Marc S. Daigle

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons.

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: an empirical investigation.

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of “Rogerian” nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.

Suicide attempts: prevention of repetition

Objective: To present an overview of promising strategies to prevent repetition of suicidal behaviours. Method: This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. Results: Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo—a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. Conclusions: There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.

Preventing suicide in prisons, part II. International comparisons of suicide prevention services in correctional facilities.

The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.

Reaching suicidal people with media campaigns: New challenges for a new century.

Five variables were investigated in the evaluation of Suicide Prevention Weeks (SPW) held in 1999, 2000, and 2001 in Québec, Canada: exposure to the campaign, previous suicide ideation, knowledge, attitudes, and intentions. After the year 2000 campaign, a telephone survey conducted on a representative sample of 1020 men revealed that only those actually exposed to the SPW had gained more knowledge of suicide facts and resources. However, the SPW did not influence attitudes or intentions to seek help. Results are not surprising, considering the low intensity of the campaign, especially in the media. Campaigns aimed at changing suicidal behaviors must be intensive.

Inter-regional variations in men’s attitudes, suicide rates and sociodemographics in Quebec (Canada)

BackgroundSuicide rates can vary quite considerably and attitudes regarding suicide may explain part of the variation.MethodThe present study investigated, across the 17 regions of Quebec (Canada), men’s attitudes towards suicide, expressing pain and help seeking, as they are related to suicide rates and sociodemographic variables (unemployment, divorce/separation, income and education).ResultsMost correlations were non-significant. However, in regions with an above-average educational level and with higher divorce/separation rates, men had better attitudes towards expressing pain. Furthermore, in regions where men were more inclined to express pain, suicide rates were lower. Also, significant positive correlations were found between suicide rates and low educational level, but also between an increase in suicide rates and an increase in income level.ConclusionsWhere the aetiology of suicide is concerned, researchers must examine both sociodemographic factors and the psychological factors associated with them.

Mental health and suicide prevention services for Canadian prisoners

There is a dissonance between the purposes and services of the justice system compared to the needs of suicidal people or those with mental health problems. Correctional authorities are faced with sometimes difficult responsibilities when they have to incarcerate those who fall through the gaps in the social safety net. Correctional Service Canada’s (CSC) mandate is to carry out the sentences of two or more years imposed by the Court; consequently that federal authority may have more time and means than its provincial counterparts receive for inmates on remand or serving shorter sentences. CSC developed strategies for inmates with mental health problems and, specifically, an exhaustive suicide prevention program. The implementation of all the components of the mental health strategy is not completed but it is based on good planning. With respect to suicide prevention activities, these are mainly based on screening the most vulnerable inmates at the time of intake, but they cover a larger spectrum.

Pilot Evaluation of a Group Therapy Program for Children Bereaved by Suicide

BACKGROUND Thousands of children are bereaved each year by suicide, yet there exists very little literature specifically on the psychological care, programs, and interventions available to help them. AIMS (1) To build and validate theoretical models for the Group Therapy Program for Children Bereaved by Suicide (PCBS); (2) to test these models in a preliminary evaluation. METHODS In the first part, we built theoretical models, which were then validated by scientists and clinicians. In the second part, the sessions of the PCBS were observed and rated. The participating children were tested pre- and postprogram. RESULTS Positive changes were observed in the participating children in terms of basic safety, realistic understanding and useful knowledge, inappropriate behaviors, physical and psychological symptoms, child-parent and child-child communication, capacity for social and affective reinvestment, actualization of new models of self and the world, self-esteem, awareness and use of tools, cognitive, verbal, written and drawing abilities, cognitive dissonance, ambivalence, antagonism, and isolation. CONCLUSIONS The changes reported in the bereaved children show that the PCBS has some efficacy.

How to improve testing when trying to predict inmate suicidal behavior

OBJECTIVE To measure the predictive power of the Suicide Probability Scale (SPS) in a male inmate population (federal penitentiary) with the added contribution of actuarial data. METHOD SPS scores and data from the files of 518 inmates were analyzed in relation to their suicidal behaviors over the following 10 years. RESULTS During this period, 12 inmates committed suicide (2.32%), 43 engaged in non-lethal self-harm (8.3%) and 15 expressed serious suicidal intention (2.9%), for a total of 70 (13.51%) who manifested at least one form of suicidal behavior. The records of the 518 inmates allowed identifying seven actuarial variables (out of 24 documented) that distinguished the group that acted out. These variables were tested in combination with the SPS score to determine the best predictive models of suicidal behavior. Depending on type of suicidal behavior and on observation period, the following seven variables could prove useful in improving the predictive capacity of the SPS: age, prior suicidal behavior, borderline personality disorder, length of sentence, number of sentences, prior incarceration in a provincial prison, and juvenile priors. However, analyses did not allow developing a better predictive model for the specific subgroup of suicide completers. CONCLUSIONS SPS is improved when adding actuarial data.