Corrections authorities once believed that suicidal jail inmates could be kept from killing themselves by housing them in "isolation" cells. A dramatic turnabout in this view occurred, however, when they began to see a strong relationship between isolation and successful inmate suicides. The prevailing belief now is that the isolation itself is pernicious and fosters suicidal behavior.

In fact, neither viewpoint is correct, according to forensic psychiatrist Alan Felthous, M.D. Using isolation as a suicide prevention strategy can be successful, he maintained, but only when accompanied by additional measures, including improved staffing patterns, that encourage closer inmate observation and "complete disarmament."

Felthous, chief of the forensic service and a professor of psychiatry at the University of Texas Medical Branch in Galveston, presented his ideas on the disturbing link between isolation and jail suicides at the annual meeting of the American Academy of Psychiatry and the Law in October. He emphasized that psychiatrists and mental health professionals have not done enough to convince corrections officials that "suicide prevention policies can be both effective and humane."

One dilemma for these officials is that while isolation seems to "fuel the flames of self-destructive impulses," the alternative of placing suicidal inmates in the general population makes it impossible to keep them away from every potentially harmful type of material or instrument, he said.

Most of the studies that have provided the data tying suicide to placement in isolation cells, however, failed to document the degree to which inmates were effectively "disarmed"--that is, had every potential means of committing suicide removed from their possession. While shoelaces, belts, and sharp objects are routinely removed from these inmates, jail staff overlook the fact that "virtually any cloth material" including clothing can be an instrument of suicide. Moreover, paper products, which "in addition to being flammable, can be twisted, twined, and braided into a cord with impressive tensile strength," he noted.

The only successful alternative to the expensive strategy of continuous observation is "complete disarmament"--preventing access to "all cloth, paper, plastic materials, sharp instruments, and fire-setting materials."

While continuous observation may not be a tactic likely to be implemented by short-staffed jail officials, a level of observation well above the current norm is critical to suicide prevention, because it provides inmates in "austere" isolation conditions periodic human contact, he said.

One potential strategy for increasing the amount of observation of suicidal inmates that has had success in New York City jails is to assign "trusted inmates" to provide continuous observation. The suicidal inmates need an opportunity to communicate their self-destructive feelings to some other person; when inmates are left alone in their cells, staff have no chance to identify signs of suicidal intent.

"Virtually complete withdrawal of social and psychological support undoubtedly can worsen a person's mental state," which may partly explain the link between jail isolation and suicide, Felthous added.

Other factors contributing to the link are that inmates who intend suicide may take steps, including harming themselves or expressing terror about being placed with other prisoners, to ensure that they are housed in isolation cells, he noted. Even when not isolated, however, "the seriously suicidal inmate can be expected to look for an opportunity to be alone or wait until other inmates are asleep before taking his life." At minimum, cells used to house suicidal inmates must have "crossbars and other attachments" removed.

"Isolation alone is never an appropriate response to acute suicidality," he emphasized. "If suicidal inmates are isolated without implementation of any other preventive measures, it is no wonder that they kill themselves." He pointed out, though, that he "has not found a single example" in his experience or in the literature "where an inmate completed a suicide while in a single cell, divested of potentially dangerous materials and observed closely."

(Psychiatric News, November 15, 1996)