Inmate Suicide and Time Spent in Special Disciplinary Housing in New York State Prison

The forensic institutional review board of the New York State Office of Mental Health reviewed and approved this study. Data were extracted from a quality assurance database that had been cleared of personal identity information. We examined total number of days in the special housing unit before suicide and length of aggregate disciplinary sentence the inmate was serving. Between 1993 and 2003, a total of 32 inmates were identified as being in a special unit in New York State prison at the time of the suicide. There were a total of 132 suicides throughout the New York State prison system during the period studied.

Inmates in New York State prison may be placed in the special housing unit if they have committed a very serious infraction of prison rules. Examples of infractions include assault on staff, assault on another inmate, and possession of a weapon. These inmates generally are allowed out of their special housing cells for only one hour per day for recreation, three mental health treatment sessions per month, medical treatment, and visitors. Sentence length depends on the number of infractions (charges) within the behavioral incident, the seriousness of the behavior, and the extent of injury. Additional time is added to infractions that occur while the inmate is in a special housing unit.

Thirty-two inmates committed suicide in a special housing cell in the 11-year period from 1993 to 2003. The median number of days in a special housing cell before suicide was 63, with a mean±SD of 382±790 days (range of zero to 2,977 days). The median length of aggregate disciplinary sentence being served at time of suicide was 298.5 days (mean=1,452±2,432 days, range=30–8,675 days).

Suicide has a low base rate, and risk estimation is difficult and complex. It is therefore important to note that a large number of inmates are placed in special housing units in the New York State prison system (11,756 in 2003) and most do not commit suicide.

Therefore, understanding the factors that contribute to specific inmates' committing suicide is very challenging. However, the results suggest that the first two months in a special housing unit should be added to the risk factors that we have discussed elsewhere ( 3 ). Inmates recently transferred to a special cell should receive enhanced observation for at least two months. For example, motion detectors could be installed to alert a correctional officer when an inmate gets out of bed in the quiet hours after midnight. Getting out of bed and using the bed sheet for hanging is the most common method of prison suicide. Motion detectors have been used elsewhere for suicide-vulnerable populations.

The length of stay in a special housing unit was short before suicide occurred. These data do not support the idea that the special housing unit for most inmates causes slow deterioration of mental health over several months that eventually leads to suicide. The literature is mixed on effects of lengths of stay in the 30- to 60-day range. Grassian ( 9 ) reported that he found psychiatric deterioration and suicidal behavior in his cohort of 14 men who had a median length of stay of two months in segregated housing. Sestoft and associates ( 15 ) reported that Danish prisoners (N=125) who were in solitary confinement for more than four weeks had a 20-fold greater probability of being hospitalized for psychiatric reasons. In contrast, in their review of studies, Bonta and Gendreau ( 13 ) did not find any mental deterioration for inmates in segregation for ten days or less. Zinger and Wichmann ( 12 ), in a study of 136 inmates, found no change for those segregated for 60 days or less, and Andersen and associates ( 11 ) reported in a study of 228 prisoners that inmates' mental health did not worsen over the first few weeks of solitary confinement.

To address the mental health needs of inmates in these special housing units, the Central New York Psychiatric Center of the New York State Office of Mental Health has dramatically increased the amount of mental health service offered to inmates in these environments since 2002, and it has moved many seriously ill inmates from special housing units to special enriched mental health programs. To screen for suicide as well as other mental health issues, a mental health clinician is required to stop at each special housing unit cell in most of the prisons in our system every work day and attempt to engage these inmates.

Also two important new processes have been introduced: first, improved mental health testimony in the disciplinary infraction hearing process, which may prevent placement into special housing, and second, the use of case management committees that can recommend to the prison superintendent that an inmate be removed from special housing.

For a majority of inmates who completed suicide in a disciplinary cell, the length of stay was fairly short. However, five inmates in the study group were in a disciplinary cell for more than a year. The range of days in special housing for these five was from 869 to 2,977. Recent placement in disciplinary housing does not appear to be a factor for them. The trigger for suicide for these inmates needs to be explored.

Admissions to special housing units should receive extra attention in the first two months to help prevent suicide. Such attention includes closer monitoring of inmates after waking hours and engaging inmates on a daily basis to screen for suicide. Administrative and process measures, such as those implemented in the New York State prison system to create mechanisms for removing inmates from special housing when warranted, should also be considered.

The authors report no competing interests.

The authors are affiliated with the Central New York Psychiatric Center, New York State Office of Mental Health, Box 300, Marcy, NY 13403 (e-mail: [email protected]).The authors are also with Upstate Medical University, Syracuse, New York.