In 2013, 46 of every 100,000 jail inmates committed suicide, marking nearly four times the suicide rate for the total U.S. population, according to a report published by the Bureau of Justice Statistics. That number triples to 128 deaths per every 100,000 former detainees a year after jail release, said Lauren Weinstock, associate professor of psychiatry and human behavior.
Weinstock, along with her co-investigator Jennifer Johnson, associate professor of public health at Michigan State University, recently received a $6.8 million grant to test whether a new intervention — the Suicide Prevention for at-Risk Individuals in Transition — can help lower these numbers.
“People in jail tend to have higher rates of mental health and substance abuse difficulties,” Weinstock said. “We’re focusing on this vulnerable group of people during an acute crisis and helping them transition during that time.”
Weinstock and Johnson plan to enlist 800 detainees released from the Rhode Island Department of Corrections jail in Cranston, Rhode Island, and the Genesee County Jail in Flint, Michigan to participate in a trial of the intervention.
As part of the trial, participants will be assigned to either standard care or the Safety Planning Intervention, conducted by local mental health clinicians.
The Safety Planning Intervention will focus on providing detainees with resources they can take advantage of if suicidal thoughts arise in the years after their release.
Trained mental health providers will work with the detainees while they are still in jail to formulate a safety plan — a list of important family members and friends to contact, methods for managing suicidal thoughts and information about public resources such as the Samaritans 24-Hour Crisis Hotline.
Those same clinicians will also check back with the individuals at various times post-release through follow-up phone calls.
“The detainees spend time with the interventionists going through the safety plan, so all of it is literally spelled out on a piece of paper they can take with them when they leave jail,” Weinstock said, adding that the follow-up phone calls will supplement the safety plan and provide additional support.
Josiah Rich, professor of medicine and epidemiology and the co-founder of The Center for Prison Health and Human Rights at Miriam Hospital, who is not involved with the trial, said offering detainees help during this critical time is crucial.
“You would think being released from incarceration is a joyous occasion, but it’s actually more difficult. You have to worry about a whole lot of things you didn’t have to before — basic things, like where you’re going to sleep and how to get your next meal,” Rich said.
The trial will track the former detainees over the span of four years, examining suicidal behavior, psychiatric and substance abuse outcomes and re-arrest rates, according to a University press release.
Rich said the high suicide rate of incarcerated individuals likely coincides with a high rate of mental illness. “The question needs to be asked: Is this system working? We’re locking up the mentally ill. We’re locking up people with addictions. They need treatment — they don’t need to be locked up,” he said.
As a clinician at the Rhode Island Correctional Facility, Rich provides specialized care and advocates public health policy changes to improve the health of people with addiction.
“The whole system is fundamentally unfair. The people who end up spending time incarcerated are different from everyone else, and it’s not because of the crime they committed,” Rich said. “It’s because of who they are in terms of their poverty, their zip codes, their race and their opportunities in life. This is not the land of the free where everyone has equal opportunity. Most people do not … so we have to re-do this system.”
Weinstock and Johnson designed the study with an eye toward eventual implementation. By hiring local therapists, Weinstock hopes to develop a realistic method for community intervention. The researchers have also included several stakeholders in the study, including the Rhode Island Department of Corrections and the Providence Center, an organization that provides supportive services to those affected by psychiatric illness or addiction.
“With important input from the stakeholders at this stage in the research, we are optimistic that we can integrate their feedback into the research study to increase the odds that this will become adopted,” Weinstock said.
