Bad News Kills
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John* had been in the county jail for several months, but was due for release in less than 30 days. During his incarceration, John had struggled with sobriety and the daunting prospect of rebuilding his life as a free citizen. At each suicide screening and assessment, he denied a history of self-harm and responded to questions about suicide with, “I would never do that. I have kids to raise”. Less than a day after his most recent suicide screening, he received news that his children’s case worker had been trying to locate him, and his parental rights were being terminated. His children would be adopted out, and he would not be permitted to see or talk with his kids again. That night, he hanged himself dead.
*Name and identifying details have been changed to protect the privacy of individuals.
Bad News Kills: ASQ about Suicide
Being incarcerated is stressful, and negative events can strip a person of hope and critical social support. Poor legal outcomes such as being denied bond or facing a sentence greater than expected can trigger feelings of hopelessness and despair. Receiving news that one’s marriage or other significant relationship is being severed can lead people to take their own lives.
Jails routinely ask about suicide at booking, however, risk for suicide can occur at any point in confinement: especially after a stressful event. The key to suicide prevention in these cases is identifying when such events have occurred, asking about suicide, documenting and escalating concerns in a timely manner, and implementing suicide precautions.
Asking about suicide can be done in a variety of ways, but not all ways are equal. A formal tool that has been validated by research is the Ask Suicide-Screening Questions (ASQ) for Detention Facilities tool, developed from a partnership between correctional experts and the National Institute of Mental Health.
Actions Speak Louder Than Words: Implement Suicide Precautions
Asking about suicide is only ‘half the battle.’ The behavior and demeanor of the person should be considered with more weight than what is said. Many people deny suicidal ideation and yet go on to kill themselves. For some, denial is a means to prevent intervention. In that moment, they don’t want to be stopped. For others, it’s because they act impulsively and have little insight into their thoughts and behaviors. Whatever the reason for the denial, professionals should attend to changes and deterioration in behavior and emotional states.
Examples of actions speaking louder than words which may indicate suicide precautions include, but are not limited to:
- If a person says, “I’m fine,” and yet presents as distressed or agitated
- If a person’s reaction to a severe stressor is unexpected, such as looking calm or even happy when learning that he or she faces a severe legal outcome
For those who have suffered with feelings of helplessness, they may take solace in the perceived control that suicide promises. They may look stable, but truly are not. There is truth in the saying that “actions speak louder than words.”
Due to the significant number of suicides that occur as a direct response to poor legal outcomes, it is recommended that all patients be screened for suicide following return from court. Information provided by court personnel, attending officers, probation/parole agents, etc. can be valuable in assessing true risk.
If you would like additional information about ASQ or other mental health related topics,
please contact Dr. Melissa Caldwell at (309)692-8100 or email Melissa.Caldwell@advancedch.com
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All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis.