BOP Program Statement 5332.01 § 9

§ 552.41 Program procedures.

(e) Assessment. A psychologist will clinically assess each inmate placed on suicide watch.

During regular working hours, inmates referred for assessment of suicide potential will be seen

by a psychologist as soon as feasible, but no longer than within 24 hours of the referral. Constant

visual observation of the inmate must be maintained until a formal SRA can be completed by a

psychologist. During non-regular working hours, the on-call psychologist will consult with

institution staff and may choose to see the inmate immediately or have the inmate placed on

suicide watch. It is important to note that constant visual observation of the inmate must be kept

until a psychologist has made a determination of suicide risk for that particular inmate. In either

case, the inmate will be seen in person for a formal SRA within 24 hours of referral. Ordinarily,

the SRA will be completed in the EHR within 24 hours of the incidents outlined below. In

instances where the SRA is to be reviewed by another psychologist, the document must be

submitted to the review queue within 24 hours of the incidents outlined below. The supervisor

then has three working days to finalize the SRA.

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An SRA will be completed when:

■ Staff refer an inmate to Psychology Services because the inmate may be at risk for suicide.

■ An inmate’s written or verbal communication is suggestive of suicide.

■ An inmate exhibits behavior suggestive of suicide (e.g., the inmate refuses/gives away their

property).

■ Any instance of SDV.

■ Any other condition is present that would lead the psychologist to believe that an SRA is

warranted.

At a minimum, the SRA includes:

■ Type of housing and cell accommodation.

■ Classification of suicide-related behaviors.

■ Lethality assessment.

■ Reason for referral, including date and time of referral and date and time of the SRA,

identification of initial referral source, and details resulting from interviewing the initial

referral source.

■ Mental health and SDV history.

■ Current problem, including case conceptualization.

■ Current mental status.

■ Narrative of risk and protective factors assessed, which weighs risk and protective factors in

support of the decision to initiate or not initiate suicide watch.

■ An explanation of why some risk or protective factors were not assessed.

■ Diagnosis.

■ Recommendations, which include social, environmental, and clinical interventions; if no

clinical recommendations are made, a clear rationale for this decision is required.

During an SRA, psychologists are required to make several complex determinations based on the

totality of information gleaned from an SRA. Thoughts, threats, and acts of violence toward

others and self should be considered when evaluating risk of suicide. Psychologists should also

consider stability of thoughts, escalation of behaviors, and recency of said thoughts and

behaviors when documenting the conceptualization of suicide risk. Interventions are then based

on the documented and transparent conceptualization of risk factors. It is recognized that the risk

of suicide is dynamic and may change rapidly or over time, resulting in changes to the planned

interventions. Decision-making considerations should be clear within the documentation of risk

factors noted in the SRA.

a. Lethality. Assessment of lethality refers to an estimate of the likelihood of death resulting

from an inmate’s self-injurious actions or plans. Some self-injurious behaviors may be estimated

as having low lethality when they are unlikely to result in injury or death, such as making a

superficial cut on one’s wrist in the presence of staff. Other self-injurious behaviors may be

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estimated to reflect moderate lethality because they could or did result in injury and/or efforts

were made to obscure the behavior from others. Finally, self-harm behavior may be considered

to have high lethality if it could have resulted in death, such as a suicide attempt in a private area

with no expectation of immediate intervention or life-saving measures.

When self-harm behaviors or plans are determined to be of low lethality, it should not

automatically be concluded that acute suicide risk is low. However, it is appropriate to

conceptualize behaviors or plans of moderate or high lethality as indicative of elevated acute risk

of death by suicide in the absence of suicidal ideation.

b. Acute Risk. Acute risk refers to an inmate’s potential for imminent self-harm. Psychologists

estimate acute risk as low, moderate, or high based on their analysis of the information gleaned

during the SRA. Acute risk is particularly determined by current dynamic risk factors such as

hopelessness, depression, and agitation.

c. Chronic Risk. Chronic risk refers to an inmate’s potential for death by suicide based on their

history. Chronic risk has been operationalized as two or more suicide attempts prior to the

current assessment. Chronic risk is determined to be either present or absent, based on history.

Inmates identified as being at chronic risk for suicide should be considered for a care level

designation of two (i.e., Care2-MH) or higher. See the Program Statement Treatment and Care

of Inmates with Mental Illness for additional recommendations in the management and

documentation of inmates with chronic suicide risk.