Episode 8: How Jails Prevent Suicide
And Why It's So Hard
Suicide prevention is one of the most important responsibilities of jail mental health systems. In this article, the focus is on why suicide is such a significant risk in jails, how to build a layered suicide prevention system, and what suicide watch should look like in practice.
This discussion approaches suicide prevention from an operational perspective. It is not a tutorial on how to conduct a clinical suicide risk assessment. That topic will be addressed in a separate article.
The First Three Rules of Jail Mental Health
Jail mental health has a few core rules.
The first rule is that no one dies in the jail.
The second rule is that no one dies in the jail.
The third rule is to remember that suicide is statistically the most likely way someone will die in a jail.
With those rules in mind, suicide prevention must be approached as a system with multiple overlapping layers of protection.
Intake Screening and Early Warning Signs
The first layer of suicide prevention begins at intake. Medical staff should ask arresting officers whether the individual made any suicidal statements or engaged in concerning behavior during the arrest.
The inmate should then be asked directly about suicidal thoughts during the nursing intake assessment. At the same time, medical staff should remain alert to behavioral and physical indicators of self-harm risk, even if the inmate denies suicidal intent.
These indicators may include:
Cuts or scars on the wrists, arms, or legs
Flat affect, vacant expression, or marked withdrawal
Statements suggesting hopelessness or a lack of desire to live
Examples of passive suicidal statements include phrases such as “I just want to go to sleep forever” or “I will never leave this place.”
Any of these signs or statements should result in the inmate being held in a location where they can be observed until mental health staff complete a more thorough evaluation.
Placing an Inmate on Suicide Watch
If mental health staff determine that an inmate is at risk for suicide or self-harm, the inmate should be placed on suicide watch. Some facilities refer to this as Close Observation, which is a more flexible term that allows observation for reasons beyond suicide risk.
At this point, the inmate should be housed in a mental health unit if one exists. If not, the inmate may be placed in a medical unit or another designated observation area. Whenever possible, the inmate should be housed in a suicide-resistant cell.
Suicide-Resistant Cell Design
A suicide-resistant cell is designed to minimize ligature opportunities. Ligature-based hanging is the most common method of suicide in jails, making ligature points the primary environmental hazard.
Key features of a suicide-resistant cell include:
Minimal or no ligature points
A single bunk made of composite material without sharp metal edges
No desks, chairs, or tables
No electrical outlets
Bright lighting controlled from outside the cell
A secure door with no gaps that could be used to anchor fabric
A metal mirror rather than glass
The cell should contain only a bed and a toilet.
Fire suppression systems also deserve attention. Tamper-resistant sprinkler heads are not tamper-proof. If an inmate damages a sprinkler head, the exposed fixture can become a ligature point. In such cases, the inmate should be moved or the cell repaired immediately.
The Role of Cameras
Cameras in suicide-resistant cells serve two purposes. First, they provide secondary observation. Cell feeds can be displayed in officer booths or counseling offices, increasing the likelihood that concerning behavior will be noticed quickly.
Second, cameras act as a deterrent. Inmates who know they may be observed are less likely to attempt self-harm. This mirrors the logic behind the Panopticon design (watch the video to learn more), where uncertainty about observation discourages dangerous behavior.
Although cameras reduce privacy, courts have consistently held that inmate safety outweighs privacy concerns in these contexts.
When Suicide-Resistant Cells Are Not Available
Facilities without suicide-resistant cells may need to house inmates on suicide watch in traditional cells. In those situations, housing suicidal inmates together can provide an additional layer of protection.
It is difficult for an inmate to attempt suicide without interruption when another person is present. Cellmates are likely to alert staff if they observe dangerous behavior.
Observation Checks and Timing
The primary method of monitoring inmates on suicide watch is direct visual checks, often referred to as checks or clocks. Staff physically observe the inmate at random intervals ranging from every 7 to 15 minutes.
This timing is intentional. Approximately 90 percent of jail suicides occur through hanging or self-asphyxiation. Irreversible brain injury can begin after approximately five minutes without oxygen, with death or severe injury likely after ten minutes.
Randomized checks prevent inmates from timing suicide attempts between observations. Some facilities layer additional officer rounds on top of mental health checks, increasing observation frequency even further.
Clothing and Property Restrictions
Inmates on suicide watch are issued suicide-resistant smocks, typically made of durable canvas material that is difficult to tear or fashion into a ligature. Footwear is limited to soft shoes or sandals.
Initially, inmates may have only a mattress and no additional property. As risk decreases, privileges can be gradually reintroduced. Suicide watch is inherently restrictive and uncomfortable. While these conditions reduce risk, prolonged exposure can worsen mood, so restrictions should be eased as soon as it is clinically safe to do so.
Daily Clinical Contact and Treatment
If staffing allows, an advanced-level mental health provider should meet with inmates on suicide watch daily. These visits are often brief but provide continuity and monitoring.
Medication management may be part of treatment, though medications are not typically forced. Antidepressants are commonly prescribed when appropriate, while recognizing that medication alone is not a complete solution to suicide risk.
Authority to Place and Remove Suicide Watch
Any staff member should be able to initiate suicide watch temporarily if there is concern for safety. The inmate should remain under observation until mental health staff complete an evaluation.
Decisions to discontinue suicide watch should, at a minimum require approval from both a licensed prescriber. In my jail, I instituted a policy which requires both a licensed prescriber and a behavioral health supervisor to agree to rescind suicide watch. Requiring two clinical approvals provides both safety and accountability.
Step-Down and Follow-Up
After removal from suicide watch, inmates should transition to a step-down housing unit if available. If not, temporary placement in mental health or medical housing may be appropriate.
Follow-up appointments are essential. A common model includes check-ins after one day, three days, and one week to monitor for recurrence of suicidal thoughts.
Movement and Release Considerations
Any movement of an inmate on suicide watch should require approval from a licensed mental health staff member. This includes court appearances, transfers, hospital visits, and release.
Release presents particular risk. Individuals released from jail experience suicide rates significantly higher than the general population during the first year after release.
If an inmate is released while on suicide watch, a mental health evaluation should occur immediately. Depending on findings, this may include safety planning, family involvement, or emergency psychiatric detention if necessary.
Summary: A Layered System
Effective suicide prevention relies on multiple overlapping protections:
Intake screening
Staff awareness and reporting
Mental health evaluation
Suicide-resistant housing
Frequent observation checks (or clocks)
Video monitoring
Clinical follow-up
Controlled movement and discharge planning
No single measure is sufficient. Each layer reduces risk incrementally, making suicide less likely and more difficult to carry out.
This layered approach is how jails reduce the most common cause of death in custody and uphold the most important rule of jail mental health: no one dies in the jail.