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I remember a fellow, slender of build and young in years, who was new to the chaos of prison life. I watched him from a distance for I knew that he was at a perilous moment in his life. Transitioning from the free world to this world of concrete and iron is akin to skydiving without instruction. You find the rip cord and survive or you plummet to the earth.

As the weeks wore on I watched him blindly fumble about. Predators circled like prey and plans were hatched by men who saw him as a means to an end. Just another extortion. I wanted to intervene, to pull him from the path of fate, but the code of prison life prohibited this. That was 25 years ago, and it’s a decision I regret.

One morning he stripped the sheet from his bunk, hooked it through the high vent of the cell, looped it around his neck and stepped off of the stainless steel sink. They found his dangling lifeless body during midmorning count.

Ashley Smith’s post “Pain Is Universal” is a window into the trauma time inflicts on us incarcerated. Suicide is something we incarcerated simply don’t talk about. Each time one of our peers surrenders to this environment, there is a trauma inflicted upon all of us. Prisons nationwide are ill equipped to handle this truth.

In a recent article with Prison Journalism Project https://prisonjournalismproject.org/2023/03/03/prison-ptsd-latest-mental-health-crisis/ I discuss the trauma of incarceration and some of the traumas I have had to personally cope with. I am not unique. For us incarcerated and especially those with long sentences, the prison experience inflicts log lasting trauma. Sadly, suicide is a common outcome.

I, and others on this blog, write from the perspective of being incarcerated. These stories are our experiences and viewpoints. Oftentimes we feel that those tasked with our care and supervision fail us, that they are indifferent to our struggles. This is sometimes true. Other times not, but more to do with a system that is ill equipped to handle traumas defying simple solutions. However, discussion and awareness is the first step in bringing about these solutions.

Christopher

Response to suicidal behavior in Ohio prisons by Scott Quimby

Ashleigh’s excellent post titled “Pain is Universal” suggested that readers might be interested in how mental health services in the Ohio Department of Rehabilitation and Corrections (ODRC) as well as ODYS (Ohio Department of Youth Services) views and responds to suicidal behavior from an insider’s perspective. I am a retired clinical psychologist who spent 20 years working in Ohio adult and juvenile prisons with both males and females and can honestly say they take suicide very seriously.

Suicidal behavior in prisons is a complex issue involving a range of behaviors from verbal threats – “I want to kill myself,” to self-injurious behavior such as cutting, to hanging.  These individuals have a wide range of personality dynamics. Some but not all are on a mental health caseload and being seen by professionals such as myself.

Although prisons are often seen as dumping grounds for mentally ill individuals, in ODRC only about 18 percent of the total population is on a mental health caseload. A study of suicides in Ohio adult prisons found an average of seven suicides per year occurred between 2000 and 2013. This was about the national average.

Those exhibiting suicidal behavior do so for a variety of motivations. Those few who do kill themselves most likely are experiencing serious mental health problems such as depression, but not always. They may have engaged in serious self-injurious behavior for some reason other than to actually die but mistakenly carried it too far. Inmates exhibit various motivations for making verbal threats that were not serious, most commonly, to get away from others on their living units who were hassling them.

Ohio prisons, both adult and juvenile, have strict standards for how suicidal behavior is to be handled. The following observations involve the years 1994 – 2014. Procedures might have changed since and varied a bit among institutions.  In an attempt to prevent inmates from carrying out suicidal behavior, they were monitored as soon as the intent to do so was discovered. There were two levels of monitoring, observation and constant watch, collectively referred to as watch.  Observation was for those deemed at some risk but not seriously so. In the adult system (ODRC) an inmate placed on this status was housed in a safe cell in segregation with any means for self-harm removed. This also involved being placed in what was referred to as a suicide gown that was a one-piece garment made of material that could not be torn to strangle oneself. Those on observation were to be checked on by an officer at least every 15 minutes.

Constant watch was used for inmates who had exhibited actual self-injurious behavior or were at serious risk of doing so and was typically only used one to three days until the inmate’s monitoring status was lowered to observation. An officer was required to actually observe an inmate on constant watch at all times including when they were using the toilet and shower. In the adult system inmates placed on constant watch were housed in a safe cell in the infirmary.

Officers monitoring watch inmates were required to enter their observations on a log every 15 minutes. While typically very brief, they provided an important source of information.

Any staff person could place someone on watch without a formal assessment. All that was required to do so was that the inmate say or do something that suggested he or she was thinking about self-harm. Juveniles, particularly females, sometimes made an agreement with friends to claim they were suicidal so they could be housed together while on watch.

Many of those who had been placed on watch by staff were not actively suicidal.  There was a common belief among officers that inmates making suicide threats  and even those who engaged in self-injurious behavior, with the exception of those found hanging in their cells, were manipulative, not serious. This tended to result in the officers not being as careful in monitoring those on watch as policy called for.

Typically at my institutions I was responsible for suicide watch inmates two –  four times a week including weekends, with other psychologists handling the other days. Each morning when arriving at the institution I first visited the captain’s office where names of those on watch were posted. Typically, in all my years in both adult and juvenile institutions this varied from no one to five or six at the most. Typically, no more than a few days passed with no one on watch.  Given the ODRC total prison population of 45, 753  (2020) in its 28 different institutions, the fact that only seven inmates on average killed themselves each year speaks to the effectiveness of its suicide procedures.

For those newly placed on watch I got observations from the captain on duty as to the reason for this, if known. I would then go to my office and review anything we had in the mental health files on each. Then I visited each inmate.

As previously noted, adults on observation were housed in segregation, a kind of jail within a jail for rule violators. The rationale for this was that segregation had cells that were stripped and safer. However, it seemed to me that for those who were actually suicidal this sent a message their behavior was inappropriate. Certainly, being in this environment in a suicide gown was not therapeutic.

While any staff could place an inmate on watch, only a licensed mental health professional could authorize them to be removed. This was the most difficult of my responsibilities. Many questions had no clear answers. Was watch actually preventing them from self-harm?  To what extent if any was manipulation involved? Was watch actually exacerbating their mental health issues?  If removed, might they soon do something to get right back on? A few inmates saw their  suicidal behavior was a way to punish staff and administration by necessitating the extra paperwork involved as well as the institution having to allocate staff to watch them, sometimes involving overtime pay.

During my first year in the system a fellow psychologist at a different institution removed a youth from watch, and that very night he successfully hung himself. The psychologist was not blamed for his clinical judgement. However, this does emphasize, that these decisions were never completely cut and dried.

While I would feel safe in lowering those on constant watch to observation after a couple of days of stable behavior, removing them from watch altogether was sometimes a different story.  A manipulative inmate might tell me, “I’m still suicidal and if you take me off watch, I’ll kill myself.”  Fairly frequently I was asked to see the watches at another institution on weekends and would find inmates who had been left on watch, sometimes for weeks, by the institution professionals wanting to avoid any liability for a mistaken call.  I never received a direct order to remove even those from watch, but I certainly heard grumbling about it from staff, which I understood.

I recall an older inmate who requested several times to be transferred to another prison where his son was incarcerated but was turned down. He stabbed himself in the stomach, and, of course, was placed on constant watch in the infirmary. Believing that he no longer had the means to harm himself,  I lowered his monitoring status to observation. He then managed to tear out his stitches. Again he was bumped up to constant watch. Recognizing that he couldn’t be left on this status forever, I again lowered him to observation but left instructions with the staff to check on him every five minutes. Again he managed to tear out his stitches. The prison administration would not acquiesce to his request to be transferred. Finally, he realized his self-injurious behavior was a losing cause.

While interacting with an inmate on observation I could ask to see them in a somewhat private area, but this was always in segregation with its noise and activity.  These sessions were typically fairly brief and consisted primarily of assessing the inmate’s immediate stability and needs. Once removed from watch they were returned to their living unit. If they were not on our mental health caseload, I could schedule later sessions in my office.

A few suicidal and troubled inmates found the general isolation of a suicide cell comforting with its lack of some of the stresses of institutional life. They could reflect on their lives and might make therapeutic gains. Most, however, found being on watch distasteful and wanted to be taken off.

One of my other responsibilities was to conduct training for staff on mental health and suicide issues and procedures.  I very clearly remember a training where we discussed signs and symptoms of suicide and the procedures we were to follow. Among those attending were segregation officers.  A few days after the training one of them killed himself. Suicide is not just an offender issue.

So, this is one insider’s account of how suicidal behavior is handled in Ohio prisons. I hope you have found it informative.

Scott Quimby, PhD