Webinar presenter Dr. Lisa Boesky answered a number of your questions after her presentation, Preventing Jail Suicides: Issues We Don’t Talk about, But Should. Here are just a few of her responses.
Audience Question: What is your experience with malingering individuals using Suicide Watch to move units or change their situation?
Dr. Lisa Boesky: Yes, that’s a very good question. So, do some individuals use suicide or exaggerate their suicide or even fake suicide, suicidal thoughts, or behaviors to get certain things. Would we all agree? Yes. I’d say yes. The word we typically use for that is manipulation. And when you think about it, I mean, if we look it up in the dictionary manipulation pretty much means trying to get people to do what you want them to do. And so, the first thing you want to do is think about, “Okay, this person is trying to manipulate the suicide prevention system in our facility”, and without judgment. They’re trying to manipulate it, so, they must need something. What is it that they need? So, they may need more attention or want more attention. They want to move to a different housing unit, or they want to be housed by themselves. A lot of times inmates will say it’s too chaotic on the unit. They prefer being down in booking or isolated in a cell where it’s much calmer for them. If that’s the case, you must take it seriously, you don’t want to not take it seriously because we find many individuals who manipulate the system, if we don’t respond they just up the ante until we do respond. So, if you don’t respond when I’m biting my arm, well then fine, I’m going to take my spork and slit open my wrists. So, you want to respond, but what you really want to do is meet as a team. So, on a particular unit, or if that person’s moving throughout the jail, meet jail-wide, with medical, mental health, custody, classification, and whoever else is relevant or important for that, to talk about how are we going to manage this individual? Now, sometimes, you may have to give in, and say, “You know what? It is worth it for the sake of all the other inmates to give this inmate what they want and let them be housed in booking because it’s negatively affecting all these other people, and it’s too dangerous.” Other times, what you can do is you can get really creative, which is, let’s say it’s an inmate, who, who doesn’t want to be housed in general population, they really like to be housed in isolation by themselves, nice and quiet. You can actually have them. Earn it. I know this sounds strange, but we’ve done it before. Which is, basically, if you can keep yourself safe, all day or just first shift, or just second shift, we will let you go down to housing for two hours to chill out in a holding room. Now some of you might be like, “Oh, my God. You’re giving them exactly what you want. How can you let…” If it’s between you and an inmate who’s manipulating, they will always win when it comes to suicide. Because they can always smash their head against the wall, they can always jump off the second tier. You want to make it a win-win for everybody. You want to first ask the question, what are they after? And then, is there a way we can give it to them by them doing appropriate behavior versus them demanding it by engaging in dangerous behavior? Because when they engage in dangerous behavior, we have no choice but to react. We have to respond if they are doing things to hurt or possibly kill themselves. And, so, it usually takes a team, because, they have nothing to do all day, but to think about all the creative ways they can manipulate the system. You’re busy doing other things. So, you want a team around it, and not one staff person who has to figure it out themselves, and the first thing you might try might not work. You might have to try something else. You might have to adjust it. But, in the end, the goal is for them not to engage in suicidal behavior. And the goal for you is not to give them too much stuff, so that other inmates don’t learn. Oh, if I do that, I’m going to get that. It’s a tricky balance. It’s not the majority of individuals we have, but it’s enough of a percentage that makes managing them very, very challenging. The last thing I will add, promise me you will never say, “But he/she is just manipulating,” because there is no either-or. There’s a lot of ways to manipulate the system. If you’re using suicidal behavior to do it, that is very risky. And so many of those individuals who were manipulating have ended up dead when staff either got complacent or were like, “Well, they haven’t done it yet. Are they ever really going to do it?” or literally just got burned out and just were exhausted from this person. And then they do end up killing themselves. They can be incredibly high risk. It’s not either-or, a serious suicide risk or a manipulator. Oftentimes it’s an and or a both. Good question.
Audience Question: Do you have to be a licensed mental health professional to be able to take the CAMS training?
Dr. Lisa Boesky: Oh, that’s a great question. My understanding is you do not need to be a licensed mental health professional to engage or take the CAMS training because I think they do cams in school. I’m not going to say for sure, because I don’t know, but I want to say, I don’t think so. And I will say, even if you do, which I’m not sure that you do. The whole idea behind CAMS is rather than be, I’m the doctor, and you’re the patient; I’m the officer, and you’re the inmate; I’m the mental health professional and you’re the inmate. I’m going to fix you, are you having these symptoms? And then, here’s the answer, here’s my treatment. Here’s what we’re going to do. Instead, it’s saying, help me understand what you’re going through. Tell me, so what is it about your cellmate that’s driving you crazy? What is it about being housed on that unit? So, you’re terrified that your wife is going to leave you, tell me more about that. And it actually has assessment tools that you can use that are, so I feel like the most effective type of assessment we can do. It is called the SSF, suicide status form, I think, is what it stands for. I really encourage you to look at it. My answer is I’m not sure. I don’t think so. And I’m crossing my fingers that, that even if you’re not a licensed mental health professional, you can take some type of training with CAMs that may be for non-mental health professionals.
Audience Question: What is the best way if people want to reach out to you directly? What is the best way? Is it through your website?
Dr. Lisa Boesky: So, two things. One, my website, which is suicidepreventionexpert.com. And then, one of the things we were talking about at Justice Clearinghouse, if there are additional issues, like, if you had additional questions, or there are additional issues about suicide prevention that we didn’t cover in part one, or part two. If you want to just put them in the question-and-answer thing, it can just be three words. Can you talk about this just like that question that came up? How about malingering? We may do a part three, but I would only want to do a part three if there are issues that are of interest to the audience. So, if there are things or if you want to take a deep dive into some of the issues that we’ve talked about in Part one and Part two but had to go over very quickly and you want to do a deep dive at the bottom of your screen where it says Q&A, just type in a couple of words in there. You don’t even have to say I’d like to hear more. Just put in the words more on this or just put malingering or suicide smocks or monitoring, whatever it is. And if we get enough people asking for the same things, maybe we’ll do a part three too.
Click Here to Watch a Recording of Preventing Jail Suicides: Issues We Don’t Talk about, But Should.