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Brief Report   |    
Inmate Suicide and Time Spent in Special Disciplinary Housing in New York State Prison
Bruce B. Way, Ph.D.; Donald A. Sawyer, Ph.D., M.B.A.; Sharen Barboza, Ph.D.; Robin Nash, B.A.
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.4.558
Abstract

Objective: This study examined the number of days that prisoners spent in a special disciplinary housing unit in New York State prison before a suicide occurred. Methods: Suicides that occurred between 1993 and 2003 were reviewed. Results: A total of 32 suicides occurred in one-person special housing cells during the 11-year period. Inmates spent a median of 63 days in a special disciplinary housing cell before committing suicide. The aggregate median sentence these inmates were serving in special housing at the time of suicide was 298.5 days. Conclusions: Because most suicides in a special housing unit occurred within eight weeks of placement, enhanced observation of special housing inmates is warranted in that period at a minimum. (Psychiatric Services 58:558—560, 2007)

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The authors are affiliated with the Central New York Psychiatric Center, New York State Office of Mental Health, Box 300, Marcy, NY 13403 (e-mail: bruceway@omh.state.ny.us).The authors are also with Upstate Medical University, Syracuse, New York.

Suicide by a correctional inmate is a very serious event. It has powerful effects on numerous individuals and governmental organizations. Prison suicide is a leading cause of litigation (1). However, it is relatively infrequent, with an annual rate of 14 suicides per 100,000 inmates (2). Research is critical to identify and more fully understand its risk factors to aid prevention.

One risk factor for prison suicide that has been consistently identified is type of prison housing. Almost all suicides in state prisons occur in single cells as opposed to in dormitories or double-bunked cells (3,4). Suicide is a very private act, and whether it occurs in a hospital (5), in the free community (6), or in prison (3), it almost always occurs when the person is alone.

There has been considerable controversy over the use of isolation cells for suicidal inmates. Hayes (7), in his U.S. Department of Justice report on prison suicide, stated, "A primary recommendation, based chiefly on overwhelming consistent research, is that isolation should be avoided whenever possible." Felthous (8), however, noted that the literature does not distinguish between two very different environments of isolation—isolation with limited social contact versus isolation with close observation by staff: "The problem is not so much the use of single cells or separating vulnerable inmates; the lethal risk comes from leaving suicidal inmates unattended and with materials that can be used for self-destruction."

Single-cell disciplinary housing, as opposed to a mental health observation conducted with continuous staff observation, has been identified as one of several risk factors for prison suicide (3). Some articles (9,10) argue that these disciplinary housing environments deprive individuals of adequate sensory input and thereby cause deterioration of mental functioning. This deterioration then leads to suicide. However, there are several reports that no psychological deterioration occurs during short periods of isolation (11,12,13,14).

There are numerous potential reasons for these conflicting results, and full reviews are reported elsewhere (10,12,14). One reason worth noting here is that the actual amount of sensory restriction varies enormously among cell blocks labeled as "disciplinary housing." Furthermore, some authors claim that sensory input in solitary confinement may not be that much different from that in regular cells because inmates in solitary confinement communicate with medical, mental health, and correctional staff; other inmates; and visitors; they also have access to reading material, mail, and often radio and television (14).

One important issue that has been unexplored is the amount of time an inmate is confined in a special disciplinary housing cell before the suicide occurs. The purpose of this study was to examine the timing of suicides after inmates were placed in special disciplinary housing. The study is a retrospective review of records of inmates who completed suicide in disciplinary housing.

The forensic institutional review board of the New York State Office of Mental Health reviewed and approved this study. Data were extracted from a quality assurance database that had been cleared of personal identity information. We examined total number of days in the special housing unit before suicide and length of aggregate disciplinary sentence the inmate was serving. Between 1993 and 2003, a total of 32 inmates were identified as being in a special unit in New York State prison at the time of the suicide. There were a total of 132 suicides throughout the New York State prison system during the period studied.

Inmates in New York State prison may be placed in the special housing unit if they have committed a very serious infraction of prison rules. Examples of infractions include assault on staff, assault on another inmate, and possession of a weapon. These inmates generally are allowed out of their special housing cells for only one hour per day for recreation, three mental health treatment sessions per month, medical treatment, and visitors. Sentence length depends on the number of infractions (charges) within the behavioral incident, the seriousness of the behavior, and the extent of injury. Additional time is added to infractions that occur while the inmate is in a special housing unit.

Thirty-two inmates committed suicide in a special housing cell in the 11-year period from 1993 to 2003. The median number of days in a special housing cell before suicide was 63, with a mean±SD of 382±790 days (range of zero to 2,977 days). The median length of aggregate disciplinary sentence being served at time of suicide was 298.5 days (mean=1,452±2,432 days, range=30—8,675 days).

Suicide has a low base rate, and risk estimation is difficult and complex. It is therefore important to note that a large number of inmates are placed in special housing units in the New York State prison system (11,756 in 2003) and most do not commit suicide.

Therefore, understanding the factors that contribute to specific inmates' committing suicide is very challenging. However, the results suggest that the first two months in a special housing unit should be added to the risk factors that we have discussed elsewhere (3). Inmates recently transferred to a special cell should receive enhanced observation for at least two months. For example, motion detectors could be installed to alert a correctional officer when an inmate gets out of bed in the quiet hours after midnight. Getting out of bed and using the bed sheet for hanging is the most common method of prison suicide. Motion detectors have been used elsewhere for suicide-vulnerable populations.

The length of stay in a special housing unit was short before suicide occurred. These data do not support the idea that the special housing unit for most inmates causes slow deterioration of mental health over several months that eventually leads to suicide. The literature is mixed on effects of lengths of stay in the 30- to 60-day range. Grassian (9) reported that he found psychiatric deterioration and suicidal behavior in his cohort of 14 men who had a median length of stay of two months in segregated housing. Sestoft and associates (15) reported that Danish prisoners (N=125) who were in solitary confinement for more than four weeks had a 20-fold greater probability of being hospitalized for psychiatric reasons. In contrast, in their review of studies, Bonta and Gendreau (13) did not find any mental deterioration for inmates in segregation for ten days or less. Zinger and Wichmann (12), in a study of 136 inmates, found no change for those segregated for 60 days or less, and Andersen and associates (11) reported in a study of 228 prisoners that inmates' mental health did not worsen over the first few weeks of solitary confinement.

To address the mental health needs of inmates in these special housing units, the Central New York Psychiatric Center of the New York State Office of Mental Health has dramatically increased the amount of mental health service offered to inmates in these environments since 2002, and it has moved many seriously ill inmates from special housing units to special enriched mental health programs. To screen for suicide as well as other mental health issues, a mental health clinician is required to stop at each special housing unit cell in most of the prisons in our system every work day and attempt to engage these inmates.

Also two important new processes have been introduced: first, improved mental health testimony in the disciplinary infraction hearing process, which may prevent placement into special housing, and second, the use of case management committees that can recommend to the prison superintendent that an inmate be removed from special housing.

For a majority of inmates who completed suicide in a disciplinary cell, the length of stay was fairly short. However, five inmates in the study group were in a disciplinary cell for more than a year. The range of days in special housing for these five was from 869 to 2,977. Recent placement in disciplinary housing does not appear to be a factor for them. The trigger for suicide for these inmates needs to be explored.

Admissions to special housing units should receive extra attention in the first two months to help prevent suicide. Such attention includes closer monitoring of inmates after waking hours and engaging inmates on a daily basis to screen for suicide. Administrative and process measures, such as those implemented in the New York State prison system to create mechanisms for removing inmates from special housing when warranted, should also be considered.

The authors report no competing interests.

Metzner JL: Class action litigation in correctional psychiatry. Journal of the American Academy of Psychiatry and Law 30:19—29, 2002
 
Suicide and Homicide in State Prisons and Local Jails. Washington, DC, Department of Justice, Bureau of Justice Statistics, 2005
 
Way BB, Miraglia R, Sawyer DA, et al: Suicide risk factors in New York State prisons. International Journal of Psychiatry and Law 28:207—221, 2005
 
He X, Felthous AR, Holzer CE, et al: Factors in prison suicide: one-year study in Texas. Journal of Forensic Sciences 46:896—901, 2001
 
Perez-Carceles MD, Inigo C, Luna A, et al: Mortality in maximum-security psychiatric hospital patients. Forensic Science International 119:279—283, 2001
 
Appleby L: Suicide in psychiatric patients: risk and prevention. British Journal of Psychiatry 161:749—758, 1992
 
Hayes LM: Prison Suicide: An Overview and Guide to Prevention. Washington, DC, US Justice Department, National Institute of Corrections, 1995
 
Felthous AR: Does "isolation" cause jail suicides? Journal of the American Academy of Psychiatry and Law 25:285—294, 1997
 
Grassian S: Psychological effects of solitary confinement. American Journal of Psychiatry 140:1450—1454, 1983
 
Haney C: Mental health issues in long-term solitary and supermax confinement. Crime and Delinquency 49:124—156, 2003
 
Andersen HS, Sestoft D, Lillebaek T, et al: A longitudinal study of prisoners on remand: repeated measures of psychopathology in the initial phase of solitary versus non-solitary confinement. International Journal of Law and Psychiatry 26:165—177, 2003
 
Zinger I, Wichmann C: The Psychological Effects of 60 days in Administrative Segregation. Ottawa, Correctional Service of Canada, 1999
 
Bonta J, Gendreau P: Reexamining the cruel and unusual punishment of prison life, in Long Term Imprisonment: Policy, Science, and Correctional Practice. Edited by Flanagan TJ. Thousand Oaks, Calif, Sage, 1995
 
Suedfeld P, Ramirez C, Deaton J, et al: Reactions and attributes of prisoners in solitary confinement. Criminal Justice and Behavior 9:303—340, 1982
 
Sestoft D, Andersen H, Lillebaek T, et al: Impact of solitary confinement on hospitalization among Danish prisoners in custody. International Journal of Law and Psychiatry 21:99—108, 1998
 
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References

Metzner JL: Class action litigation in correctional psychiatry. Journal of the American Academy of Psychiatry and Law 30:19—29, 2002
 
Suicide and Homicide in State Prisons and Local Jails. Washington, DC, Department of Justice, Bureau of Justice Statistics, 2005
 
Way BB, Miraglia R, Sawyer DA, et al: Suicide risk factors in New York State prisons. International Journal of Psychiatry and Law 28:207—221, 2005
 
He X, Felthous AR, Holzer CE, et al: Factors in prison suicide: one-year study in Texas. Journal of Forensic Sciences 46:896—901, 2001
 
Perez-Carceles MD, Inigo C, Luna A, et al: Mortality in maximum-security psychiatric hospital patients. Forensic Science International 119:279—283, 2001
 
Appleby L: Suicide in psychiatric patients: risk and prevention. British Journal of Psychiatry 161:749—758, 1992
 
Hayes LM: Prison Suicide: An Overview and Guide to Prevention. Washington, DC, US Justice Department, National Institute of Corrections, 1995
 
Felthous AR: Does "isolation" cause jail suicides? Journal of the American Academy of Psychiatry and Law 25:285—294, 1997
 
Grassian S: Psychological effects of solitary confinement. American Journal of Psychiatry 140:1450—1454, 1983
 
Haney C: Mental health issues in long-term solitary and supermax confinement. Crime and Delinquency 49:124—156, 2003
 
Andersen HS, Sestoft D, Lillebaek T, et al: A longitudinal study of prisoners on remand: repeated measures of psychopathology in the initial phase of solitary versus non-solitary confinement. International Journal of Law and Psychiatry 26:165—177, 2003
 
Zinger I, Wichmann C: The Psychological Effects of 60 days in Administrative Segregation. Ottawa, Correctional Service of Canada, 1999
 
Bonta J, Gendreau P: Reexamining the cruel and unusual punishment of prison life, in Long Term Imprisonment: Policy, Science, and Correctional Practice. Edited by Flanagan TJ. Thousand Oaks, Calif, Sage, 1995
 
Suedfeld P, Ramirez C, Deaton J, et al: Reactions and attributes of prisoners in solitary confinement. Criminal Justice and Behavior 9:303—340, 1982
 
Sestoft D, Andersen H, Lillebaek T, et al: Impact of solitary confinement on hospitalization among Danish prisoners in custody. International Journal of Law and Psychiatry 21:99—108, 1998
 
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