Content warning: discussion of suicidal ideation and suicide watch protocol.
Today is an emotionally tough day. Bowing out is fine. Being furious is 100% reasonable.
The protocol is either visual checks every 15 minutes (Q15) and control of environment (no self-harm material) or 1 to 1 pairing, staff assigned to the patient 24/7.
The protocol calls for step-down as time passes.
(I also note this has never been my wheelhouse at all. But there’s academic work on it. mdedge.com/psychiatry/art…
(And more sources later)
15 minutes is plenty of time to die if someone is determined. Without getting into details, people have gotten creative, and suicidal ideation doesn’t come with reliable narration. People do lie about their emotional state. Often well.
1 to 1 distresses the client - there’s no privacy, not even for toileting. Both 1 to 1 & q15 escalate any ongoing paranoia.
Watch proves to a person who already feels out of control that they’re not.
Ideally, you don’t want to keep someone on watch for more than 72 hours maximum.
In part because watch itself makes suicidal ideation worse, but also because even suicidal ideation reverts to mean, most of the time. 5/30
no clothing but a quilted safety smock, which can’t be used as a noose.
No bedding, just the bare, usually vinyl, mattress.
Lights always on.
Very limited reading material, usually no access to other media.
Toileting only with permission, under observation.
While I see people saying suicide watch should be perpetual after an attempt, in jail?
The defendant is both legally innocent, and will need to be competent to stand trial. BoP can’t psychologically break them worse. 7/30
In an in-patient setting, that person should be stepped down. Their dignity matters.
1st thing a patient gets back is clothing & toileting - no safety smock, self-directed toileting.
Time between check lengthens, usually by 15 minute intervals.
During this time, however, patients who are motivated also improve at convincing the staff they’re not suicidal.
In today’s case? He was a highly skilled manipulator & liar. 9/30
One of the better documented suicides in legal captivity was Göring, during the Nuremberg trials. He’d been convicted & sentenced, and was scheduled to hang the next day.
And yet, he used a cyanide capsule. 10/30
By being the agent of his own death, he denied his captors - whom he considered the enemy - the justice they wanted to impose on him.
Göring was not even the first of the Nuremberg suicides. 11/30
It can also be an expression of control & defiance, a refusal to submit to people they don’t consider their equals, stealing victory & creating a mess & ruin.
It can be a giant fuck off to everyone.
But also being unable to use their learned tools - manipulation, privilege - is an existential horror. 14/30
We know the jail suicide rate is 3x the rate of the population as a whole.
Inescapable captivity - which this one had never experienced - and total loss of autonomy breaks people.
But I always take selfish, stupid & lazy over competent conspiracy. (Incompetent conspiracies are another matter.)
But I’d call it revenge. A FU to victims, justice system, associates.
(Think of the probate...)
I see the theories already forming& they’re taking the form of 9/11 truthers: Let It Happen On Purpose, Made it Happen on Purpose.
I feel bad for the therapist who had to have signed off on step down — this is the nightmare situation for any provider.
But therapists can be manipulated, too.
We *DON’T* know what they have. And that’s good for justice.
My suspicion is that quite a few already have, and the FBI isn’t going to out them.
Les Wexner should talk more now.
I’m sorry, please pick one.
I can think of a dozen ways that don’t rely on a Rube Goldberg conspiracy. 22/30
He worked the system — just like he did in Florida jail — to get the privileges he wanted.
He observed the routine, used his brain, learned from his prior mistakes, and followed through with his intent to not be in jail again. 23/30
But we know he was a finely-tuned manipulator.
Even if the only thing he ever did was successfully snow-job his way into wealth management, he conned his way into it.
A conspiracy means there’s someone in charge, someone to blame. An Intelligent Designer. Who might take a fall someday.
Stupidity & manipulation & fail-prone protocols don’t provide that. 26/30
They’re NOT this competent, and they suck at the cover-up. Go read the first chapter of Michael Lewis The Fifth Risk. The part about the transition committee. The tantrum over stealing *my* fucking money. It applies.
Remember that Chris Christie & Rick Perry are the ethical geniuses in this crowd... and they’re barely competent criminals.
Tom Clancy would reject these dopes.
But when we let the conspiracy override our cognition, we grant what we want to be true —that there is an Intelligent Design at work— instead of accepting the reality that jail staff can fuck up massively, and do, regularly.
We just don’t usually notice.
(Abstracts, because I’m not hunting free copies and won’t send you at paywalls)
Be excellent to each other.
Take deep breaths.
Call for help if you’re in a dark space. 1-800-273-8255 (US)
Crisis text line: US: text to 741741
UK: text 85258
Canada: text 686868
More hotlines, regional & group specific: suicidehotlines.com