Suicide Precautions

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October 7, 2014 by The Jailhouse Doc

I have already written about suicide protocol,.. and some of this has already been articulated, but I feel compelled to write more about it.  More about how it feels for ME to have the power that I have, and how the inmate must feel when put on suicide precautions.  This issue in particular reinforces this sense of “other worldliness” that is the jail.  What I have to do is so far removed from how you interact with other normal human beings out in the real world, that sometimes I just an bewildered by the idea that I have the power to strip someone of so much.

If a patient is deemed in anyway to be at risk of self harm, or harming others, they need to be admitted to a “safe cell.”  These cells don’t have any furniture, and the patient is watched closely to ensure they don’t do anything to themselves until they are released by the psychiatric team.  But here’s the frustrating part:

Most people put on suicide precautions aren’t really suicidal.

More on that in a moment.

It’s no shock to think that the jail is a highly stressful place- even people without any mental health issues on the street can behave bizarrely once incarcerated.  It can be overwhelming to find yourself with little power and little control.  People with diagnosed mental illnesses can either get better because they’re finally getting treatment, or they get worse because there are so many stressful triggers.

People are lonely.  Frustrated.  Angry. Sad. Tired. Overwhelmed. Desperate. Hungry for something other than bologna.  Uncomfortable.  Unable to sleep.  In pain.  Restless.  Suspicious.  Vengeful.  Manipulative.  Apathetic.  Anxious. Defensive.  Demanding. Entitled.  Defeated.

When you are experiencing these wide ranges of emotions, you say and do things you might not on the street.  When you have no control over what you eat, wear, where you sleep, when you go to bed, what you can and can’t do, and you can’t change your circumstances no matter how angry you are,… again, you say and do things you might not do elsewhere.

The problem is, because suicide in jail is a major problem, you have a large population of hyper-vigilant officers who have been trained to report any slight change in behavior paired with this highly stressed, largely mentally ill population of human beings that say and do all manner of things when they are desperate.

And that’s where I come in.  They officers call ME.

And now it’s my job, and my license and job is on the line to make a decision on whether or not that inmate needs to be put on suicide watch.  It is one thing when people actually have a history of hurting themselves, suicide attempt, and voice a true threat or thoughts of self harm.  That one’s easy.  It’s the rest that are hard.  It’s the patients who swallowed something to go to the hospital.  The ones who said something out of exasperation that was misconstrued.  The ones who make a threat that seemed reasonable to them at the time, something like,.. “I’m going to lose it if I don’t get out of this cell.”  “I don’t know if I can take it anymore, I don’t know what I might do.”  They are the ones who win themselves a trip to the safe cell, and the shit hits the fan because “I’M NOT SUICIDAL!!!”  “I didn’t mean it!”  “I was just frustrated!”

Wouldn’t we all be?  I mean, how abnormal would it be for any normal person to feel like they might lose it?  Especially when you think about the fact that most of the inmates are not only stressed about their legal situation, but also the stress of poverty, drugs, death and violence around them.  Oh and their depression.  I mean, really.  Any normal person would throw their hands in the air, desperate for a break.

But, once someone has said or done something, not to be ironic but now my hands are tied- because if I dismiss them without putting them on precautions because I don’t think they are suicidal, and they end up hurting themselves, that’s my job, license and possibly a lawsuit.

Let me tell you what it means for me to put someone on suicide precautions.

We take their clothes.  ALL of them.  They get to wear a little “smock” or dress, essentially, made of thick material that they can’t destroy or use to hurt themselves.  Or a gown made of paper.

We take their belongings.  They can’t have ANYTHING in the cell.  No book, even.  Hey- you can try to choke yourself on paper.

Depending on the severity of their threat, they may or may not have a mattress or blanket.

No shoes.  No socks.

Finger foods only.

If they need toilet paper, they have to ask for it.

And they sit.  And wait.  In silence.  Undignified.

Until they are evaluated by psychiatry and released, which, could be days of evaluation before release.

I have this kind of power over real human beings.  I have the power to determine whether or not they even get a blanket.  I get to go home to my warm bed, knowing that right at this VERY second, there are inmates on suicide precaution sleeping on the concrete in a little smock because they said or did something that they maybe didn’t even really mean, but had to be taken seriously.

I get that they are in JAIL.  I get that they forfeited those rights when they violated the law (but keep in mind- all my inmates are innocent until proven guilty, and many of them are awaiting their day in court).  I get that we can’t take the risk of someone hurting themselves.  I’m not saying that this needs to stop, that there is some wonderful alternative, there isn’t right now.  But it’s really overwhelming as a compassionate person who wants to fight for justice, wants to live out the prophet Isaiah’s word of bringing freedom and justice to the oppressed, that I, I am the one with the power to reduce a powerless inmate to what many of them have voiced to me as feeling like they’re treated like “animals.”  Now, if you think about human rights violations, they’re not being abused in anyway, but if it was YOU, or ME in that position.  Or YOUR mom or dad, brother or sister.  I can’t put the face of my mom or dad on the bodies I see through the glass window, begging me to let them out.  I just can’t even picture it.  That’s why it’s so other-worldly.  It feels like a bad dream, and I’m the perpetrator of some injustice against them, at least in their minds.  Last night a distraught female was screaming, crying, accusing me of not caring.  Not giving a shit.  Lying to her.  Treating her like an animal.  ME.  Me who took a job in a jail because I wanted to confer dignity onto a marginalized population of people.  See, she had no concept in that moment, through her hysterics and despair that there is even a chance that my heart breaks to see that she’s even in jail, addicted to drugs and struggling to survive in this world.  I’m the heartless bitch who locked her in there.  I’m the heartless bitch that gets to go home to my comfortable house.  And here I am right now, in my fleece pajamas, drinking hot chocolate.  She’s probably still in that room, feeling like an animal.  I mean, come one.  I’d feel like an animal too.  And that’s what is so gut wrenching about the power I have.

I think about the IJM volunteers and employees who get to go to jails and prisons and be encouraging, fighting for the release of those wrongfully incarcerated.  I resonate so much more on a heart level with what they get to do.  It is so hard to be seen as the enemy.  No matter how much I plead that we have to follow the protocols.  That I wish there was another way.  That I HEAR them in their desperation.

She, of course, is an example of the inmates who take it really hard.  Some inmates are calm, understanding, and cooperative.  Like the guy who carved the initials of his dead brother into his arm because he misses him, and is on suicide precautions for self mutilation.  I mean, that act had meaning to him, helped him cope with the loss in his life, but you just can’t do something like that in a jail.

Sometimes I wonder if the whole production involved with suicide precautions makes things worse for people, rather than “protecting them”.  I can see why it might feel like a punishment.  For people who are truly suicidal and had the courage to say something, it feels like a punishment.  Maybe next time they won’t say anything.  For those who are in there for making threats in order to try and get something they wanted, it feels like a punishment for acting out.  And yet, you have to play ball in jail, because nobody’s going to risk losing their job in order to appease an inmate.  You try to fight the system either physically or by making threats, you land in “the hole,” or lockdown, or the other lockdown- suicide precautions.  You don’t get to “win” in jail.  You aren’t the one with the pepper spray and radio.  Regardless of how unfair the circumstances are, and sometimes power IS abused in the jail (it’s run by people after all) you don’t get to win.  You’re not going to “show” anybody.  You just give the powers that be the opportunity to practice their use of force. And if there’s any question of self harm, I am part of that machine of power that strips you of your freedoms even more.

I wish I could communicate effectively to each patient that I put on suicide precautions that I care about them, their safety, their health.  I want their circumstances to change, I want them to change their life, I think their life matters.  I don’t want to punish them.  I wish it didn’t have to be this way.  But, I feel like most of the time they don’t believe me.  And why should they?  I’m sure they feel like the system has let them down enough as it is.  I’m just another privileged white woman who can’t possibly understand what it’s like to be them.  And they’re right about that part.

So,… I don’t know that there’s anyway for me to win in these situations.  I know my own heart and why I’m truly working there.  I just never want to become jaded about power and freedom.  I want these issues to always bother me.  Because I want humanity to be better.  I want better ways of really “correcting” people, so that they are able to be successful in society.  I want people with mental health issues to have access to treatment.  I don’t have a problem putting someone on suicide precautions because the voices in their head told them to do something bad, but how do we help people like that in our community avoid these crisis situations altogether?  I can’t change the system, but I can take hope in knowing that there are good people trying to change it.

No matter what I do, however, I will never forget the images in my mind of people stuck behind a metal door, pleading with me through a glass window.  Pleading for freedom.

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