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Justice-involved Individuals with Substance Use Disorder are at a higher risk for suicide, even with just one night in a criminal justice facility

Updated: Feb 14



Death by suicide has increased by more than 30 percent over the past two decades and is currently among the ten most common causes of death in the United States.1 Over 90 percent of individuals who die by suicide have a history of substance use disorders (SUD) and/or mental health disorders (MHD).2 The increased risk for suicide connected to SUD and mental health disorders is even greater among individuals who are also involved in the criminal legal system.3,4 Research shows that individuals with SUDs, mental health disorders, and criminal legal involvement are five times more likely to consider suicide compared to the general public4 and have an increased risk of death by suicide and overdose during release from incarceration.5  What this means for practitioners


The overrepresentation of suicide risk, compounded by a high prevalence of SUD/MHD in the criminal legal system, presents significant challenges in implementing evidence-based practices to prevent, identify, and provide linkages to care for individuals with a history or who are at risk of suicide.2 Given that high rates of suicides occur in the context of a recent criminal or legal stressor (often arrest and jail detention), reducing the risk of suicide after incarceration, court, or police contact could have a noticeable impact on national suicide rates.


Within jail systems, the high admission and discharge volumes, short stays, and understaffing mean that most of the county and local jails have difficulties coordinating care adequately, resulting in unnecessary cycling in and out of the system, which can increase suicide-related morbidity and mortality.6 Other barriers and challenges include ineffective methods of sharing data and clinical information between criminal legal and health care systems, insufficient capacity for conducting evidence-based screenings and assessments, and limited knowledge and misconceptions about suicide, SUD, and MHD and response strategies2. Outside the criminal legal settings, many individuals with legal involvement are supported by professionals in publicly funded systems, who are typically unaware that their client was in jail and may drop the client for missing appointments4.


Collectively, these barriers and challenges reflect difficulties in interpreting or applying daily, operational decisions by organizations, agencies, governments, and stakeholders in and out of the criminal legal system, which can impact the utilization of evidence-based practices. Therefore, better communication, coordination of care, and use of evidence-based interventions between the criminal legal system and health care systems are crucial to improving individual- and system-level outcomes and advancing strategies to identify and provide quality care to at-risk individuals and reversing troubling suicide trends. 

 

What is currently being done


Fortunately, initiatives are underway to improve care pathways for individuals interacting with the criminal-legal system (including crisis lines, 911, police contacts, pretrial jail detention, court, jails, and probation) who are at risk for suicide and other health conditions to access life-saving services. This encompasses more than 250 million 911 calls per year, over 53 million police contacts per year, and more than 10 million jail admissions and releases per year, often after just a few days.7


The National Center for Health and Justice Integration for Suicide Prevention (NCHATS) is a national research center funded by the National Institute of Mental Health (NIMH) meant to build information bridges between healthcare organizations and criminal legal systems to identify individuals at risk for suicide and connect them to care. NCHATS will evaluate the effectiveness and cost-effectiveness of suicide prevention activities that bridge criminal legal contacts and community care. Specifically, the Center uses contact with the criminal legal system as an indicator of potential suicide risk in the general population and connects individuals at risk for suicide to community care.


NCHATS includes several projects to link publicly available data on criminal-legal involvement to health system records to help health systems identify individuals at risk for suicide and connect them to care. For example, one study aims to harmonize publicly available jail release data with healthcare records at two large healthcare systems in Michigan and Minnesota. This will facilitate rapid identification of at-risk individuals upon release from jail, prompting suicide prevention interventions and care connection. Another study assesses the effect of the Cambridge Police Department’s Family and Social Justice Section (FSJS) intervention, a police-based multi-system intervention that includes a team of specialty mental health resource officers and mental health clinicians in Massachusetts. The FSJS intervention trains officers in mental health first aid, trauma-informed policing, linking community and healthcare services, and more, to ensure better, coordination of care and follow-up, and to provide clinical and community resources for those who encounter law enforcement and who may be at increased suicide risk.  

 

The Takeaways

  • Research shows that individuals with SUDs, mental health disorders, and criminal legal system involvement are five times more likely to make suicide attempts compared to the general public and have an increased risk of death by suicide and overdose during release from incarceration. 

  • Better communication, coordination of care, and use of evidence-based interventions between the criminal legal system and health care systems are crucial to improving individual- and system-level outcomes and advancing strategies to identify and provide quality care to individuals at risk of suicide. 


To learn more about NCHATS or about becoming a partner, please visit our website or email contact.NCHATS@msu.edu


Citations: 

  1. Centers for Disease Control and Prevention. (2023). Facts About Suicide. https://www.cdc.gov/suicide/facts/index.html

  2. Substance Abuse and Mental Health Services Administration. (2019). Screening and Assessment of Co-occurring Disorders in the Justice System. U.S. Department of Health and Human Services. https://store.samhsa.gov/sites/default/files/d7/priv/pep19-screen-codjs.pdf

  3. Carson, E. A. (2021). Suicide in local jails and state and Federal Prisons, 2000-2019. Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice Office of Justice Programs. https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/sljsfp0019st.pdf

  4. Cloud, D. H., Garcia-Grossman, I. R., Armstrong, A., & Williams, B. (2023). Public Health and Prisons: Priorities in the Age of Mass Incarceration. Annual review of public health, 44, 407–428. https://doi.org/10.1146/annurev-publhealth-071521-034016  

  5. Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison--a high risk of death for former inmates. The New England journal of medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115

  6. Stewart, C., Crawford, P. M., & Simon, G. E. (2017). Changes in Coding of Suicide Attempts or Self-Harm With Transition From ICD-9 to ICD-10. Psychiatric services (Washington, D.C.), 68(3), 215. https://doi.org/10.1176/appi.ps.201600450

  7. Johnson, J. E., Ramezani, N., Viglione, J., Hailemariam, M., & Taxman, F. S. (2023). Recommended Mental Health Practices for Individuals Interacting With U.S. Police, Court, Jail, Probation, and Parole Systems. Psychiatric services (Washington, D.C.). Advance online publication. https://doi.org/10.1176/appi.ps.20230029

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