EFTA00134933

V.S. Department of Justice Federal Bureau of Prisons Program OPi: CPD/PSB NUMBER: P5324.08 DATE: 4/5/2007 SUBJECT: Suicide Prevention Statement Program RULES EFFECTIVE: 3/15/2007 1. PURPOSE AND SCOPE. The Bureau of Prisons (Bureau) operates a suicide prevention program to assist staff in identifying and managing potentially suicidal inmates. Each Warden will ensure that a suicide prevention program is implemented consistent with this policy. In addition, Wardens will facilitate a discussion regarding the issue of suicide at department head meetings, staff recalls, lieutenants' meetings, etc., to heighten staff awareness about the need to detect and report any changes in inmate behavior that might suggest suicidal intent. 2. SUMMARY OF CHANGES. This re-issuance adds the following new procedures for preventing inmate suicides: a. Suicide prevention training will include three mock suicide emergencies per year, one on each shift. One of these exercises must be conducted in the Special Housing Unit (SHU) during the morning or evening watch. b. Specific minimum criteria that must be included in a Suicide Risk Assessment and a Post-Watch Report are delineated. c. Designation of a room for suicide watch outside of the Health Services area requires written approval of the Regional Director. d. Specific criteria that exclude an inmate from consideration for an inmate companion position are delineated. e. Correctional Services will notify Psychology Services when an inmate requests protective custody (PC). Psychology Services will no longer be required to monitor SENTRY for entry of a PC code. 3. PROGRAM OBJECTIVES. The expected results of this program are: a. All institution staff will be trained to recognize signs and information that may indicate a potential suicide. S ON Y_00006434 EFTA_00000519 EFTA00134933 P5324.08 4/5/2007 Page 2 t suicides with appropriate b. Staff will act to preven and referrals. sensitivity, supervision, receive found to be suicidal will c. Any inmate clinically oth er ervision, counseling, and appropriate preventive sup treatment. 4. DIRECTIVES AFFECTED a. Directive Rescinded (3/1/04) P5324.05 Suicide Prevention Program b. Directives Referenced l Housing Units Inmate Discipline and Specia P5270.07 (12/29/87) entation Program (4/3/03) P5290.14 Admission and Ori es Manual (8/13/93) P5310.12 Psychology Servic Application of Restraints P5566.06 Use of Force and (11/30/05) 05) P6031.01 Patient Care (1/15/ P6340.04 Psychi atric Ser vic es (1/15/05) in m Statement are contained c. Rules cited in this Progra . 26 CFR 552.40 through 552.41 5. STANDARDS REFERENCED lt ociation Standards for Adu a. American Correctional Ass 4-4 084 ,4- 408 4-1 ,4- 4th Edition: Correctional Institutions, 4370M,4-4371M,and 4-4 373 M. Association Performance Based b. American Correctional tion: 4- nda rds for Adu lt Loc al Detention Facilities, 4th Edi Sta -ALDF-4C- F-7 8-0 8,4 -AL DF- 78- 10, 4-A LDF-7B-10-1,4-ALDF-4C-29M,4 ALD 30M,and 4-ALDF-4C-32M. See Section 7a. 6. INSTITUTION SUPPLEMENT. Referral POL ICY . Eac h Bur eau ins titution, other than Medical 7. that s (MR Cs), wil l imp lem ent a suicide prevention program Center h Bureau outlined in this policy. Eac conforms to the procedures tte n pro ced ure s p specific wri medical center is to develo and the ten t wit h the spe cia liz ed nature of the institution consis intent of this policy. s. MRCs serve a unique a. Medical Referral Center e addressing the needs of a wid evaluation/treatment function nda rds of car e. ting community sta range of inmates, while mee ution pon sible for developing an Instit Psychology Services is res man agi ng the local procedures for Supplement that describes SDNY_00006435 EFTA_0O0O0520 EFTA00134934 P5324.08 4/5/2007 Page .3 components. Suicide Prevention Program's ent document significant treatm that the MRC psychologists are to ical Data System (PDS) so information in the Psycholog atment. ble for post-discharge tre information is readily availa n ter Contract Facilities. Whe b. Residential Reentry Cen al Ree ntry ties (including Residenti contracts for outside facili Statement of Work will include a the Centers (RRCs)) are used, ed Bureau n pla n or program that meets accept Suicide preventio standards. tract rs (CCMs) will monitor con Community Corrections Manage ine their capability to manage at- erm facilities regularly to det The CCM will consult the Regional eff ect ive ly. risk populations ator if questions arise abo ut the Psychology Services Administr n Pro gram or ility's Suicide Preventio adequacy of a contract fac fer ent a suicidal inmate to a dif about the need to transfer log y tact Central Office Psycho facility. The CCM will con -wide or interagency issues. tem Services when there is sys all possible evidence and In the event of a suicide, ved to provide data and support for ser documentation will be pre onstruction. subsequent invest iga tor s doing a psychological rec er-action ector will authorize an aft Ordinarily, the Regional Dir to be conducted by the Regional , review of a suicide at a RRC findings will be documente d as a str ato r. The Psychology Admini ach ment A. Report as outlined in Att Psychological Reconstruction ty ct Prisons. Private securi c. Privately-Managed Contra a suicide prevention and contract facilities maintain ance with American Correctional pli intervention program in com ant Director, nda rds . Ordinarily, the Assist Association (ACA) sta action on, will authorize an after-conducted Correctional Programs Divisi be tract private prison, to review of a suicide at a con tral Office Psychology Services Cen under the direction of the will be documented as a Administrator. The fin din gs achment A. cho log ica l Rec ons tru cti on Report as outlined in Att Psy 8. PROGRAM ADMINISTRATION. gram h institution must have a Pro a. Program Coordinator. Eac gra m. on's suicide prevention pro Coordinator for the instituti be responsible for managing the ll The Program Coordinator sha s and for ensuring that the inm ate treatment of suicidal the vention program conforms to institution's suicide pre ntification, ref err al, ass essment, ine s for tra ini ng, ide guidel in this policy. and intervention outlined logist will be the Program Ordinarily, the Chief Psycho nator's responsibilities wil . l not nat or. The Pro gra m Coo rdi Coordi chologist er than a doctoral-level psy be delegated to staff oth SDNY 00006436 EFTA_0000052I EFTA00134935 P5324.08 4/5/2007 Page 4 institution di na to r, in conjunction with ailable The Prog ra m Co or en su re th at ad eq uate coverage is av st n for training, executive staff, mu nt from the institutio or sh e is ab se when he annual leave, etc. ion is e th e in it ia l period of incarcerat b. Training. Wh il serious r de te ct in g po tential suicides, me fo n the often a critical ti e at an y ti me . Line staff are ofte ar is on suicidal crises may al behavior based id en ti fy si gn s of potential suicid first to s. ractions with inmate their frequent inte ring that m Co or di na to r is responsible for ensu Program The Prog ra aff. The is available to st appropriate training that all st af f will be trained en su re e signs Coordina to r wi ll gy se rv ic es pe rs onnel) to recogniz holo (ordinarily by psyc l suicide, the appropri ate referral ve of a po te nt ia indicati ques. e prevention techni process, and suicid evention at ud e di sc us sions of suicide pr aff of Wardens wi ll in cl gs , st af f re ca ll s, etc., to remind st in department head meet te s constantly for si gns of suicidal to ob se rv e in ma the need behavior. ention training r Al l Staff. Suicide prev 1) Tr ai ni ng fo tional Techniques cl ud ed in th e In tr oduction to Correc procedures will will be in in lo ca l suicide prevention Tr ai ni ng Training and curriculum. it ut io n Familiarization du ri ng In st be provided . at all institutions Annual Training (AT) will focus on: Training for staff risk factors; identifying suicide icides; iles of completed su typical inmate prof vior; ntially suicidal beha recognition of pote ation associated with s; appropriate inform te rring suicidal inma identifying and refe ., a suicide ide emergency (e.g responding to a suic pr oper use of ing location and in progress), includ ; and suicide cut-down tool of suicide ordinator, location name of Program Co watch room, etc. m nt al Sp ec ia li ty Training. The Progra 2) Supp le me f having r su pp le me nt al training.to staf Coordinator wi ll of fe specialty . Or di na rily, supplemental frequent inmate co nt ac ts s Assistants, se rv ic es st af f (i.e., Physician' training for he al th Registered on er s, Em er ge nc y Me dical Technicians, Nurse Practiti SONY 00006437 EFTA_00000522 EFTA00134936 P5324.08 4/5/2007 Page 5 ered ), lie ute nan ts, and cor rectional counselors is off on AT. Nurses instituti after the conclusion of approximately six months pro vid ed dur ing regularly enc our age d tha t thi s training be It is possible. scheduled meetings when (SHU) Sup ple men tal Tra ini ng for Special Rousing Unit 3) cidal recognizing potentially sui Staff. Information about low will be inc lud ed in the SHU post and pro ced ure s to fol suicide inmates exa mple of post orders for orders. Att ach men t B is an prevention in a SHU. Captain rge ncy Res pon se Tra ining. At a minimum, the 4) Eme cide cho log ist wil l joi ntl y conduct three mock sui and Chief Psy months yea rly , one on eac h shift, approximately four h emergenci es xes wil l com ple te the exercises separately at eac apart. Com ple plex. institution within the com at least one of these Within the calendar year, in the SHU during the exercises will be conducted (Institutions that do evening or morning watch. ps) are exempted from not have a SHU [e.g., Cam still required to this requirement, but are e emergencies yearly). conduct three mock suicid e emergency training Confirmation of mock suicid Associate Warden over the will occur in writing to Psychology Ser vic es wit h a copy to the Suicide nator for placement in a Prevention Program Coordi e. See sample training documentation fil ment C. memorandum format in Attach on to the supplemental This training is in additi utenants, health speciality training for lie nal counselors. services staff, and correctio ATES. 9. IDENTIFICATION OF AT-RISK INM een a . Medical staff are to scr a. Medical Staff Screening is at ris k for signs that the inmate newly admitted inmate for ce wit hin screening is to take pla suicide. Ordinarily, this ins tit ution. inmate's admission to the twenty-four hours of the /NP) ant/Nurse Practitioner (PA + The Physician's Assist tionally distur bed inm ates on will refer suicidal or emo nat or or Program Coordi an emergency basis to the designee. b. Psychological Intake. Pre-Sentence Detainees, and 1) Pre-Trial Detainees, ause of the FDCs, FTCs, or Jails. Bec Holdovers in MCCs, MDCs, short length of stay in MCCs, MDCs, high rate of admissions and SDNY_00006438 EFTA_00000523 EFTA00134937 P5324.08 4/5/2007 Page 6 chological units, the comprehensive psy FDCs, FTCs and Detention wil l be logy Services ordinarily intake conducted by Psycho ng sui cidal or who are suspected of bei performed only on inmates s or table (e.g., mental illnes appear psychologically uns withdrawal), or who request services se significant substance abu via the Psycholog y Ser vic es Inmate Questionnaire. -Return Inmates. For newly 2) Newly Assigned or Writ a s or writ-return inmates, assigned designated inmate comprehensive psychological intake psychologist will conduct a 's admission to the institution. ate within 14 days of the inm For transferred inmates, a 3) Transferred Inmates. intake comprehensive psychological psychologist will conduct a tit uti on if ate's admission to the ins within 30 days of the inm s it is clinically warranted based upon the psychologist determine ble inmate records. the PSIQ and other availa ion or s in Administrative Detent c. Inmates in SRUs. Inmate ris k for tus often may be at higher Disciplinary Segregation sta SHU will cid al beh avi or. Inm ate s being transferred into the crying, sui g., potential suicide risk (e. be monitored for signs of f-h arm , or eng aging in nal ly dis tra ugh t, thr eats of sel emo tio eral con duc t to pur pos efu lly effect removal from the gen referred mis l be ibiting such behavior wil population). Inmates exh to the Shift Lieutenant. g Inmates. Inmates requestin 1) Protective Custody (PC) act ual ly tec tiv e cus tod y or dem anding to be housed alone maytective pro When an inmate requests pro be contemplating suicide. Services tod y or dem and s to be celled alone, Correctional cus staff will immediately: rdinator or designee in + notify the Program Coo normal business hours, or Psychology Services during l g hours notify the on-cal + during non-routine workin psychologist. on within 72 PC inm ate sho uld be scr eened for suicidal ideati The ted by rs of bei ng pla ced int o SHU. When clinically indica hou l be Suicide Risk Assessment wil this screening, a formal conducted. y staff to Pro gra m Coo rdi nat or wil l work closely with custod g., The tal status for behavior (e. monitor each PC inmate's men n, sing agitation, depressio hopelessness, anxiety, increa d for an increased level of nee psychoses) that suggests a services. m l Precautions. The Progra 2) Inmates Requiring Specia of or wil l pro vid e SHU sta ff with a list ("hot list") Coordinat SONY 00006439 EFTA_00000524 EFTA00134938 P5324.08 4/5/2007 Page 7 dangerous, conditions who may become inmates with mental health the SHU . al when placed into self-destructive, or suicid needed and This list will be updated as Services, Health distributed to Correctional ff. This list will be Services, and Unit Team sta ff. made available to all sta list" is placed into When an inmate on this "hot vices Supervisor will the SHU, a Correctional Ser immediately. notify Psychology Services 3) SHU Custodial Issues. olvement. At a minimum, the A) Program Coordinator Inv of SHUs ee will make weekly rounds Program Coordinator or design inm ates se areas concerning any and consult with staff in tho needing special attention. or Log. The Program Coordinat B) Review of Lieutenant's det erm ine if log each working day to will review the Lieutenant's in the SHU . lth problems has been placed to assess an inmate with mental hea inmate as soon as possib le A psychologist will see the and alert SHU staff. the inmate's mental status Services policy contains C) Health Services. Health received s placed in SHU continue to procedures to ensure inmate needed medications. notified whenever an Psychology Services will be /her medication. If inmate refuses or misses his to become violent, the inmate has the potential without the al self-destructive, or suicid ist s wil l notify SHU staff of medication, psycholog this. h ry SHU will be equipped wit D) Suicide Rescue Tool. Eve ure t is sharp, stored in a sec a suicide rescue tool(s) tha trained ble. All SHU staff will be location, and readily availa cedures for responding to a suicide pro to use the tool and in the emergency. or SKS. The Program Coordinat E) Inmate Removal from the pot ent ial ate exhibiting significant will arrange to have an inm pla ced on sui cid e watch. SHU and for suicide removed from the returned ril y, onc e the cri sis is over, the inmate will be Ord ina ction that was imposed. to the SHU to satisfy any san ff may identify an inmate as d. Staff Referral. Any sta observed ent ial ly sui cid al at any time based upon the inmate's pot behavior. SDNY_00006440 EFTA_00000525 EFTA00134939 P5324.08 4/5/2007 Page 8 SDNY 00006441 EFTA_00000526 EFTA00134940 P5324.08 4/5/2007 Page 9 HTLY ANY INMATE SUICIDE STAFF MUST NEVER TARE LIG INFORMATION OR HINTS FROM THREATS OR ATTEMPTS OR ANY ATE BEING POTENTIALLY OTHER INMATES ABOUT AN INM SUICIDAL. may be staff mem ber who has reason to believe an inmate Any suicidal should: s ate under direct, continuou • ordinarily maintain the inm observation, t for assistance, and • contact the Shift Lieutenan contact the Program • during regular working hours, any other available e., Coordinator or designee (i. psychologist ). hours, the Shift Lieutenant • During non-routine working• chologist and continue psy will contact the on-call ce direct, contin uou s obs erv ation, or immediately pla the inmate on suicide watch. ately rge ncy sit uat ion s, the Shi ft Lieutenant will immedi In eme that in watch. It should be noted place the inmate on suicide ff member may place an inmate on emergency situations any sta re the cedures may apply to MRCs whe suicide watch. Special pro may be limited to specific clinical initiation of suicide watch staff. play a Inm ate Ref err al. In add ition to staff, inmates can e. tate rol e in hel pin g to pre ven t inmate suicides. To facili by: vital referrals on will encourage inmate this process each instituti institution inmate including a statement in the • als encouraging inmates to handbook/orientation materi or situation that may or notify staff of any behavi is ups et and potentially suicidal, suggest an inmate inmate referrals into the incorporating the topic of • lesson plan for Psychology Admissions and Orientation Services, sing unit addressing the • placing posters in each hou topic, and on is made available to • ensuring that the informati as appropriate, inmates in multiple languages particularly Spanish. SONY_00006442 EFTA_00000527 EFTA00134941 P5324.08 4/5/2007 Page 10 During T OF IDENTIFIED INMATES. 10. SUICIDE RISK ASSESSMEN t of suicide ates referred for assessmen regular working hours inm priority basis. During non -regular potential will be seen on a con sul t with or or designee should hours, the Program Coordinat imm edi ately or ose to see the inmate institution staff and may cho cas e, the suicide watch. In either have the inmate placed on 24 hou rs of ividual assessment within inmate will receive an ind referral. will be completed when: A Suicide Risk Assessment Psychology Services because staff refer an inmate to suicide (e.g., the inmate the inmate may be at risk for talks about ending his or refuses his or her property, her life), behavior is suggestive of an inmate's written or verbal suicide, or suggestive of self-harm, an inmate exhibits behavior sent that would lead the any other condition is pre essment is warranted. clinician to believe an ass ted in PDS k Assessment will be comple Ordinarily, the Suicide Ris nts outlined above. At a minimum, within 24 hours of the incide l include: wil the Suicide Risk Assessment erral, reason for / source of ref risk factors assessed, risk assessment findings, diagnosis, and follow-up recommendations. ed e a referral based on observ When a staff member has mad l also who interviews the inmate wil ed the behavior, the psychologist erv iew the staff member who obs make every effort to interv in the 's comments will be included behavior. The staff member report/clinical notes. tion of the suicide risk 11. INTERVENTION. Upon comple or or designee will determine rdinat assessment, the Program Coo the ent ion that best meets the needs of the appropriate interv us beh avi or doe s not self-injurio inmate. Because deliberate entions essari ly ref lec t sui cid al intent, a variety of interv nec med on suicide watch may be dee other than placing an inmate rdinator, such as heightened staff Coo appropriate by the Program ation, inm ate int era cti on, a roo m/cell change, greater observ or SDNY 00006443 EFT4_00000528 EFTA00134942 P5324.08 4/5/2007 Page 11 ication. ent in res tra int s, or ref erral for psychotropic med placem l assume Coordinator or designee wil In any case, the Program ent ion and cle arly ommended interv responsibility for the rec document the rationale. the Program Coordinator a. Non-suicidal Inmates. If suicidal, does not appear imminently determines that the inmate for thi s conclusion ll doc ume nt in wri ting the basis he/she sha n will tre atm ent rec omm end ati ons made. This documentatio and any tral file. medical, psychology, and cen be placed in the inmate's ermines Sui cid al Inm ate s. If the Program Coordinator det b. cide, the imminent potential for sui the individual to have an ins tit ution's cide watch in the inmate will be placed on sui ion s and findings of n room. The act designated suicide preventio wit h cop ies going to l be documented, the Program Coordinator wil fil e, and the record, psychology the central file, medical Warden. 12. SUICIDE WATCH. ms on must have one or more roo a. Housing. Each instituti on sui cid e wat ch. housing an inmate designated specifically for in ade qua te con trol allow staff to mainta The designated room must obs erv e and mising the ability to of the inmate without compro protect the inmate. cide watch designating a room for sui + The primary concern in and mai nta in erve, protect, must be the ability to obs . adequate control of the inmate ructed access, privacy, and unobst The room must permit easy times. vision of the inmate at all m may not have fixtures or The suicide prevention roo ury. t would easily allow self-inj architectural features tha ignated ced in the institution's des Inmates on watch will be pla non-administrative suicide prevention room, a lth ordinarily located in the hea detention/segregation cell ate will not cell's location, the inm services area. Despite the l ind ications t unless there are medica be admitted as an in-patien ate hospitalization. that would necessitate immedi be room in a different area may Placement of a suicide watch uti ons . tures of some instit warranted given the unique fea e of the m for suicide watch outsid + However, designating a roo written approval of the Health Services area requires ms must meet all of the Regional Director. Such roo ve. requirements identified abo SDNY_00006444 EFTA_00000529 EFTA00134943 25324.08 4/5/2007 Page 12 ls disciplinary segregation cel + Administrative detention and cel ls. approved as suicide watch will not be designated or be placed Und er eme rge ncy con dit ions a suicidal inmate may the • in a cell other than temporarily on suicide watch be ch room. The inmate must institution's designated wat watch room as soon as one cide moved to a designated sui becomes availa ble . the nt. While on suicide watch, ctive b. Conditions of Confineme res tri finement will be the least inmate's conditions of con . and safety available to ensure control inarily be seen by the Program wil l ord The inmate on watch will have rdi nat or on at lea st a daily basis. Unit staff Coo ch. inmate while he/she is on wat erview or frequent contact with the des ign ee wil l int rdinator or Ordinarily, the 'Program Coo record r eac h inm ate on sui cid e watch at least daily and monito each visit.' clinical notes following e of Pro gra m Coo rdi nat or or designee will specify the typ be The clothing, magazines, that may personal property, bedding, allowed. d if If app rov ed by the War den, restraints may be applie t be • r control, but their use mus necessary to obtain greate ported. clearly documented and sup ions may Any dev iat ion s fro m pre scribed suicide watch condit ce. • gram Coordinator's concurren be made only with the Pro s to l develop local procedure The Program Coordinator wil r when to the inmate's Unit Manage ensure timely notification nal ted and terminated. Correctio nator a suicide watch is initia the Pro gra m Coo rdi tation with Services staff, in consul ly res pon sible for the inmate's dai or designee, will be tie s. tine activi custodial care, cell, and rou m consultation with the Progra • Unit Management staff in to be responsive to routine needs Coordinator will continue e watch. while the inmate is on suicid cide watches: c. Observation. For all sui ques used to monitor the Any visual observation techni focus on the inmate l suicide companion program wil on suicide watch only. companion and/or the inm ate al inmate will not be in the The observer and the suicid e a locked door between same room/cell and will hav them. cide watch must have a The person performing the sui ately (e.g., phone, radio) means to summon help immedi gMY0CO36414M EFTA_00000530 EFTA00134944 P5324.08 4/5/2007 Page 13 suicidal or unusual if the inmate displays any behavior. l establish procedures for The Program. Coordinator wil the inmate's behavior in a of documenting observations a log boo k, whi ch will be maintained as Suicide Watch inmate observers wil l secure document. Staff and ks. Post Orders will boo document in separate log ion to sta ff on requirements for provide direct documentation. cide watch may be conducted 1) Staff Observers. The sui ch must sta ff obs erv ers . Sta ff assigned to a suicide wat ques using tion to Correctional Techni eiv ed tra ini ng (In tro duc have rec ore and sign the Post Orders bef or in AT) and must review gra m Coordinat or wil l rev iew the Post starti ng the wat ch. The Pro ir accuracy. Orders annually to ensure the use the Warden may authorize the 2) Inmate Observers. Only e companion program). The of inmate observers (inmat be made by of inmate companions is to authorization for the use bas is. If the War den aut horizes a on a cas e-b y-c ase the Warden ponsible gram Coordinator will be res companion program, the Pro assignment, and rem ova l of for the selection, training, s selected as companions are ate individual companions. Inm n they are ution work assignment whe considered to be on an instit for man ce pay for shall receive per on their scheduled shift and ially suicidal inmate. ent time spent monitoring a pot n Post-Watch Report. Based upo d. Watch Termination and des ign ee wil l: m Coordinator or clinical findings, the Progra cide watch when the inmate is 1) Remove the inmate from sui for suicide, or no longer at imminent risk al transfer to a medical referr 2) Arrange for the inmate's e facility. center or contract health car not be ced on watch, the watch may Once an inmate has been pla stance, without the Program terminated, under any circum tion. forming a face-to-face evalua Coordinator or designee per will have the authority to remove an Only the Program Coordinator ort Generally, the post-watch rep or as inmate from suicide watch. the wat ch, prior to terminating should be completed in PDS watch termination, to ensure l be soon as possible following e. Copies of the report wil appropriate continuity of car medical record, psychology file, e, forwarded to the central fil be a clear description of the and the War den . The re sho uld care. and guidelines for follow-up resolution of the crisis SDNY_00006446 EFTA_0000053I EFTA00134945 P5324.08 4/5/2007 Page 14 ll include: a mi ni mu m, th e post-watch report wi At ed, risk factors assess of watch, + an ge s in ri sk fa ct ors since the onset ch + from watch, and + reasons for removal dations. + follow-up recommen OGRAM. MA TE OB SE RV ER S - INMATE COMPANION PR 13. IN cause of the very Se le ct io n of In mate Observers. Be ction of inmate a. na tu re of su ch as signments, the sele e round-the-clock sensitive provid considerable care. To s, a sufficient numb er observers requires ll y su ic id al in ma te ld ntia candidates shou observation of pote tr ai ned, and alternate er s sh ou ld be of observ rform be available. le ct ed ba se d up on their ability to pe Observers will be se also for their reputation within the t must the specific task bu Program Coordinator's judgement, they th bo institution. In the dividuals who have credibility with , re li ab le in og ra m be mature in the Pr They must be able, privacy staff and inmates. t, to pr ot ec t th e suicidal inmate's en aff. Coordinator's judgem ile being accepted in the role by st r in ma te s, wh th ey mu st be from othe m Co t, ordinator's judgemen for direct in th e Pr og ra Finally, l need r duties with minima able to perform thei supervision. not: wh o is se le ct ed as a companion must mate In addition, any in boarder; in pr e- tr ia l st at us or a contractual • Be 0-level ve be en fo un d to have committed a 10 or • Ha the last three years; prohibited act within . Drug Ed Refuse status • Be in FRP, GED, or will work a Sh if ts . Observers ordinarily b. Inmate Ob se rv er ces, observers if t. Ex ce pt un de r unusual circumstan y 24-hour four-hour sh shift in an than one five-hour time will not work longer ers will receive performance pay for te ob se rv period. Inma on watch. ll receive at ng In ma te Ob se rv er s. Each observer wi signed to a c. Traini re being as initial training befo er will also receive at least four hours of rv er shift. Each obse session suicide watch observ aining semiannually. Each training their ur s of tr te s on least four ho qu ir em en ts and instruct the in ma li cy re cl ud in g: will review po ti es du ri ng a suicide watch, in on si bi li duties and resp ide watch areas; the location of suic ng all shifts; summoning staff duri SONY 00006447 EFTA_00000532 EFTA00134946 P5324.08 4/5/2007 Page 15 ion; be ha vi or al si gn s of stress or agitat recognizing and watch log. ns in the suicide recording observatio meet at Pr og ra m Co or di na tor. Observers will d. Meetings with designee to th e Pr ogram Coordinator or least quar te rl y wi th nt training. ed ur es , di sc us s issues, and suppleme ram Coordinator review proc the Prog served as observers, ly or in groups, to After inmates have vi du al brief them, indi m changes, if nece ssary. or designee will de s an d ma ke pr og ra rience discuss their expe intain a file s. Th e Pr og ra m Coordinator will ma e. Reco rd containing: • gned of un de rs ta nd in g and expectations si An agreement rver; by each inmate obse discussed at tendance and topics Documentation of at training meetings; which s av ai la bl e to se rve as observers, Lists of inmate es personnel • be av ai la bl e to Correctional Servic wi ll working hours; and during non-regular performed ri fi ca ti on of pa y for those who have • Ve watches. Suicide Watch. of In ma te Observer During a f. Supe rv is io n of their ll be se lected on the basis Although obse rv er s wi , they still ma tu ri ty , and responsibility emotional. stab il it y, rforming a le ve l of st af f supervision while pe require some suicide watch. staff who are in io n wi ll be provided by Th is su pe rv is h room or who e im me di at e ar ea of the suicide watc e inmate th o observation of th have continuous vide observer. alerts staff to wh en an inmate observer In al l ca se s, diately respond • em er ge nc y si tu at ion, staff must imme ary action to an cess h room and take ne ing debilitating to the suicide watc om in cu rr on watch fr prevent the inmate no case wi ll an in mate observer be inju ry or de at h. In ovisions for a wa tc h without adequate pr assi gn ed to to obtain f su pe rv is io n or without the ability staf stance. immediate staff assi ATED US E IN MA TE OB SE RV ERS MUST BE PREDIC THE DECISION TO FOUR MINUTES TH E FA CT TH AT IT TAKES ONLY THREE TO ON ATHS TO OCCUR. FOR MANY SUICIDE DE SONY 00006448 EFTA_00000533 EFTA00134947 P5324.08 4/5/2007 Page 16 -minute checks nsist of at least 60 the Supervision must co Staff will initial conducted in-person. . on conducting checks chronological log up ee may remove og ra m Coordinator or design g. Remo va l. Th e Pr tion. Removal of er fr om th e pr og ra m at his/her discre cords kept by any observ in the re should be documented an inmate observer tor. the Program Coordina The Program S TO OTHER INSTITUTIONS. 14. TRAN SF ER OF IN MA TE ncy referrals of re sp on si bl e for making emerge Coordinator wi ll be . No inmate te s to th e ap pr op riate medical center transferred suicidal inma al will be be imminently suicid who is determined to n, except to a medical center on an to another institutio emergency basis. not respond to Re fe rr al. Inmates who do a. Medi ca l Ce nt er idal require te rv en ti on s an d re main imminently suic referral may treatment in psychiatric ation. Although a rred emergency hospitaliz me, ordinarily the inmate shall be refe at an y ti h fo r 72 be indicated she has been on contin uous watc m to a MRC after he or exceeds 72 continuous hours, the Progra hours. If th e wa tc h Coordinator must: tor to ac t th e Re gi on al Psychology Administra ncy transfer Co nt ge • determine if an emer discuss the case and is appropriate. mate to a MRC, th e de ci si on is no t to transfer the in for If est t initiating a requ the rationale for no me nt ed in the PDS. ge nc y tr an sf er mu st be docu emer at each ic es at MRCs. Psychology Services b. Psycho lo gy Se rv fo inmates r pr op ri at e intervention program MRC will provid e an ap ogram will ad mi tt ed fo r su ic idal behavior. The pr who have been include: assessment, tions, and • therapeutic interven discharge planning . gnate an pl an ni ng ma y in clude a request to desi y and level The discharge ide the custod st it ut io n fo r th e inmate that can prov t re-hospitalization. in en rvice needed to prev of psychological se eration As pa rt of the referral consid c. Consulta ti on s. ntal health be be ne fi ci al to co nsult with other me process, it may hology Services ur ce s, MR C st af f, or the Regional Psyc reso Administrator. king of mmunication and trac • To ensure maximum co Program Coordinator will notify e suicidal inmates, th SONY 00006449 EFTA_00000534 EFTA00134948 P5324.08 4/5/2007 Page 17 when a on al Ps yc ho logy Administrator his or he r Re gi a suicide wa tc h is be gu n or terminated and when suicide urs. watch exceeds 72 ho nt the m Co or di na to r or designee will docume the The Progra s taken in ions and all action referral considerat inmate's PDS record. It is critically ch Al ert" Assignments. e to d. SE NT RY "P sy in st it ut io ns ar e notified when they ar risk important that other recent suicidal indications and are at receive inmates with for self-harm. a suicidal tor must ensure that n the SENTRY The Program Coordina gi ve red to a MRC is inmate being transfer nt to signal all staff that me "Psych Alert" assign management problems and yc ho lo gi ca l serious ps y of ca re " issues are present. "continuit e ES . If an in ma te suicide does occur, th ID 15. ANALYSIS OF SUIC ll immediately notify the Regional wi Program Coordinator logy Services. Administrator, Psycho th an ll be tr ea te d in a manner consistent wi ve The suicide scene wi ation. All measures necessary to preser ig inmate death invest ence needed to support subsequent me nt th e ev id e recorded and docu ma intained or otherwis at io ns wi ll be investig adequately. arly su ic id e, in st it ut ion staff, particul In the event of a staff, and other law enforcement Corr ec ti on al Se rv ic es me level of ne l, wi ll ha nd le the site with the sa h has occurred. pers on deat ec ti on as an y cr im e scene in which a prot ved to en ce an d do cu me nt ation will be preser ing + All possible evid pport for subsequent investigators do provide data and su nstruction. a psychological reco an after-action , th e Re gi on al Di rector will authorize logist from Ordinarily a psycho e to be completed by ce. Psychologists who review of the suicid of fi or administrative in another institution involved in treatment of the inmate or have prev io us ly be en participat e in th e the case shall not s peer consultation in . The report will address all the area co ns tr uc ti on nstr uc ti on of an suicide re fo r th e Psychological Reco listed in th e "G ui de achment A). Inmate Suicide" (Att view the al Ps yc ho lo gy Ad mi nistrator will also re for The Region th Services port prepared by Heal discrepancies with the Mortality Review Re an y n and to explain additional informatio uction Report. tr Psychological Recons SONY 00006450 EFTA_00000535 EFTA00134949 P5324.08 4/5/2007 Page 18 forward Re vi ew . Th e Re gional Director will a. Central Office ca l Reconstruction Re port to: th e Ps yc ho lo gi copies of Division; Di re ct or , Co rr ectional Programs the Assistan t on; and + t Di re ct or , He al th Services Divisi ew + the Assistan ctor, Program Revi th e Se ni or De puty Assistant Dire + Division. Assistant Co mm it te e. Th e PRD Senior Deputy tee. b. Special Review re po rt to th e Special Review Commit th e report and assess Director will submit it te e will review the Co mm sed The Specia l Re vi ew fo r co rr ec ti ve ac tion will be addres ons whether recommendati vel. ti on al or lo cal institution le at the na or will be ty Assistant Direct The PRD Senior Depu actions and acking corrective responsible for tr complished. ective action is ac verifying the corr lations appear in RE GU LA TIONS. Federal Regu 16. CODE OF FE DE RA L 28 of the Code of , as re pr oduced from volume bracketed bo ld te xt gulations that Ch ap te r 5. The federal re Federal Re gu la ti on s, s are primarily f to sp ec if ic program practice bind Bureau st af rights, Bu re au programs and inmate intended to de sc ri be members of the or re sp on si bi li ti es to inmates and privileges, public. d scope. [§ 552.40 Purpose an ide prevention s (B ur ea u) operates a suic lly The Bureau of Pr is on in id en ti fy in g an d managing potentia program to assist staff mate as being at risk Wh en st aff identify an in Based suicidal in ma te s. pl ac e th e in ma te on suicide watch. for suicide, staff will ate the suicide , st af f will either termin upon clinic al fi nd in gs risk for suicide no longer at imminent watch when th e in ma te is l referral center r th e in ma te 's tr ansfer to a medica or arrange fo care facility. or contract health edures. 552.41 Program proc st have a or di na to r. Each institution mu (a) Pr og ra m Co ide prevention or di na to r fo r th e institution's suic Program Co program. sponsible for e Pr og ra m Coordinator is re (b) Tr ai ni ng . Th to staff and to ap pr op ri at e tr ai ning is available ensuring that inmate observers. inmates selected as of at risk inmates. (c) Identification ed inmate for f ar e to sc reen a newly admitt (1) Medi ca l st af dinarily, this ma te is at ri sk for suicide. Or signs that th e in s of the to ta ke pl ac e wi thin twenty-four hour screening is to the institution. inmate's admission SDNY_00006451 EFTA_00000536 EFTA00134950 P5324.08 4/5/2007 Page 19 make an he th er me di ca l or non-medical) may (2) Staff (w observed an y ti me ba se d upon the inmate's identification at behavior. be at risk . St af f wh o id en tify an inmate to (d) Referral on suicide watch. su ic id e wi ll ha ve the inmate placed for assess each nt . A ps yc ho lo gi st will clinically (e) Assessme tch. inma te placed on suicide wa the clinical Upon completion of (f) Intervention. na to r or designee will determine og ra m Co or di of the assessment, the Pr ti on th at be st meets the needs te rv en the appropriate in inmate tch conditions. § 552.42 Suicide wa more rooms ch in st it ut io n must have one or (a) Housing. Ea ide watch. r ho us in g an inmate on suic designated specific al ly fo te control mu st al lo w st af f to maintain adequa The designated room e and t co mp ro mi si ng th e ability to observ ou of the inmate with protec t th e in ma te . (b) Observation. scheduled ai ne d in ma te ob se rvers operating in (1) Staff or tr mate under consta nt ar e re sp on si bl e for keeping the in shifts observation. e of inmate ) On ly th e Wa rd en may authorize the us (2 observers. stitution rv er s ar e co ns id er ed to be on an in (3) Inmate obse duled shift. gn me nt wh en th ey are on their sche work assi to document ) Su ic id e wa tc h lo g. Observers are (c book. behavior in a log significant observed Program Ba se d up on cl in ical findings, the (d) Termination. signee will: Coordinator or de te is te fr om su ic id e watch when the inma (1) Remove the in ma or nt risk for suicide, no longer at immine referral th e in ma te 's tr an sfer to a medical (2) Arrange for .] health care facility center or contract /s/ Harley G. Lappin Director SONY 00006452 EFTA_00000537 EFTA00134951 P5324.08 4/5/2007 Attachment A, Page 1 L GUIDE FOR THE PSYCHOLOGICA CIDE ATE SUI RECONSTRUCTION OF AN INM Prepared by: Name: Date: Reg. No: Date of Death: Date of Birth: I. Background Information Education Marital/Family Status lvement Religious Preference/Invo Race/Ethnic Background Offense Sentence/Time Served tory Occupational/Military His Release Plans ty Description II. Health Care and Personali ing Physical Status-Function Pre vio us/ Cur ren t ing Social Status-Function Pre vio us/ Cur ren t ioning Psychological Status-Funct Previous/Current Suicidal History Medication History Mental Health History Diagnosis/Treatment Abuse History Drug/Alcohol Assaultive History Institutional Infractions nces III. Antecedent Circumsta Identifiable Stressors Staff Opinions Inmate Opinions t Last Person to Have Contac Last Staff Con tac t SONY ocoxiis3 EFTA_0000053 EFTA00134952 P5324.O8 4/5/2007 Attachment A, Page 2 ne (to include of Suicide Act and Sce IV. Full Description diagrams were appropriate) Date/Time of incident Location Method ions Predictors of Suicidal Act Suicide Note on Other Relevant Informati V. Conclusions/Recommendations ed VI. List of Documents Examin Inmates Interviewed VII. List of Staff and SDNY_00006454 EFTA_OOOOO539 EFTA00134953 25324.08 4/5/2007 Attachmen t B, Page 1 "SAMPLE" ON SUICIDE PREVENTION INFORMATI UM TO POS T ORDERS SPECIAL HOUSING UNIT ADDEND BOP HIGH RISK GROUPS ission hours and days after adm • New Inmates - The first few exp eri ence incarcerated inmates may can be critical. Newly guilt, fear, sadness, anger, feelings such as shame, ationship problems, legal agitation, depression, rel helplessness, which can concerns, hopelessness, and cide risk. contribute to increased sui s who volunteer to enter • Protective Custody - Inmate ecially high risk for suicide, esp protective custody are at uld be in SHU. These inmates sho during the first 72 hours vices immediately. referred to psychology ser are y Inmates - These inmates • Long-term Protective Custod a depression that can lead to particularly vulnerable to clo sel y whi le they cid e att emp t, and sho uld be monitored sui are in SHU. s - These ate s Tak ing Med icatio n for Mental Health Reason • Inm ts and developing suicidal though inmates are vulnerable to med ica tio n. sing on their attempting suicide by overdo be monitored to make sure they Inmates on medication sho uld n. Any signs of distress, are not hoarding medicatio or or sudden changes in behavi deterioration in hygiene, logy. should be reported to psycho THE PROBABILITY THAT AN INMATE FACTORS THAT CAN INCREASE MAY BECOME SUICIDAL: • Mental Health Factors History of mental illness ively psychotic? 1. Is the inmate depressed, act ant with psychotropic 2. Has the inmate been compli medication? eating, sleeping, hygiene, 3. Have there been changes in level? weight, recreation, activity Prior suicide attempt 1. How lethal was the attempt? n made? 2. How many attempts have bee SONY_000064SS EFTA_00000540 EFTA00134954 P5324.08 4/5/2007 Attachment B, Page 2 ect, and behavior Inmate's current mood, aff upset, angry, easily 1. Is the inmate emotionally agitated? ed (vs. Are the inm ate 's tho ughts clear and goal direct 2. nature)? delusional or psychotic in inm ate dep ressed , has there been a recent loss? 3. Is the even after the 4. Has hopelessness persisted depression has lifted? y property, revised a will, 5. Has the inmate given awa say his goodbyes? requested a phone call to ic Pain Medical Condition(s)/Chron ical • Doe s the inm ate hav e a chronic life threatening med 1. illness? health diminished recently? 2. Has the inmate's overall pain or other negative 3. Is the inmate experiencing symptoms? Relationship Difficulties Dear John letter? 1. Has the inmate received a its decreased? 2. Have communications and or vis the relationship? 3. Has there been a change in • Situational Factors ictment; loss of appeal to 1. Legal issues - pending ind reduce sentence. er inmates. 2. Difficulties with staff or oth 3. Gambling debts, drugs. with another inmate. 4. Ending of a close relationship assault. 5. Possible victim of a sexual INMATE BEHAVIOR REPORTING AND DOCUMENTING ate behavior(s) that is • Report Your Concerns - Any inm a change in mental health questionable and may reflect to the Shift Lieutenant status should be reported immediately. t of Inform the Shift Lieutenan • During non-working hours - if or. He/she will determine any questionable inmate behavi ds to be contacted. the on-call psychologist nee nges in inmate behaviors • Segregation Log Book - Any cha arding book. A detailed note reg should be noted in the log the log isable. Documenting in the observed behavior is adv a First, the entry serves as book serves two purposes. , it other staff members. Second means of communication for ft. t of activity during your shi provides an accurate accoun nal . t, legible, and professio Documentation should be nea SDNY_000064% EFTA_0000054 1 EFTA00134955 P5324.08 4/5/2007 Attachment B, Page 3 RGENCY RESPONDING TO A SUICIDE EME of erving an inmate in the act • A Segregation Officer obs nju rio us beh avi or, g other self-i committing suicide, causin wil l cal l for back- who app ear s to hav e com mitted suicide or ify the l. The officer will not up before entering the cel by rad io of the utenant's Office Control Center and the Lie BAC K-U P MUS T BE ate back-up. situation and request immedi A CELL. PRESENT IN ORDER TO ENTER on a ated in the storage closet • The "cut-down" tool is loc pon sib ili ty to officer's res shadow board. It is the #1 ft. Thi s too l is rt of the shi locate this item at the sta sit uat ion s. in emergency only authorized to be used l s too l is not permitted and wil Miscellaneous use of thi of the tool. result in dulling the blade the mits suicide, the scene of • In the event an inmate com ten t wit h the a manner consis suicide will be treated in ary to ate death. All measures necess investigation of an inm to sup por t evidence needed preserve and document the ise ns will be maintained or otherw subsequent investigatio adequately recorded. SDNY_00006457 EFTA_0O0O0542 EFTA00134956 P5324.08 4/5/2007 Attachment C, Page 1 "SAMPLE" INING MEMORANDUM DOCUME NTI NG MOCK SUICIDE EMERGENCY TRA DATE: 4/5/2007 TO: Name, Associate Warden FROM: Name, Operations Lieutenant ng Subject: Mock Suicide Emergency Traini ining a mock suicide emergency tra l Housing This memorandum documents in the Spe cia exercise occurred exercise. This training ay's date at 5:30 a.m. Unit on Morning Watch on tod Staff present were: Name, Psychologist t Name, Operations Lieutenan Name, Correctional Office r r Name, Correctional Office ice r Name, Correctional Off cell. involved a hanging in a SHU utenant The mock suicide emergency rat ion s Lie notifying the Ope Staff responded quickly in l, AED, appropriate keys to allow too and Control. The Cut Down n the cel l door ficient staff to ope access to the cell, and suf n XX minutes). were assembled quickly (withi poses. and response for training pur Staff discussed the exercise CAN BE ADDED TO ENDATIONS ARE MADE, TEXT (IN CASES WHERE RECOMM AND CORRECTIVE ACT ION TAKEN, e.g.) DESCRIBE THE RECOMMENDATION Cut Down the security cage housing the Staff suggested the key to Com pou nd ions Lieutenant's and tool be placed on the Operat ty work order has been initiated to uri Officer's key rings. A sec do this. e cide Prevention Training Fil cc: Psychology Services, Sui SDNY_00006458 EFTA_00000543 EFTA00134957