This Patient Needs to Be Seen by Mental Health, But When?

This morning, inmate Gibbs had a visit.  The nurse passing medications in the housing unit noticed that he was not ready when his name was called.  Unusual.  Mr. Gibbs is typically aware of his visits and is up and ready at least five minutes before it’s time to go.  The nurse asked Mr. Gibbs if he was feeling ok.  Mr. Gibbs just shrugged and left the unit for his visit.  Later that day, the nurse noticed that Mr. Gibbs was not out in the day room playing cards with others, like he usually is.  The nurse walked by Mr. Gibbs’ cell and noticed he was just lying on his bunk looking at the ceiling.  The nurse asked again if everything was ok and Mr. Gibbs stated, “Just not my day.  Things aren’t working out for me.  That’s the problem with hope, you always get disappointed.”  “Anything I can do?” the nurse asked.  “No, man.  Thanks.  Just gotta do what I gotta do.”

Every individual who works in a correctional setting has unique experiences with inmates.  Based on your role, your personality, your style of interaction and how others perceive you, you are likely to see and hear things that others do not see and hear.  In the above example, the nurse has a unique perspective on what’s happening with Mr. Gibbs. 

Do not underestimate the value and importance of what you see and hear.

When you notice things are out of the ordinary, ask questions.  If the answers leave you feeling unsure, make a referral. 

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Suicide – Don’t Be Afraid to Ask

It’s September, which is National Suicide Prevention Awareness Month.  Let’s start with awareness. According to the Centers for Disease Control, rates of death by suicide have increased in this country by 35% from 1999 to 2018.  More specifically, the rate has increased by 2% every year from 2006 to 2018.  The overall rate of death by suicide in 2018 was 14.2 people per 100,000.  For men, the rate is higher than the rate for women, with a suicide rate of 22.8 per 100,000 for men and 6.2 per 100,000 for women.  The rate for women, however, increased by 55% between 1999 and 2018.

According to the most recent data released by the Bureau of Justice Statistics, the rate of death by suicide in state prisons was 21 per 100,000 up from 14 per 100,000 in 2001.  In federal prisons the rate in 2016 was 12 per 100, 000 down from 13 per 100,000 in 2001.  In local jails, the rate of death by suicide in 2016 was 46 per 100,000 down from 48 per 100,000 in 2000.

These rates tell us despite our efforts in training, education and suicide prevention within our jails and prisons, people are still choosing to take their own lives.

Suicide is the intentional ending of one’s own life. Think about that.  Just sit and think about the fact that thousands of individual human beings, every year, decide that the life they have should end.  Many of these individuals experienced emotional and cognitive distress beyond what they believed they could handle and saw death as the best possible choice in the moment.  They likely felt alone, isolated, trapped and hopeless.  Like there was nowhere to turn. We can change that.

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Mental Health Screening – Set Up for Success

It was a holiday weekend in the middle of the night.  The booking area of the jail was a big, open, noisy pit with people sitting in plastic chairs, watching TV or on phones and the officers either behind desks or circling the perimeter. It was filling up.  A staff member was completing initial mental health screenings in a corner of the open room, up on a platform and behind a computer.  She had the electronic health record open to the mental health screening form and she was going through each “yes/no” question, reading from the computer screen and not looking at the recently arrested individual, a young man picked up on a possession charge.

“Are you currently taking any medications for mental health problems?”  “No.”

“Have you ever been hospitalized for mental health reasons?”  “No.”

“Are you currently thinking about hurting or killing yourself?”  Pause. Swallow.  “No.”

“Have you ever been treated for withdrawal from drugs or alcohol?” “No.”

She missed it.  She missed the pause; she missed the swallow.

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Introducing Sharen Barboza

I am pleased to be joined on JailMedicine by my colleague Dr. Sharen Barboza! Dr. Barboza has been providing correctional mental health care for more than 20 years. Her complete bio can be found in the About The Authors tab (here). Besides her broad experience, intelligence and common sense, Dr. Barboza is simply the best speaker I have heard at any correctional medicine conference. I am honored to have her as my co-editor at JailMedicine! Jeffrey Keller

Dr. Sharen Barboza

I am truly honored, grateful and humbled to join Dr. Keller on JailMedicine.com.  I think that now, more than any other time in the past, we are all realizing the impact that our mental health has on our ability to function in the world.  For so many of us, we take the “health” part of our “mental health” for granted.  We trust our thoughts to be based in reality; we rely on our emotions to adequately and appropriately meet the moment; and we have confidence in our ability to cope with what comes our way.  Most days. 

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