Mass. Department of Correction releases Hayes Report
on Suicide Prevention Strategies
"The incidence of suicide in the DOC was greater than in prior years, and we know that nationally the number of mentally ill entering the prison system is increasing. In order to determine what steps are necessary to improve preventive practices within the DOC, we sought the assistance of a national expert," said Commissioner Dennehy. A contract with Lindsay Hayes, Project Director for the National Center on Institutions and Alternatives, Inc., in Mansfield, MA, was signed in July 2006 with the review beginning in September 2006 and extended to include the three tragic suicides that occurred in December 2006.
The Technical Assistance Report on Suicide Prevention within the Massachusetts Department of Correction was completed January 31, 2007 and gives 29 recommendations categorized within eight critical components of a suicide prevention policy. Those eight critical components are: staff training, identification/screening, communication, housing, levels of supervision, intervention, reporting, and follow-up/mortality review. The DOC appreciates the comprehensiveness and practicality of the report, is committed to implementing its recommendations and has completed an expedited planning process to do this.
A summary of the recommendations follows, and the full report, as well as the DOC Corrective Action Plan, is available on the DOC website ( www.mass.gov/doc):
Staff Training - Four recommendations address pre-service and in-service suicide prevention training hours, curriculum and staff to be trained, and revisions to both DOC and University of Massachusetts Correctional Health (UMCH; DOC's health care provider) suicide prevention policies.
Identification/Screening - Four recommendations address medical assessment of inmates returning from court; the requirement that sending agencies complete and submit a brief discharge/transfer form to DOC documenting any immediate concerns about the newly arrived inmate; access to and updating of the Q5 Inquiry section of Criminal Justice Information System (suicide attempt history while in lock-up) and medical and mental health screens on DOC IMS; and the development of alternative placement options.
Communication - Two recommendations address the process for developing and maintaining inmates on the Mental Health Risk List and a quality assurance process to audit selective security files and health care charts.
Housing - Seven recommendations address increasing the number of and making watch cells as reasonably "suicide-resistant" as possible; the revision of the suicide precaution policy, ensuring sufficient staff to provide proper level of observation as well as out of cell time; clinical judgment regarding placement and length of stay on suicide precautions; 15 minute security rounds on in-patient health service units; non-sanctioning of self-injurious behavior; and creation of transitional housing and/or step-down process for inmates discharged from mental health watch.
Levels of Supervision - Seven recommendations address the description of type of behavior and/or circumstances necessitating a specific level of observation; the deletion of 30 minute observation status for suicidal inmates; the correct use and placement of "Correction Officer Observation Check Sheet" and "Mental Health Watch Form;" prohibition of inmates on suicide precautions covering their heads with bedding; 30 minute security rounds on special housing units, including residential treatment units, with auditing; revision of UMCH suicide prevention policy regarding downgrading and discharging inmates from suicide precautions with documented risk assessment and justification for levels of observation, with auditing. In addition, they address all inmates discharged from suicide precautions remaining on mental health caseloads and receiving regularly scheduled follow-up assessments; and the use of administrative or security watch versus mental health watch.
Intervention - Four recommendations address revision of DOC and UMCH policies regarding the emergency response to attempted suicides, equipment, and training.
Reporting - There are no recommendations for this component.
Follow-up/Mortality Review - One recommendation addresses the excellent existing policies and practices regarding the mortality review process and suggests the development of a more formal corrective action plan in response to mortality review recommendations.
The Hayes Report states: "I have met numerous DOC and UMCH officials and supervisors, as well as officers, nurses and clinicians, who were genuinely concerned about inmate suicide and committed to taking whatever actions were necessary to reduce the opportunity for such tragedy in the future. And based upon a pro-active approach and high caliber management and line staff, I am confident that implementation of the various recommendations contained within this report will result in successful efforts to reduce the likelihood of future inmate suicides within the Massachusetts Department of Correction."
In addition to implementing the 29 recommendations contained in the Technical Assistance Report, the Department of Correction is also reviewing all policies, procedures and practices as they relate to the management of mentally ill offenders, such as:
- Redefining the role and operation of the Departmental Disciplinary Unit (DDU).
- Establishment and expansion of suitable programs in the DDU.
- Development and imposition of time frame limitations on length of time to be served in the DDU.
- Establishment of different levels of privileging, depending on status, in segregation units.
- Alternative placement to DDU and and/or segregation units.
- Identification of objective and measurable diagnostic criteria to be utilized for contraindications for segregation placement or continued placement.