Girls are more likely to have suicidal thoughts while young men aged 15-19 are more likely to die by suicide. Incarcerated juveniles have higher suicide risks than the general youth population. Mental health problems, substance abuse, abuse histories, and prior self-harm are predictors of juvenile suicide both in the general population and in correctional facilities. Suicide screening, written prevention policies, close observation of at-risk youth, and staff training can help reduce suicide among incarcerated juveniles. However, many facilities still lack adequate prevention measures.

1. CHAPTER TEN
Preventing Suicide and Self-Harm

2. Adolescent Suicide
• Girls are more likely to have suicidal ideation and attempt suicide
• Young men aged 15 to 19 years are five times more likely to complete
suicide
• Juvenile suicide rates are the highest among American Indians and
lowest among Asian/Pacific Islanders; however, adolescent Whites
are the most common victims
• Incarcerated juveniles have higher levels of suicide risk and complete
suicides compared to the general youth population
• Suicide attempts for incarcerated teens was eight percent higher and
the injury rate after the suicide attempt was six percent higher than
the national average
• Approximately one in ten juvenile detainees had thought about
committing suicide in the past six months, and one in ten had ever
attempted suicide
• Suicide was still the leading cause of death for adolescents detained
in juvenile correctional facilities from 2002 to 2005

3. Predictors for Juvenile Suicide in the
General Population
• Predictors regarding suicidal ideation, attempts and completed suicide among
youth include: mental health problems, substance abuse, histories of emotional,
physical, and sexual abuse, prior delinquency, and previous self injurious
behavior and suicide attempts
Substance Abuse
• Abuse of both drugs and alcohol significantly increases the likelihood of suicide
and it increases even more in they also suffer from a mental illness
Histories of Abuse
• Personal trauma in terms of physical and sexual abuse is also associated with
juvenile suicide
• Physical abuse in early childhood can lead to poor social skills, an inability to
interact and social isolation
Self-Harm and Delinquency
• The greatest predictor of a youth suicide is a past attempt
• Almost one-quarter of juvenile suicides had engaged in prior attempts
• A previous attempt represents a 30-fold elevated risk for completed suicide in
boys and a threefold increased risk for girls
• There is no one common factor between juveniles and completed suicides

4. Predictors of Suicides in
Juvenile Correctional Facilities
Mental Health Problems
• Psychiatric disorders and a history of substance abuse are found in over 90% of
completed juvenile suicides
• The rate of mental illness is twice as high for juveniles inside the justice system
• 74% of those completing suicide inside a youth facility had a history of mental
illness and 53% of the suicide victims had been taking psychotropic medications
at the time of their death
• Anxiety and depression are prevalent among incarcerated youth who commit
suicide
• Traumatic stress and substance abuse are the best indicators of suicide risk in
detained youth
• Juveniles completing suicide inside residential facilities are often victims of
emotional abuse, verbal abuse, neglect, excessive punishment, and general
family dysfunction
• Nearly 60% of youth in the juvenile justice system have been emotionally abused
and 60% of juveniles who committed suicide while incarcerated had been
emotionally abused
• Over 50% of incarcerated youth suffer from post traumatic stress disorder (PTSD)
which stems from witnessing traumatic events such as assaults or abuse

5. Predictors of Suicides in
Juvenile Correctional Facilities
Self-Harm and Suicide
• In general, many individuals attempt suicide at least once before completing suicide
• Many juveniles exhibit self-harm behaviors prior to attempting suicide
• Self-harm (which often involves some form of self-mutilation) and suicidal behavior can be
differentiated by three characteristics: lethality, repetition, and ideation
• Self mutilation is typically low in lethality, but can be repetitive, often taking the form of cutting
or “slashing”
• Not all juveniles who harm themselves are suicidal – sometimes they do it to manipulate staff
or to get attention
• These acts tend to be “infectious” and if one youth engages in self-harm, others model that
behavior and sometimes youth who do not intend on committing suicide accidentally kill
themselves
• Suicidal ideation is rare in those who self-harm
• Approximately 22% of incarcerated juveniles had considered suicide, 20% planned an
attempt, 16% actually attempted, and 8% were injured during their suicide attempt
• Almost 72% of persons who committed suicide in juvenile detention had a history of suicidal
behavior – almost one-third of these suicide victims had a history of suicidal ideation and
almost one-quarter were involved in self mutilation prior to the deaths

6. Predictors of Suicides in
Juvenile Correctional Facilities
Isolation
• Placing a youth in an isolated environment greatly increases
the chance of suicide
• The stark and dreary environment of these settings contributes
to a youth’s depression
• Almost three-quarters of suicide victims inside juvenile
correctional facilities lived in single occupancy rooms
• Death by suicide rises by a factor of seven (or 60%) in facilities
that lock juveniles in their sleeping rooms
• Removing these trouble youth from human contact tends to
amplify feelings of isolation and hopelessness
• Thoughts of desperation increase suicidal tendencies
• When placed in cold, empty rooms by themselves, youth have
little to focus on except all of their reasons for being depressed
and the various ways that they can attempt to kill themselves

7. Suicide Prevention
Intake Screening
• The most prudent way to reduce the number of attempts and completed suicides in juvenile
facilities is to screen all adolescents for suicidal behavior when they are first admitted
• Screening involves a series of questions that ask a youth about his current mental health
including feelings of depression, his likelihood of engaging in self-harm, if the youth has a plan
to harm himself, the lethality of the plan, and his prior history
• If a youth reports feeling depressed, hopeless or has a plan to harm himself, he is referred to a
medical or mental health professional for further assessment and treatment
• Approximately 70% of all juvenile correctional facilities reported screening all of their residents
for the threat of suicide and 17% of facilities screen some incoming youth for suicide ideation
• Over 20% of the facilities that experiences a completed suicide had no type of screening at
intake
• When some youth are initially admitted, they are sometimes under the influence, putting the
youth at greater risk for self-harm or suicide within the first few hours of admission
• In 2004, only one of 16 suicides had occurred within a day of the youth’s admission, 13 of the
suicides had occurred after the residents had been incarcerated for more than two weeks – not
until 75 days after admission were half of the reported suicides accounted for
• 60% of victims placed in isolation were dead within 48 hours of their admission and almost
90% of the youth who completed suicides within 48 hours were intoxicated at the time of
incarceration

8. Incarceration and Suicide Risk
• Research shows that juvenile suicides were widely distributed
throughout a 12-month period of confinement, not just the first
few hours
• There were just as many suicides (ten) in the first three days
after admission as there were after a year-long incarceration
period, with 70% of juvenile suicides happening within four
months
• A juvenile might commit suicide shortly after being admitted to
a detention center because of feelings of despair and
uncertainty
• Some youth may harm themselves on the anniversary date of a
loved one’s death or during the holidays such as Christmas or
Thanksgiving if they cannot be with their families
• A small number of juveniles also commit suicide shortly before
their release dates because they fear their community reentry

9. Operational Factors
• Deploying competent, well-trained and caring staff and having written
suicide prevention policies are the best strategies to reduce suicides
• Four specific suicide prevention measures:
• Intake screening of all youth
• Written procedures detailing how staff should help suicidal juveniles
• Close observation of suicidal youth
• Training the staff to manage suicidal juveniles
• Facility staff should have at least eight hours of suicide prevention
training before working with incarcerated youth and an additional two
hours of training every year afterward
• Hayes (2004) discovered that 43% of juvenile correctional facility
employees received no pre-service, annual or periodic suicide
prevention training – of those who had received some training, 65%
had training which lasted two hours or less
• 15% of those deemed to be mental health professional hired into
juvenile facilities had only a bachelor’s degree or less formal training

10. Characteristics of Suicides in Juvenile Corrections
Methods of Death
• Hanging is the most common form of suicide in detention and treatment centers;
between 80% and 93% of suicide victims in correctional facilities hanged
themselves
• Detainees have hanged themselves from exposed pipes in ceilings, doorknobs or
bed frames – a noose can be fabricated out of cloth, wire, or even a plastic
garbage bag
• A study showed that over 70% of the victims relied on some sort of bedding to
hang themselves, although belts, clothing, and shoelaces were also used
• Even in suicide resistant rooms, youth have used toilets, sinks, and window
frames as anchoring devices for a noose
Victim Characteristics
• Most adolescents in the general population who take their own lives are White
and male – 80% of victims were male and almost 70% were White
• From 2002 to 2005, almost 90% of the suicides were male, only 37% were White
and almost 42% were Black

11. Time of Day and Suicide Checks
• Completed juvenile suicides in custody do not appear to happen in
the middle of the night when the staff to resident ratio is the lowest
• Over half of the completed adolescent suicides occurred from 6:00
p.m. to midnight, while only 11% took place from midnight to 9:00 a.m.
• The most common check for an at-risk or suicidal youth is at least
once every 15 minutes
• Almost half of completed suicides in juvenile facilities occur while the
victims are being observed at least once every 15 minutes
• Over 40% of completed youth suicides occurred while the juvenile
was being monitored once every 15 minutes
• 84% of all completed adolescent suicides happened when staff
observations were done hourly
• About 42% of the victims were under observation once every 15
minutes and almost 90% were being supervised at least once per

12. Cross-National Concerns with
Incarceration Juvenile Suicide
• Studies from the United Kingdom and Australia have
demonstrated similar findings in regards to the rates of
adolescent suicides in residential settings
• Australia’s youth suicide rate has been one of the highest in
the industrialized world
• Suicide rates among incarcerated Australian youth are four
times higher than their national average
• Evaluations over a 12-year span have indicated consistent
relationships between mental illness, substance abuse,
delinquency, and youth who committed suicide in Australian
facilities
• Studies in the United Kingdom found higher rates of completed
suicide among those juveniles with histories of self-harm
• Failure to screen juveniles at intake for suicidal ideation and
inadequate staff training also occur in the U.K.

13. Conclusions
• Common factors in most successful juvenile suicides are mental
illness or other disabilities, histories of emotional, physical, sexual,
substance abuse, and a predisposition for self-harm
• Intake screening, written policies, and staff training specifically aimed
at identifying those in need of suicide prevention are not mandatory in
all jurisdictions
• Suicides in custody are preventable and a first step after
acknowledging the problem is to recognize that failures by staff are
often a significant contributing factor to these tragedies
• Some residential placements have no mandatory, suicide reporting
policies
• There is no centralized body that collects data about suicides in group
or foster homes or other privately operated juvenile facilities – if an
adolescent commits suicide, a governing or regulatory body is not
contacted and statistics are not gathered
• Many suicides go unreported