Correctional centres are unique environments with a vulnerable population that is significantly more at risk of suicide than that of the general community, according to the Justice Health and Forensic Mental Health Network (Justice Health NSW).
This is why Justice Health NSW has adapted Towards Zero Suicides to suit the distinctive circumstances that come with caring for people in custody through its tailored implementing of Zero Suicides in Custody
There is also a huge overlap risk factors, as Senior Project Lead Kirsty Smith explains:
"The overlap of those risk factors means that what has made someone vulnerable to offending can make them vulnerable to suicidal thoughts and behaviours."
Justice Health NSWprovides mental health and suicide prevention services to adults and young people in the forensic mental health and criminal justice systems as well as those who are transitioning back into community, working closely with Corrective Services NSW (CSNSW) to reduce the suicide rate within custodial settings.
Regardless of the circumstances leading to a person's incarceration, the goal is to prevent them from taking their own lives.
"Obviously it can be quite a stressful period for many people between court and custody," Kirsty says.
"They're socially isolated. There are areas where they may feel unfamiliar or unsafe, which is a huge adjustment for some, and they don't have a great deal of control over their day, so we try to identify and manage those who are more vulnerable than others."
Justice Health NSW has adopted the Towards Zero Suicides framework to underpin their efforts to educate inmates in suicide and health literacy, the lack of which, as Kirsty says, can make people vulnerable to offending in many cases.
Building suicide literacy in the prison population helps individuals recognise when they need to ask for help. It also provides the tools and confidence to alert staff when another person – friend, cellmate or someone in their wing – may need help too.
"That is particularly helpful because we know that there can be a reluctance among the inmate populations to actively seek help due to the distrust between those in green (inmates) and those in blue (staff). So, we have a range of initiatives to build suicide literacy and manage those who have come across our radar as being in distress or have made a suicide attempt," Kirsty says.
One such initiative involves the development of postcards designed by inmates who wish to help others by way of helping themselves through a positive contribution to a challenging environment, as Governor of Long Bay Hospital Jason Hodges outlines:
"The plan is for mental health pathway inmates to provide drawings and quotations to assist other inmates in transitioning from risk to routine."
As Kirsty explains, it's an end-to-end process allowing inmates to participate in suicide prevention and find a measure of pride in having made a positive contribution to the population.
"The postcards are designed by those with a lived experience who are currently in prison for people who may have gone through a suicidal crisis to help them transition back to some sense of normalcy," Kirsty says.
The postcards are then printed by inmates employed by CSNSW, offering them the opportunity to learn skills on the job. Correctional and Justice Health NSW staff then distribute the postcards to people who have been flagged by the Risk Intervention Team. The purpose is to help them get through in that moment and remind them to proactively take steps to manage their distress and access support in the future.
The postcard pictured below was designed by an inmate named Corey, who has a lived experience of a chronic mental health condition. Corey wanted to apply his creativity and compassion to let others know that there is life for them while in custody and beyond.
A large focus of Justice Health NSW is promoting collaborative interagency relationships, working closely with CSNSW to establish a person-centred approach while meeting safety and security requirements. This involves working closely with CSNSW Officers, Psychologists and Services and Programs Officers to support vulnerable inmates based at the Metropolitan Remand and Reception Centre. Introducing safety planning that acknowledges the delicate balance of safety, dignity and security has helped at-risk inmates.
"Many inmates have complex needs, are living with mental health concerns, drug and alcohol issues or have experienced adverse childhood events. So, when you have those factors plus the offence they've committed and being in a prison environment, inmates can find it difficult to feel safe," Kirsty says.
"Safety planning empowers the inmate to identify their early warning signs, utilise their coping strategies and access staff support. So far, we've had some good feedback with inmates feeling like they aren't going through it alone and that they have been given tools to keep themselves safe."
The Zero Suicides in Custody initiative has promoted a whole-of-person approach that encourages working as a team to support and empower an individual who needs help.
"We're focused on building a therapeutic relationship and providing treatment and overall safety while they're in our care and beyond. For those who are leaving our care, we make sure their safety plan is updated and they have been linked into their closest Towards Zero Suicide initiatives in the community."