”

If the inmate has already made the suicide attempt, call for backup, survey the situation for security, provide CPR and any required first aid as needed.  The officer should also attempt to preserve, as much as possible, any evidence that will be used in the ensuing investigation.  Furthermore, the officer should document all actions following the end of the situation.

  Inmates with diminished mental capacity, whether due to mental illness, mental retardation, or substance use, present unique opportunities for abuse.  Three types are: 1) Physical abuse, 2) Withholding Treatment, 3) Sexual Abuse.