Adolescent Suicide• Girls are more likely to have suicidal ideation and attempt suicide• Young men aged 15 to 19 years are five times more likely to complete suicide• Juvenile suicide rates are the highest among American Indians and lowest among Asian/Pacific Islanders; however, adolescent Whites are the most common victims• Incarcerated juveniles have higher levels of suicide risk and complete suicides compared to the general youth population• Suicide attempts for incarcerated teens was eight percent higher and the injury rate after the suicide attempt was six percent higher than the national average• Approximately one in ten juvenile detainees had thought about committing suicide in the past six months, and one in ten had ever attempted suicide• Suicide was still the leading cause of death for adolescents detained in juvenile correctional facilities from 2002 to 2005
Predictors for Juvenile Suicide in the General Population• Predictors regarding suicidal ideation, attempts and completed suicide among youth include: mental health problems, substance abuse, histories of emotional, physical, and sexual abuse, prior delinquency, and previous self injurious behavior and suicide attempts Substance Abuse• Abuse of both drugs and alcohol significantly increases the likelihood of suicide and it increases even more in they also suffer from a mental illness Histories of Abuse• Personal trauma in terms of physical and sexual abuse is also associated with juvenile suicide• Physical abuse in early childhood can lead to poor social skills, an inability to interact and social isolation Self-Harm and Delinquency• The greatest predictor of a youth suicide is a past attempt• Almost one-quarter of juvenile suicides had engaged in prior attempts• A previous attempt represents a 30-fold elevated risk for completed suicide in boys and a threefold increased risk for girls• There is no one common factor between juveniles and completed suicides
Predictors of Suicides in Juvenile Correctional Facilities Mental Health Problems• Psychiatric disorders and a history of substance abuse are found in over 90% of completed juvenile suicides• The rate of mental illness is twice as high for juveniles inside the justice system• 74% of those completing suicide inside a youth facility had a history of mental illness and 53% of the suicide victims had been taking psychotropic medications at the time of their death• Anxiety and depression are prevalent among incarcerated youth who commit suicide• Traumatic stress and substance abuse are the best indicators of suicide risk in detained youth• Juveniles completing suicide inside residential facilities are often victims of emotional abuse, verbal abuse, neglect, excessive punishment, and general family dysfunction• Nearly 60% of youth in the juvenile justice system have been emotionally abused and 60% of juveniles who committed suicide while incarcerated had been emotionally abused• Over 50% of incarcerated youth suffer from post traumatic stress disorder (PTSD) which stems from witnessing traumatic events such as assaults or abuse
Predictors of Suicides in Juvenile Correctional Facilities Self-Harm and Suicide• In general, many individuals attempt suicide at least once before completing suicide• Many juveniles exhibit self-harm behaviors prior to attempting suicide• Self-harm (which often involves some form of self-mutilation) and suicidal behavior can be differentiated by three characteristics: lethality, repetition, and ideation• Self mutilation is typically low in lethality, but can be repetitive, often taking the form of cutting or “slashing”• Not all juveniles who harm themselves are suicidal – sometimes they do it to manipulate staff or to get attention• These acts tend to be “infectious” and if one youth engages in self-harm, others model that behavior and sometimes youth who do not intend on committing suicide accidentally kill themselves• Suicidal ideation is rare in those who self-harm• Approximately 22% of incarcerated juveniles had considered suicide, 20% planned an attempt, 16% actually attempted, and 8% were injured during their suicide attempt• Almost 72% of persons who committed suicide in juvenile detention had a history of suicidal behavior – almost one-third of these suicide victims had a history of suicidal ideation and almost one-quarter were involved in self mutilation prior to the deaths
Predictors of Suicides in Juvenile Correctional Facilities Isolation• Placing a youth in an isolated environment greatly increases the chance of suicide• The stark and dreary environment of these settings contributes to a youth’s depression• Almost three-quarters of suicide victims inside juvenile correctional facilities lived in single occupancy rooms• Death by suicide rises by a factor of seven (or 60%) in facilities that lock juveniles in their sleeping rooms• Removing these trouble youth from human contact tends to amplify feelings of isolation and hopelessness• Thoughts of desperation increase suicidal tendencies• When placed in cold, empty rooms by themselves, youth have little to focus on except all of their reasons for being depressed and the various ways that they can attempt to kill themselves
Suicide Prevention Intake Screening• The most prudent way to reduce the number of attempts and completed suicides in juvenile facilities is to screen all adolescents for suicidal behavior when they are first admitted• Screening involves a series of questions that ask a youth about his current mental health including feelings of depression, his likelihood of engaging in self-harm, if the youth has a plan to harm himself, the lethality of the plan, and his prior history• If a youth reports feeling depressed, hopeless or has a plan to harm himself, he is referred to a medical or mental health professional for further assessment and treatment• Approximately 70% of all juvenile correctional facilities reported screening all of their residents for the threat of suicide and 17% of facilities screen some incoming youth for suicide ideation• Over 20% of the facilities that experiences a completed suicide had no type of screening at intake• When some youth are initially admitted, they are sometimes under the influence, putting the youth at greater risk for self-harm or suicide within the first few hours of admission• In 2004, only one of 16 suicides had occurred within a day of the youth’s admission, 13 of the suicides had occurred after the residents had been incarcerated for more than two weeks – not until 75 days after admission were half of the reported suicides accounted for• 60% of victims placed in isolation were dead within 48 hours of their admission and almost 90% of the youth who completed suicides within 48 hours were intoxicated at the time of incarceration
Incarceration and Suicide Risk• Research shows that juvenile suicides were widely distributed throughout a 12-month period of confinement, not just the first few hours• There were just as many suicides (ten) in the first three days after admission as there were after a year-long incarceration period, with 70% of juvenile suicides happening within four months• A juvenile might commit suicide shortly after being admitted to a detention center because of feelings of despair and uncertainty• Some youth may harm themselves on the anniversary date of a loved one’s death or during the holidays such as Christmas or Thanksgiving if they cannot be with their families• A small number of juveniles also commit suicide shortly before their release dates because they fear their community reentry
Operational Factors• Deploying competent, well-trained and caring staff and having written suicide prevention policies are the best strategies to reduce suicides• Four specific suicide prevention measures: • Intake screening of all youth • Written procedures detailing how staff should help suicidal juveniles • Close observation of suicidal youth • Training the staff to manage suicidal juveniles• Facility staff should have at least eight hours of suicide prevention training before working with incarcerated youth and an additional two hours of training every year afterward• Hayes (2004) discovered that 43% of juvenile correctional facility employees received no pre-service, annual or periodic suicide prevention training – of those who had received some training, 65% had training which lasted two hours or less• 15% of those deemed to be mental health professional hired into juvenile facilities had only a bachelor’s degree or less formal training
Characteristics of Suicides in Juvenile Corrections Methods of Death• Hanging is the most common form of suicide in detention and treatment centers; between 80% and 93% of suicide victims in correctional facilities hanged themselves• Detainees have hanged themselves from exposed pipes in ceilings, doorknobs or bed frames – a noose can be fabricated out of cloth, wire, or even a plastic garbage bag• A study showed that over 70% of the victims relied on some sort of bedding to hang themselves, although belts, clothing, and shoelaces were also used• Even in suicide resistant rooms, youth have used toilets, sinks, and window frames as anchoring devices for a noose Victim Characteristics• Most adolescents in the general population who take their own lives are White and male – 80% of victims were male and almost 70% were White• From 2002 to 2005, almost 90% of the suicides were male, only 37% were White and almost 42% were Black
Time of Day and Suicide Checks• Completed juvenile suicides in custody do not appear to happen in the middle of the night when the staff to resident ratio is the lowest• Over half of the completed adolescent suicides occurred from 6:00 p.m. to midnight, while only 11% took place from midnight to 9:00 a.m.• The most common check for an at-risk or suicidal youth is at least once every 15 minutes• Almost half of completed suicides in juvenile facilities occur while the victims are being observed at least once every 15 minutes• Over 40% of completed youth suicides occurred while the juvenile was being monitored once every 15 minutes• 84% of all completed adolescent suicides happened when staff observations were done hourly• About 42% of the victims were under observation once every 15 minutes and almost 90% were being supervised at least once per
Cross-National Concerns with Incarceration Juvenile Suicide• Studies from the United Kingdom and Australia have demonstrated similar findings in regards to the rates of adolescent suicides in residential settings• Australia’s youth suicide rate has been one of the highest in the industrialized world• Suicide rates among incarcerated Australian youth are four times higher than their national average• Evaluations over a 12-year span have indicated consistent relationships between mental illness, substance abuse, delinquency, and youth who committed suicide in Australian facilities• Studies in the United Kingdom found higher rates of completed suicide among those juveniles with histories of self-harm• Failure to screen juveniles at intake for suicidal ideation and inadequate staff training also occur in the U.K.
Conclusions• Common factors in most successful juvenile suicides are mental illness or other disabilities, histories of emotional, physical, sexual, substance abuse, and a predisposition for self-harm• Intake screening, written policies, and staff training specifically aimed at identifying those in need of suicide prevention are not mandatory in all jurisdictions• Suicides in custody are preventable and a first step after acknowledging the problem is to recognize that failures by staff are often a significant contributing factor to these tragedies• Some residential placements have no mandatory, suicide reporting policies• There is no centralized body that collects data about suicides in group or foster homes or other privately operated juvenile facilities – if an adolescent commits suicide, a governing or regulatory body is not contacted and statistics are not gathered• Many suicides go unreported
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