suicide assessment are described. The work of John and
Rita Sommers-Flanagan has been used to lend some
structure to the description of clinical factors. In addi-
tion, where relevant, prisoner suicide research related to
that factor is summarized. The overarching clinical fac-
tors include the presenting problem, depression, suici-
dal ideation suicidal intent, suicidal plan, self-control,
vulnerability, and coping.Presenting Problem
Similar to a suicide assessment with a nonforensic
client, the initial goal is to attempt to establish rapport
and determine the nature of the presenting problem.
Determining the prisoner’s level of distress and cop-
ing efforts will provide some indication of how to
pace the remainder of the assessment. Identifying the
precipitating factors and current stressor(s) provides
some contextual and situational information.Depression
There is a strong relationship between depression
and suicidality as well as between depression and
hopelessness. If a user combines alcohol and depres-
sion, then risk will further elevate. Therefore, it is
important to determine the presence of depressive
symptomatology. The diagnostic criteria and sympto-
matology of depression are not detailed here. Rather,
relevant domains of functioning are reviewed as a
means of suggesting some structure for the assess-
ment process. These include emotional, physical, cog-
nitive, behavioral, and social domains.
The emotional domainprimarily refers to determin-
ing the presence of depressed mood and related factors
such as frequency, intensity, and duration. Of particular
concern is the presence of hopelessness. Research has
established hopelessness as a strong predictive factor of
suicide generally. Available research investigating this
factor in prison populations has confirmed the predic-
tive relevance of hopelessness. An additional emotional
factor that warrants attention is the occurrence of a sud-
den and unexplained change in the individual’s mood
and/or functioning. This is a salient clinical sign that
has traditionally been interpreted as an indication of
increased risk. Experts in suicide assessment suggest
that the improvement may result from the individual
making a decision about ending his or her emotional
pain or result from an alleviation of mental illness. The
suggested dynamic is that either of these occurrencesreduces ambivalence, brightens moods, and frees up
energy to act (and possibly carry out a plan for suicide).
The physical domain refers to determining the
presence of physical symptomatology indicative of
depression. Relevant factors include appetite, weight,
sleep, energy level, concentration, psychomotor func-
tioning, and self-care.
The cognitive domaininvolves assessing whether
cognitive functioning is intact. For example, there
may be the presence of thought distortions, disorga-
nized thought, impaired judgment, or event psychotic
symptoms. Research has also pointed to the relation-
ship between depression and the presence of negative
thinking about oneself, the world, and the future
(referred to as the cognitive triad).
The behavioral domainrefers to behavioral symp-
toms of depression that can be observed. These may
include decreased pleasure in one’s usual activities,
decreased physical activity, restlessness, poor concen-
tration, and poor problem solving. Changes in self-
care and other negative behavior may be present.
The social domain refers to interpersonal and
social functioning. Some examples can include social
withdrawal, rejecting support, interpersonal conflict,
and decline in social skills.Suicide Ideation and Suicidal Intent
Suicidal ideation and suicidal intent are related to
increased risk for suicide. Ideation does not necessar-
ily result in high risk. Expressing suicidal intent gen-
erally presents a greater risk than ideation. Inquiring
directly about ideation and intent is important.
Questions regarding frequency, duration, and intensity
can provide additional information. In addition, col-
lateral information and/or behavioral observations can
be useful. If the prisoner commits or contracts, it is
suggested that the commitment be made for both self-
harm and suicide rather than assuming the commit-
ment for one act will generalize to the other.Suicide Plan
Having a suicide plan can present a serious level of
risk. Determining the details is crucial. Relevant domains
of functioning to assess include prior suicide attempts,
specificity, lethality, availability, and proximity.
A history of prior suicide attempts increases the risk
for suicide. A suicide attempt within the past year ele-
vates risk even further. Obtaining details about the priorSuicide Assessment and Prevention in Prisons——— 783S-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 783