10/10/2018 BOP Inmate Suicides Rate per 100,000 or PPLSPE LOOP LEL ES EL ES * Locked units include SHUs, SMUs, ADX, Seclusion, Extended lock down units, etc. + Every year between 30 and 80% of inmate suicides occur on a locked unit’ h * Single Cells in locked units are especially jf =o misky for high-risk inmates Single Cell Suicides in SHU EFTA00126006

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Single Cells It ts recommended that all SHU Inmates be double-celled unless there is a compelling reason not to do so. Single Cells When an inmate cannot be double celled: —Piace at-risk inmates in h-ghar visibility celts — Reduce or ellmingie tie-off points = Increased monitoring of property Discuss local policies to ensure specific 4 inmates are not single celled. These may — Special notation on call door ~ Special notation on SHU — SHU Program — Other 10/10/2018 i EFTA00126007

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10/10/2018 Good Suicide Prevention + Complete SHU rounds as directed by policy and document them accuralely + Observe inmates & report concams to the SHU Lieutenant, Psychology Services, and/or the next shift as appropriate + Respond to inmate concems and accommodaia reasonable requests promptly + Prior to entering a SHU cell lo provide assistance staff should ensure their safety which may include wailing for assistance * Cut down tools should never be used for any purpose olher than responding to a suicide emergency + Know the location of the AED and how to use it + 30% suicides are committed by behaviorally disordered inmates in SHU * Al rsk for suicide AND accidenta! death In + Must be assessed by psychology EVERY time they make a new threat of self-harm * Must be taken seriously! EFTA00126008

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+ Negative perceptions or frusirations may impact your professional judgment and nead to be monitored + Manage through collaboration between departments Ih * Agroup approach is indicaled for the mos! demanding cases Behavior Disordered + Manage with positive reinforcement —Caich them being good — Praise progress, not perfection - “small steps” — Address reasonable requests promptly = Set ona goal that is guaranteed to occur + if a Suicide Risk Management Plan is in effect. follow it exactly What Is a Suicide * Risk Management Pian? * The Plan we will discuss today is not the same a5 the plan used by the institution when an inmate |s in restraints + A Suicide Risk Management Plan is atso NOT. 10/10/2018 EFTA00126009

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AL¥eourva the inmate cannot be engaged in positive change behaviors + A Suicide Risk Management Pian |S — Feedback: immediate and frequent — Rewnforcement of positive behaviors or neutral behaviors that replace harmful behaviors . — Collaboration: betwean psychology, custody, other departments, and executive staff —Targetec self-harm behaviors and other behaviors that place the inmate in danger (cutting, call fires, atc.) Creating a iy, Suicide Risk Management Plan Psychology Services identifies key issues through observation of the inmate and input from staff: } «= = High risk behaviors —Elements of the environment that perpetuate dangerous behavior —Reinforcers that may be used to reward 10/10/2018 wT EFTA00126010

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AL¥eNiva Creating a serSas Suicide Risk Management Plan 4 HES + These are combined into a brief, individualized plan that indicates ~Management strategies —When reinforcers will be provided —What harmful behaviors will trigger more intensive risk management + Present the plan to the inmate; this Is usually done collaboratively by the Captain and Chief Psychologist * Be prepared: Behaviors usually gat worse before they get betier * All staff need to adhere to the plan + Discuss concerns and issues along the way to ensure staff members are being 10/10/2018 EFTA00126011

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Mentally Ili Inmates * Approximately 30 to 60% of BOP suicides are completed by mentally #i inmates + Disorders most frequently include Depression. Bipolar Disorder. and Schaophrenia + Symptoms may include psychosis, poor hygiene. lack of energy. poor appetite, insomnia, agitation. and lack of interest in things that were once of interest Mentally Il Inmates + Monilor these inmates closely, look for changes in mood and behavior and report them to Psychology * Bulld positive rapport with these inmates to assist them with problem solving and meeting ther needs * During shake downs, ensure medications are not being hoarded and property has not been modified to allow self-harm 10/10/2018 I i EFTA00126012

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2VSO4248Ca 10/10/2018 + Both of these groups are al heighianed risk for sulcde — Both groups may be fearful of other inmates ———_———_ ae a — Both groups may be expenencing shame = Double-calll all inmates whanever possible ~ Convey requests lo speak to Psychology immediately * Place in higher vrsibility calls Emergency Response + Always initiate life saving measures + Ensure the response reflecis the emergent nature of the situation * Ail staff should carry personal protective From Local Mock Drills EFTA00126013

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an oN $¥E@A 18 704 9e1GGSAVAld4Sa few §avasA3ae faOugaed«<alasfiGusasarddcas 10/10/2018 Psychology Advisory List + The Advisory List destructive, or suicidal when placed into the SHU. a “se ee” Phone a Friend * You are required to refer an inmais to Seracas if you cbserve behaviors that indicate she or he may be at risk for suicide + Call to collaborate in managing high nsk inmates can Th 10 EFTA00126014

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2 80/46/2815 45 + Understand sulode risk associaied with locked unis and single cals + identity high sek groups { ed = mentaty Ml lnmates ~ behamor dsordersd aumates = sax offander and protective custody inmates wrategi¢s for speciic al mk * Discuss management jomaies in ths SHU * Rewew emergency response procedures QUESTIONS? 11 EFTA00126015