Women Offender Programs and Issues

Report on Self-Injurious Behaviour in the Kingston Prison for Women

Section 4: Suicide Identification

    As outlined in my report of February, 1989, I have some hesitancy in dealing simultaneously with self-injurious and suicidal behaviour for fear of reinforcing the notion that these two behaviours are one in the same. Nonetheless, the prevalence of the belief that these two behaviours are identical necessitates dealing with both. On the one hand, prison personnel need to be informed that self-injury is not a suicide attempt. This should reduce much of their anxiety in dealing with these situations. On the other hand, it is possible that self-injurious and suicidal behaviour can coexist in the same individual; therefore, it is imperative that staff not be given the message through training that self-injury necessarily precludes suicidal ideation. Self-injury is a coping strategy that has developed due to a childhood filled with abuse. The impact of abuse of such magnitude will have many repercussions. Self-injury is but one indication of the trauma withstood. Individuals who have been grossly abused suffer from lowered self-esteem, guilt brought on by societal attitudes surrounding sexual assault, suppressed anger, and a multitude of other behavioural consequences which may result in suicidal feelings. Nonetheless, it is important to distinguish between self-injury and suicidal behaviour to ensure that appropriate intervention is provided. At present, the belief that these two behaviours are one in the same has, in many cases, resulted in an over reaction to self-injury.

    As the existing protocol for a suicide attempt is identical to that outlined earlier for self-injury (cf. Pp. 11-12) I will not repeat it here. The reactions of prisoners and CX staff to this protocol have also been adequately covered under the section relating to self-injurious behaviour (cf. pp. 12-14). It should be apparent that the majority of the recommendations regarding self-injury also apply to suicidal behaviour. For the most part, if the recommendations made with respect to self-injury are implemented, this will facilitate both suicide identification and appropriate treatment. By and large, the most important point with respect to suicide is that suicidal individuals should not be placed in segregation. As mentioned earlier, the isolation imposed by segregation increases rather than decreases suicidal ideation. It is worth repeating that the National Task Force established by Health and Welfare Canada (1987) noted that a 1981 study conducted by the Correctional Service of Canada reported that suicide rates were "more prevalent in dissociation areas than in general cells" (p. 35).

• As recommended in the case of self-injury, it must be clarified that suicidal behaviour is a mental health issue as opposed to a security issue. As such, at the first indication that a woman is in emotional distress, the situation must move from the security domain to that of psychology/health care services. This will not only ensure that prisoners are provided with appropriate services, it will reduce stress among the CX staff by alleviating responsibility in areas they are not trained to handle. As in the case of self-injury, it is recognized that, at times, decisions will involve judgement calls by the CX staff and security issues will still have to be given credence.

• It must be recognized that segregation, due to the isolation imposed and the perceived punishment aspect, is an inappropriate response to suicidal behaviour. Segregation can be expected to increase rather than decrease suicide potential due to these factors. This recommendation reflects a strategic objective of Core Value 1, 1.5: "To ensure that placement in general population is the norm and to provide adequate protection, control and programs for offenders who cannot be maintained in the general population" (p. 9).

• All suicidal individuals must have immediate access to counselling services. This recommendation reflects a guiding principle of Core Value 1: "Offenders, as members of society, retain their rights and privileges except those necessarily removed or restricted by the fact of their incarceration" (p. 8). This must include the right to suicide intervention.

• Given the above two recommendations, it is further recommended that a prisoner who is believed to be suicidal be brought to health care services and given immediate access to counselling support. Following this, a psychologist should assess whether the woman is best served by remaining out of the general population. If a woman is assessed as being a high suicide risk, she should remain in the health care services area or be transferred to an alternative health care facility until adequate counselling enables her safe return to the general population. This recommendation reflects the strategic objective of Core Value 1, 1.5: "To ensure that placement in general population is the norm and to provide adequate protection, control and programs for offenders who cannot be maintained in the general population" (p. 9).

• It is important in times of emotional distress that a woman have someone with whom she can talk. The person best suited will depend on the individual case, and as such should be determined/identified by psychology/health care services with input from correctional supervisors. The woman concerned, of course, would have primary input in the identification of the individual(s). This recommendation reflects a guiding principle of Core Value 1: "Offenders, as members of society, retain their rights and privileges except those necessarily removed or restricted by the fact of their incarceration" (p. 8). These rights surely include the right to support in times of crisis.

• Given the above recommendations, it is further recommended that a prisoner identified as suicidal be allowed access to the crisis/support team outlined earlier. This recommendation reflects a guiding principle of Core Value 1: "Offenders, as members of society, retain their rights and privileges except those necessarily removed or restricted by the fact of their incarceration" (p. 8). These rights surely include the right to peer support.

• Given that the nursing staff are often a prisoner’s first contact after identification as a suicide risk, the nurses must be provided training in appropriate intervention. This recommendation reflects the strategic objective of Core Value 3, 3.8: "To provide staff training and development opportunities that are based on achievement of our Mission, develop the full potential of staff members, and emphasize interpersonal skills, leadership and respect for the unique differences and needs of all offenders" (p. 13).