Taking the Time to Prevent Suicide
Significant media attention has been given to the apparent suicide of financier Jeffrey Epstein. This death represents but one of the over 300 jail suicides that occur each year in the US, but raised many questions about the acceptable management of suicidal detainees. Specifically, questions regarding the qualifications of who removed Mr. Epstein from an earlier suicide watch and the adequacy of time spent on that watch were called into question.
Anyone can and should place a detainee on a suicide watch if there a concern; however, only qualified mental health professionals (QMHPs) should be tasked with evaluating patients for removal off a suicide watch. As defined by the National Commission on Correctional Health Care, these are professionals who by virtue of their “education, credentials, and experience are permitted by law to evaluate and care for the mental health needs of patients.” Each state regulates who is able to practice mental health. These include master’s level professionals licensed in clinical social work and professional counseling, as well as doctoral level professionals licensed as psychologists. Physicians skilled in mental health delivery are also QMHPs.
Length of Suicide Watch
“Epstein, 66, was removed from suicide watch…just six days after the self-inflicted bruising on his neck was spotted, according to the New York Times.” This fact begged the question of how long a patient should be kept on a suicide watch. The answer is “it depends.” It depends on numerous factors, such as how the patient presented at the time that suicide risk was identified, how the patient currently looks, reasons for stability, and the severity/lethality of the attempt or threat to harm oneself.
It’s important to note that there is a growing trend in litigation focusing on the minimum length of a suicide watch. The professional must be able to demonstrate that they had adequate opportunity to evaluate the patient’s stability. Can this be shown if the patient is removed from suicide watch after just a few hours? The Epstein case shows that even several days may not be deemed adequate.
The fact is there is no established time limit. Patients should be maintained on a suicide watch for as long as it takes for the professional to confidently assert that the patient is not at imminent risk for self-harm. This decision should be made on a case-by-case basis and it is recommended that patients be maintained on a suicide watch for at least 24 hours. We must ask ourselves, if the patient is injured or worse, will the decision and the record justify the action or inaction?
There is no such thing as “not being suicidal.” All detainees should be considered at risk for suicide to a degree. Whether they should be maintained on a watch is based on clinical decision-making in which the QMHP must weigh the presence of risk factors (factors that increase suicide risk) and protective factors (factors which decrease suicide risk) while evaluating for potential warning signs. It’s a complex and complicated process that is subject to many limitations, including the patient’s self-report. Patients may not be honest about what they are thinking or feeling. Others may not have good insight or understanding of their own thoughts or intentions. Finally, some patients may honestly tell you that they aren’t suicidal, but have something happen just moments later that can cause them to harm themselves.
If you need more information, please contact Dr. Melissa S. Caldwell at (309) 692-8100
or email Melissa.Caldwell@advancedch.com.
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DID YOU KNOW?
ACH offers both comprehensive and standalone mental health services for your officers and incarcerated population.