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Suicide Management/RisK Reduction

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CORRECTIONI CORPORAllOX OF AMERICA

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AUGUST 18, 2006

APRll1l, 2006

13-84.1 POLICY:
Every eCA Facllily will have a SUicide ManagemenuRlsk Reduclion Training Program. The program will
be implemented by trained qualified Heallh Services Staff.

13-84.2 AUTHORITY:
CCA Company Policy

13-84.3 DEFINITIONS:
Licens ed Independent Practilioners (LIP) - Physicians, Physician 's ASS istant, Advanced Registered
Nurse Practllioner, Dentist, and Psychiatrist Each LIP shall periorrn duties according 10 the Slate scope
at praclics guidelines.
Licensed Mental Health Professional (LMHP) - Psychiatrist, Psychologist, Licensed Chnical SOCial
Worker, and other Individuals with appropriate mental health licensure in accordance with state scope of
practice gllidelines.
qualified Health Services Staff (qHSS) - InclUdes phYSicians , physician a.,istanls. nurse practitIoners.
nurses, den lists, menial health professionals, and others who by virtue of Iheir educalion, credenli. ls,
and experience are permitted by law with in the scope of Iheir professi onal prac~ce acls to evalu ate and
care for patients.
Self-Inlurious BehaVior - Actions that result in self-harm.
Suicidal - Pre-occupatton With thoughts at setf-harm or actively engaging In behavior that is likely to
cause serious bodily harm, with the intended and explicit purpose of ending one's life.
Suicidal Gestures - Statements, threa ts and behavior that suggests thoughts, intent or plan to ha~n
onese lf.

Suicide Precautions with Constant Observation -Twenty-four (24) hour direct one-on-one observation
(per written order of a psychiatrist, physician, or mid-level practitioner) of inmates/residents who are
actively suicidal as evidenced by engaging in behavior that Is likely to ca use dealh .
Suicid e Precautions without Conslant Observation - TV/enly-four (24) hour ollservalion (oel written
oroer ot a psychiatrist, phYSician, or mid-level practitioner) of inmates/res idents WhO r
ga~ed In
12Viot, or
suicidal Ideation, verbal threats, self-harm. or who eXhibit self-Injurious or deslr'
ut:!rrlon strating other concerning behaviors. This type of observation reouires st..

Sight or sound distance, and to perlorm direct visual observation on a varier'
to fifteen (15) minutes but not to exceeo fifteen (15) minutes.
13-84.4 PROCEDURES:

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PRQCepURESINDe}(
SECTION
A
B

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A.

Training
Inilialldentification/Screenlng
On-Going Identification/Screening
Intervention
. "
. SUicide Precaution Levels
Downgrading and Discontinuation
Safe Housing
Transfer
Follow-Up

SUICIDE PREVENTION PLAN

1.

B.

SUBJECT

Suicide Prevention Plan

Each facUlty will develop a Suicide Prevention Plan that adoresses specific facility
initiatives and the facility's plan for compliance with this policy. The 13-84AA Suicide
Prevention Facility Risk Assessment (Sample) may be used as a guide. for the
development of the Suicide Prevention Plan. At a minimum, the Suicide Prevention
Plan will fnelude:
a.

Facility overview addressing facility size, population, annual intakes, and other
facility facts that may be relevant in developing the plan;

b.

Areas of focus needing improvement;

c.

Program structure to Include coordinator) facility multi-disciplinary taskforce.
meeting schedules, drills, and other structural aspects of the facility program;

d.

Monitoring and quelity improvement activities; and

e.

Pre·service and in-service training plans.

2.

The facility Suicide Prevention Plan requires revIew and approval from the FSC
Regional Director, Health Services and the Warden/Administrator.

3,

Each facility will conduct an annual review of the Suicide Prevention Plan. The plan wi!1
be updated as netessary utilizing a risk assessment process to identify areas of
potential risk and target the facility plan toward continuous improvement. Revisions to
any approved Suicide Prevention Plan require review and approval from the FSC
Regional Director, Health Services.

TRAINING

All facility personnel receive training during pre ..servlce orientatIon and at least annually in in·
service trainIng on the fOllowing:
1.

Facility Suicide Prevention Plan:

2.

Identifying the warning signs and symptoms of impending suicidal beha'lior,

3.

Understanding the demographtc and cultural parameter6 of suicidal behavlor, including
incidence and variations in precipitating factors:

4.

Responding to suicidal and depressed offenders:

5.

Communication between correctional and health services staff;

6.

Referral procedures;

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7.

Housing observatIon and suicide watch procedures;

8.

Follow·up monitoring of inmates/residents who make a suictde attempt; and

9.

Avoiding obstacles (negative attitudes) to prevention.

INITIAL IDENTIFICATION/SCREENING

1.
At the time of receiving inmates/residents, the receiving personnel will make every effort
...........•. _ ._. _ .• _. __ ..• _. __ .. _... JI)...Qb1aJn.infolTDatCoo.Jmro the arresfiog andl~gffiCflrOO..mgaminQ....tb.WL... _____ ...
assessment of tile inmate/resldenfs medical, mental health, or 6uicide risk to Include
any observed behavior. The type of Infonnation requested should include:

a.

Whether the inmate/resident appeared to be under the influence of alcohol or

drugS:
b.

Whether the inmate/resident or other Individual was making any comments that
would be cause for concem;

c.

Whether the inmate/resident appeared to be overly ashamed, embarrassed.
scared, depressed, Ot exhib~ing bizarre behavior;
.

d.

Whether theta were any facts or circumstances surrounding the arrest and/or
alleged crime that would suggest the inmate/resident to be a suicide risk;

e.

Whether the inmate/resident received a sentence; and

f.

Any other infonnaUon that may be helpful.

NOTE: The 13-8499 ArrestinglTransporting Officer Questionnaire may be used as a
guide for obtaining ana documenting appropriate medical, mental health. or

suIcide risk JnformatJon.
In the event the assessment ret1ecte mecUcal, mental health, or suicide risk, the
receiving officer will notify the health service department immediately.
2.

An Initial mental health screening will b.e performed by health trained or qualified health
services staff upon Inmate/resident arrival to the facility.

a.

Inmates/residents will be screened utilizing the 13-50B (ntake Mental Health
Screening Form. Screening wUf include Inquiry regarding past suicidal Ideation
and/or attempts; current ideation, threa~ plan; prior mental health
treatment/hospitalization; recent significant loss Gob, relationship, death of
family member/close friend, etc.); history of suicidal behavior by family
member/close friend; and suicide risk durfng prior confinement.

b

The 13-508 Intake Mental Health Screening form is a screening inventory and
IS NOT the only guide for referral to mental health services.

c.

The Inmate/residents prior medical, mental health, and suicide risk during prior
confinement wHl be verified through either manual or management InformaHon

system review.
3.

During the full health appraisal, the UP will evaluate any signs. symptoms, or
information received by the Inmate/resident that may necessitate a referral to mental
health staff.

4.

A comprehensiVe mental health eValuation will be completed in accordance with eCA
Policy 13006 1 Mental Health Services.

D.

ON-GOING IOENT/F/CATION/SCREENING

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1.

No. 6485

Any staff member identifYing an inmate/resident who appears to be potentially suicidal
Mental Health or Chemical Dependency Services
form and immediately forward it to health services staff.

will complete a 13-61 B Referral for
2.

Correctional Officers or other personnel are to immediately advise the Unit Manager

and/or Shift Supervisor of any pOlentially self·destructive behavior (related to potential
'.

suicide) displayed by the inmate/resident. Health Services staff will receive immediate
notifIcation of such behavior.

_ _ _ _ _ _ _ 0-. . . . _ _ _ _ _ . . _ _ _ _ ... _ _ • _ _ • _ _ _ • • _

3.

••• _ _ _ _ _ _ _ _ _ _ _ • _ _•

_ _ _ • _ _ _ .. _ _ _ _ _ • _ _

.~

_ _ • _ _ _ _ _ ••• _ _

If an Inmate/resident declares a Psychological Emergency, the Shift SuperviSor will be
advised. The Shift Supervisor will notify the appropriate QHSS.

4.

In ALL cases of attempted suicide. security personnel will immediately notify health
selVices staff and the Warden or Admlnlslratwe Duty Omcer.
AT THIS FACILITY ADDITIONAL NOTIFICATION PROCEDURES ARE

AS

FOLLOWS:

18T Notification:

J

I
L

H_E_A_L_TH_SE_R_Vl_C_E_S_A_U_TH_O_R_'T_Y_A_N_D_C_H_IE_F_O_F_S_:_CU_B_'_TY_ _ _ _ _

21\d

Notificetion OR after regular hours:

HEALTH SERVICES AUTHORITY AND CHIEF OF SECURITY

5.

Due to the strong association between inmate/resident suicide and special
management housing assignment (e.g. disciplinary. administrative, or protective
custody segregation). any inmate/resident assigned to a special management unit will
receive a pre..segregation health evaluation (See eGA Policy 13-42. Health Evaluations
for Pre.SegregationJSegregation Access to Health Care) for early detection of potential
sulctde risk.

E.

INTERVENTION

1.

In the event information obtained during the initial intake process, observation. history.
or interview informaUon suggests that an inmate/resrdent is potentially suicidal, the
QHSS win be immediately notified. The following steps may be directed by the QHSS
and Implemented by appropriate staff:
a.

2.

Inmate/resident may be temporarily held or housed in a cell that is as suicide
resistant as Is reasonably possible (free of all obvious protrusions and provides
full visibility to staff) and placed on Suicide Precautions. Appropriate referral
wilt be made to mental health staff for further evaluation/directions.

Procedures Following a Suicide Attempt
a.

Any correctional officer or other staff member who discovers an inmate/resident
engaging in self-harm shall ImmedIately survey the scene to assess the
severity of the emergency. alert other staff to caJl for h&alth services staff.

retrieve the housing unit's first aId kit and cut-down tool: and begin standard
first aid and/or CPR as necessary.

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b.

The first responder shaH always enter the cell and initiate appropriate lifesaving measures. Further, staff shall never presume that the victim Is dead, but
rather initiate and continue appropriate lifs-saving measures until relieved by
arriVing medical personnel.

c.

Although not all suicide attempts require emergency medical intervention. all
suiclde attempts shall result in immediate intervention and assessment by
qualified health services staff.
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SUICIDE PRECAUTION LEVELS

1.

II

I
\

When observation, history, or interview suggests that an inmate/resident IS potentially
suicidal or following a suicide attempt, the following steps are to be Implemented by
QHSS.
rn the absence of QHSS, the Warden/Administrator, Assistant
Warden/Administrator, Chief of Security, or Shift Supervisor will Implement the following
steps:
a.

The inmate/resident will be placed on SUICIDE PRECAUTIQNS:
II

In order to provide immediate safety, QHSS will place an
inmate/resident on suicide precautions upon recognition of or
notification of suicidal ideationlbehavior. The appropriate LIP WIH be
notified and an order will be written in the chart with a SOAP note
detailing reasons for placement.

•

Suicide precautions with or without constant observation may be
authorized by ~ Licensed Independent Provider who has Order'-writing
privileges. TI'\e inmate/resident will be evaluated by an LMHP as soon
as reasonably possible but within forty-eight (48) hours of placement
At that time, the LMHP will develop a plan of care for the
Inmate/resident that will Include at least dany assessment by the lMHP
orQHSS.

o

Initially Inmates/residents will be placed in a cell th~t is as suicide
resistant as is reasonably possible (free of aU obvious protrusions and
provides full visibility to staff). Personal belongings, Objects, and
clothing that could be used in a suicidal manner are to be initially
removed. When clothing is removed from a suicidal inmate/resident.
the inmate/resident Will be issued a safety garment or other proteclive
clothing that is suicide resistant and prevents humiliation al'\d
degradation. Finger foods only, eating utensils will not be permitted
•

Upon assessment from an lMHP, certain personal belongings
that could not be used in a suicidal manner may be returned to
the inmate/resident.

•

The inmatelresidenrs behavior will be observed and documented by
staff on the 13-83A Observation Monitoring form.
o

(nmates/residents under suicide precautions with constant
observation will have twenty-fouf (24) hour direct one-on one
observation.

o

Inmates/residents under 6uiclde precautions without constant
observation will have twenty..four (24) hOur observation With
staff present, within sight or sound distance. Observation will
include direct visual observatIon on a varied schedule of one

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(1) minute to fifteen (15) minutes but not to exceed fifteen (15)
minutes.

b.

Use of soft restraints and protective helmets may be authOrized by the UP or
by QHSS with verbal approval from the LIP. Written orders must be secured
within twenty-four (24) hours. Restraint/Equipment use must be in accordance

.. _.____.... _ ._. __..__ .. ____ .__ . ____JY.i!b....ccA..EnI~ 13-69._e.aoUl.Oal BeS1ra1nt.Jlli.SB..-are.....kLJWLJIla-'aasl. ___...__ ._
restrtctive management orders that are consistent with clinical conditions.
G.

DOWNGRA01NG/DISCONTINUATION

Inmates/residents under suicide precaution w1th or without constant observation may not be
or discharged from sutcide precautions until an LMHP reviews the
inmatelresident's healthcare record. confers with correctional personnel regarding the
inmate/resident's behavior, assesses the inmate/resident, writes a progress note. develops
and/or updates a wriUen plan of care, and writes an order to remove the inmateJresident from
suicide precaution or level of precaution. The LMHP will communicate with the appropriate UP
to confer on the inmate/resident's status. In the evant that the state does not permit orders by
an LMHP. the UP will write the order based on the LMHP consultation and recommendation.
downgraded

H.

SAFE HOUSING

Any inmate/resident placed on suldde precaution shall be housed in a cell that is as suicide

resistant as fs reasonably possible, free of all obvious protrusions. and provides full visibility to
staff.

I.

TRANSFER

In the event an inmate/resident on suicide precaution is being transferred from the custody of
COAl the inmate/resldenfs suicide precaution status will be documented on the 13-86A
Transfer In!Transfer Out Screening form and the 13-868 Speciallnstructtons for Transporting
Officers form to ensure continuity of care.
J.

FOLLOW-UP

1.

In order to ensure continuity of care for suicidal inmates/resident. all Inmates
discharged from suicide precautions shall remaIn on the mental health caseload and
receive regularly scheduled follow-up assessments by mental health staff until the
Inmate/resident Is transferred or reieased from the facility. Unless the Inmate/resident's
individual treatment plan directs otherwise, the reassessment schedule shall be as
follows: daily tor the first fIVe (5) days, then once a week for two (2) weeks and then
once every month until the inmate/resident is released from treatment by the LMHP. In
the absence of an LMHP. follow-up assessments may be performed by an LIP.

2.

Mortality and Morbidity Review Process

Proprfoti,y rn'omtotion

a.

All completed suicides and suicide attempts requiring Outside medical treatment
shall be examined through a mortality and morbidity review process in
accordance with CCA Policy 13-52, Quality Management Program.

h.

The review shall be multidisciplinary and include correctional, medIcal, and
mental health personnel.
.

C.

The review process shall include a critical inquiry of the following:

i.

Circumstances surrounding the inCident;

ii.

Facility procedures relevant to the Incident;

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iii.

All relevant training received by \nvolved staff:

iv.

Pertinent medical and mental health services/reports Involving the
victim:

v.

Possible precipitating factors leading to the suicide or serious attempt,

Vi.

Recommendations, if any, for changes in policy, training. physical
plant. medical or mental health services, and operational procedures.

-f-" .... 'CMtics'lliiCldent-Oebrl-eflng' -' ... - - .. ...... - -'- ... - .,........ - _.....-. __.....- - _.- - - .. _.
Hearth Services staff wUl participate in critical incident debrtefings as descnbed in CCA
Policy 5-1. Incident Reporting. The Chaplain, mental health staff or appropriate
designee will provide debriefIng to staff and inmates/residents who are affected by

criticar incidents at the facility.
13-84.5 REVIEW:
The Chief Medical Officer or qualified designee will review this policy on an annual basis.

13-84.6 APPLICABILITY:
All CCA I=acillties (Provided contractual requirements do not mandate otherwise)

13-84.7 APPENDICES:
13-84AA

Suicide Prevention Facility Risk Assessment

13-8488

Arrestingffransporting Officer QUestionnaire

13-84.8 ATTACHMENTS:
13-508

Intake Mental Health Screening

13-61 B

Referral for Mental Health or ChemIcal Dependency Services

13-63A

Observation Monitoring Form

13-86A

Transfer In/Transfer Out Screening

13-86B

Special I nstructions for Transporting Officers

13-84.9 REFERENCES:
eCA Policy 5-1
eCA Policy 13-42
CCA Policy 13-50

CCA Policy 13·52
CCA Pollcy 13.e 1
CCA Policy 13-63
CCA Policy 13-69
CCA Policy 13-86

ACA

4-4373M14-ALOF-4C-32M/3-JTS-4C·37M/J-JCRF-4C-06
4-4416/4-ALDF -4C-33

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1

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13--84

JCAHO EC.1.10
EC.1.20
PC.5.60

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