Twenty percent of adults who complete suicide in the United States have spent at least one night in jail in the year prior to death, according to a Michigan State University study. That statistic caught the attention of psychologists at Brown University.
Researchers there wanted to know: could providing trained therapists and structured suicide-prevention support to people while they’re incarcerated reduce their risk of suicidal behavior after they return to the community?
To answer that question, Ocean State Media’s Joe Tasca spoke with Lauren Weinstock, a clinical psychologist and lead researcher on a study exploring the effectiveness of suicide prevention programs in jails.
Looking beyond traditional suicide-prevention settings
Weinstock said that while decades of research have focused on individuals at high risk within health care settings, a large group of vulnerable people has been overlooked.
“We want to reach the people at highest risk in an effort to support them and help them, and prevent suicide. And much of that research has focused in the health care system,” Weinstock said. “But what we realized is that we are still missing a substantial portion of people who are at high risk for suicide. And then the question then became for us, ‘Where should we be looking?’”
The criminal justice system, she explained, is one such overlooked space with many risk factors for suicide disproportionately present.
“Many of the risk factors for suicide are overrepresented in the population of people who come into contact with the criminal justice system every year, (including) high rates of psychiatric illness, high rates of substance use, trauma exposure, people living in unsafe environments,” Weinstock said. ”So we set forward to evaluate whether an intervention that we knew to be effective in the healthcare setting would be effective in preventing suicide for people who were leaving jail detention.”
How the study was designed
To test the intervention’s impact, Weinstock and her team partnered with facilities in Rhode Island and Michigan. The study was conducted in collaboration with Dr. Jennifer Johnson, a former Brown University colleague who now works at Michigan State University in Flint.
Researchers launched a trial, enrolling 800 people total who were housed at the Rhode Island Department of Corrections or the Genesee County Jail in Flint, Michigan.
Participants were randomly assigned to receive either routine care or what researchers called the safety-planning intervention, a structured session designed to help individuals identify ways to stay safe during moments of crisis. After release, those in the intervention group also received follow-up phone calls.
“The question was whether adding safety planning with telephone follow-up after release from jail could improve outcomes for individuals over and above the routine care that people receive in these settings. Now, the results of this trial program were quite striking.”
Strong reduction in suicide attempts and related events
The results were significant.
“What we found was that the safety planning intervention with telephone follow-up after release from jail reduced subsequent suicide attempts by a rate of 55%,” Weinstock said.
When the team looked more broadly at suicide-related events, including hospitalizations and other behaviors, they also saw a marked decrease.
“We found that this also reduced significantly the suicide events by 42%,” Weinstock said. “So these are quite remarkable findings, and we were really excited to see, again, that an intervention that we knew that was helpful for individuals in other settings could be translated to the jail setting and have such an important impact on reducing suicide behaviors over time.”
Why the approach may work
The intervention itself was straightforward but targeted.
“The first thing is that the intervention components are very pragmatic,” Weinstock said. “(The) heart of the intervention is one session, so we delivered that in the jail before people return to the community. And it’s very focused on steps that individuals can take to keep themselves safe when they’re having thoughts of wanting to hurt themselves or take their own life.”
During the session, participants work through practical strategies, from distraction techniques to asking for support from others.
“Just to buy some time to allow those suicidal urges to pass, because we know that oftentimes suicidal urges can be very brief,” Weinstock said.
Weinstock also emphasized the value of continuity after release. Those who received the trial intervention also received a telephone follow-up with the same clinician they met with in jail.
“That phone follow-up I think, was really important because this is, again, a time where people tend to fall through the cracks in our systems of care,” Weinstock said. “Getting a phone call from a person who’s expressing care and support... can make a really big difference in connecting them to the care that they need.”
What’s next: implementing what works
Weinstock said the next steps involve not just publishing findings, but creating systems that ensure people get connected to care.
“If we don’t implement something that works, then the science sits on a shelf and doesn’t help the people that we’re hoping to help,” Weinstock said.
Her current work includes efforts to link jail data with health care systems so providers can better support individuals post-release.
When asked whether this approach could serve as a national model, Weinstock didn’t hesitate.
“It is a relatively low-intensity intervention, but it packs a big punch,” she said.
She added that some clinicians at the Rhode Island Department of Corrections who were involved in the study are already using their training in everyday work with people in custody.
If you or someone you know are in crisis, call or text 988 to connect with a counselor. Or visit 988lifeline.org
