Factors related to suicide in New York state prisons.

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.

Predictors of general and violent recidivism among SMI prisoners returning to communities in New York State.

Correctional and forensic mental health systems throughout the country are routinely called on to manage and provide treatment for mentally ill prison inmates. This study identifies criminal justice and mental health predictors of general re-arrest and re-arrest for violence in seriously mentally ill (SMI) persons leaving prison in New York State. Both length and diversity of criminal history predicted general re-arrest, as did substance abuse diagnoses, participation in community mental health treatment, parole supervision, and coordinated parole and mental health services. Only demographics and criminal justice measures were predictive of re-arrest for violence. The rate of re-arrest for violence in this SMI sample was lower than that of general prison release populations.

The effect of length of hospitalization on re-arrest among insanity plea acquittees.

State psychiatric hospitals are increasingly populated by forensic patients. In New York State, the growth in the forensic population is largely attributable to increased lengths of stay of patients deemed not guilty by reason of insanity (NGRI). This research was conducted to determine whether longer periods of hospitalization are associated with better outcomes in the community, as measured by re-arrest for any offense and re-arrest for violence. The sample included 386 NGRI patients released into the community in New York State. A Cox regression proportional hazards model was used to assess the unique effects of length of hospitalization on re-arrest. The results showed that the length of treatment had little effect on either measure of re-arrest. Re-arrest was largely explained by demographics and prior criminal histories.

Reducing suicides in New York State correctional facilities.

In an effort to identify modifiable risk factors for suicide in New York State prisons, the authors reviewed available statistical data and also examined a series of 40 psychological autopsies conducted on suicides of inmates who had received mental health services during their incarceration. Factors associated with suicide included substance abuse, history of prior suicide attempts, mental health treatment prior to incarceration, recent "bad news," recent disciplinary action, and manifestation of agitation and/or anxiety. This review led to changes in certain clinical policies and procedures, environmental modifications and hazard reduction in observation cells, and an improved process for quality assurance reviews of suicides.