Inmate threatens suicide...

lm8539 · Dec 17, 2009

This would be my answer:

1.) I would treat the threat as if I thought he was serious, you should never assume a patient is using attention seeking behavior.

2.) I would tell the patient there was no need to hurt himself. And ask him questions about how he was feeling and why he was feeling that way.

**I don't know what to do based on what the patient says and what the resources are....what if he misses his family or hates his life? Do I try to contact the family and ask them to visit or write a letter? Do I encourage him to reach out to family members? Do I give him a copy of the bible?

3.) I would keep him for observation, being sure that there were not items around that he could use to hurt himself.

4.) I would notify the doctor of the situation.

5.) Are there psych units or psych consults in prison? I'm not sure what the resources are...

6.) What else? I would appreciate the help...

2M896 · Dec 18, 2009

For number 2, you should never try to contact an inmates family... Because inmate phones and mail are monitored, inmates sometimes try use staff to communicate with people outside the prison, but this isn't allowed. If, for some reason, they can't contact family/friends themselves, they need to discuss that with their unit counselor.

Prisons do have mental health services. In the prison I worked at, if an inmate threatened suicide during a weekday while mental health was there, they handled it. On nights and weekends, a nurse would talk with the patient and then contact the on-call mental health professional and explain the situation, and the MHP decided how to proceed. Usually, the MPH would speak to the inmate over the phone, sometimes "contract for safety" (meaning the inmate would agree not to hurt himself), and then mental health would follow up in-person with the inmate the next day. If the MHP thought the inmate was an immediate risk and couldn't wait for an in-person follow up, they contacted the on-call psychiatrist, and the psychiatrist gave a verbal order for the inmate to be placed in an observation cell.

Orca, ADN, ASN, RN · Dec 18, 2009

For number 2, you should never try to contact an inmates family.

We never contact the family about these matters, for several reasons. There are procedures for inmate phone calls, and we do not allow inmates to use us to circumvent them. Secondly, I don't want word to get out on the yard that inmates can get phone calls by threatening suicide. There is also the issue of allowing inmates' families to contact medical directly. Inmates' families talk to one another on online forums, and if an inmate's family was ever given direct contact information for the medical department or DON you can bet it would be posted online within 24 hours and we would be buried with calls about individual inmates.

We treat every suicidal threat as real, even if we are almost certain that it is a manipulation. If it is during regular business hours we notify mental health staff so they can do a direct intervention. If it is after hours or on a weekend we admit the inmate to the infirmary on suicide precautions until the inmate can be assessed by mental health.

Quiskeya · Dec 18, 2009

I am a correctional nurse, when an inmate threatens to harm him/herself wether they are attention seekers or not I would take the threat SERIOUSLY. I have found out working in this field that a great number of our inmates have some type of metal disorder/problems. We deal with folks that suffer anywhere from depression all the way to schizphrenia. During med pass it seems like almost everyone takes some type of psych meds. That been said, I would suggest you treat every threat as if they were to truly carry it on.

katkonk, BSN, RN · Dec 22, 2009

We treat every suicidal threat as real, even if we are almost certain that it is a manipulation. If it is during regular business hours we notify mental health staff so they can do a direct intervention. If it is after hours or on a weekend we admit the inmate to the infirmary on suicide precautions until the inmate can be assessed by mental health.

Absolutely admit them to a psych or observation cell. If they are trying to manipulate you, then they may think twice about it after being stripped and given only a blanket for the entire night. (Our process is to issue them only a blanket in a solitary cell so they have nothing they can harm themselves with.) If the threat is legitimate, then you have them where you need them. MH is obviously your first point of contract and should guide the way the inmate is handled. Also, there should be a nursing protocol written at your facility for this.

Orca, ADN, ASN, RN · Dec 30, 2009

If they are trying to manipulate you, then they may think twice about it after being stripped and given only a blanket for the entire night.

That is an added bonus. Sometimes the inmate will admit that he/she wasn't serious, and I always reply "You threatened to kill yourself. That sounds serious to me." Inconvenience and discomfort can have a great deterrent effect.

In a medium-security facility I once worked in, we had two holding cells in the front of the infirmary with concrete benches. If we got an inmate who was yanking our chains or just wanting attention, he might be on "observation" for three or four hours after the actual assessment. After an hour or so on the bench the inmate was usually begging to go back to his unit. I would tell him that I had to make sure he was stable before he went back (especially if he was one of the fake chest pain bunch). Getting the doctor to admit him to the infirmary overnight for observation when he doesn't want to be there also works (but only if you have the beds).

tunafish1800 · Dec 31, 2009

If on your shift, a patient told you that he wanted to kill himself, and you suspected that it might be attention seeking behavior, what would you do?

Ask him if that was his purpose... depending on his response we would discuss it there or refer the offender to mental Health services, If he can not contract with you to be safe, and not make a suicide attempt then custody needs to be involved immediately to assure the inmates safety