SUICIDE D-260 FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
EFFECTIVE DATE: 02-04-91 REVISED: 12-25-94, 07-04-96, 08-19-98, 11-01-98, 03-01-01,
03-01-04, 03-23-17, 03-30-17, 06-15-18, 07-01-21,
05-25-23
AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff G. Gularte
REFERENCE: Penal Code Section 6030; California Code of Regulations, Title 15,
Sections 1020, 10217 10237 10297 10307 10557 12057 1207, and 1220; Anderson
v. County of Kern 45 F.3d 1310 (9th Cir. 1995); Training Curriculum on Suicide
Detection and Prevention in Jails and Lockups, National Institute of Corrections,
March 1995; and Hall v. County of Fresno, E.D. Cal. No: 1:11-CV-02047-LJO-
BAM (2015).
PURPOSE:
The purpose of this policy is to establish and maintain a suicide prevention and
intervention program, designed to identify, monitor, and when necessary, provide for
emergency response and treatment to those who present a suicide risk while incarcerated
at the Fresno County detention facilities.
POLICY:
It is the policy of the Fresno County Sheriffs Office Jail Division to minimize the incidence
of suicide by establishing and maintaining a comprehensive suicide and prevention and
intervention program designed to identify people who are at risk of suicide and to
intervene whenever possible.
It is the policy of the Fresno County Sheriffs Office Jail Division that all incarcerated
people shall be medically and mentally screened at the time of intake by a medical staff
member for possible signs and symptoms of suicidal behavior.
It is the policy of the Fresno County Sheriffs Office Jail Division that all incarcerated
people who display signs of suicide risk shall have a comprehensive suicide risk
assessment form completed by a mental health clinician to determine if they present a
low, moderate, or high risk of suicide.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
PROCEDURES:
I. TRAINING
Annual suicide prevention training shall be provided to all custodial staff.
A. All correctional officers are trained in recognition of suicidal risk factors
and suicide prevention as part of their initial training upon employment.
This training includes verbal, non-verbal, and behavioral cues that indicate
a potential suicide and how to respond appropriately.
B. Correctional officers shall receive suicide awareness and prevention
training annually. All such training shall be provided by a licensed mental
health clinician having expertise in correctional suicide prevention and
expertise in the use of a suicide risk assessment form.
C. All correctional officers are trained in standard basic first aid and are CPR
certified. Every housing security station is equipped with emergency
equipment, including a first aid kit, protective apparel bags (mask, face
shield, suit, and gloves), an Ambu-bag (manual resuscitator), and a cut-
down knife (to cut through fibrous material).
D. Nurses assigned to perform intake screenings (i.e., Booking Nurses) are
Registered Nurses (RN's) who have received additional training by a
licensed mental health clinician regarding the intake assessment for
mental illnesses and suicide risk factors.
11. IDENTIFICATION/ASSESSMENT
A. Identification of suicidal people begins with the initial screening conducted
by the Booking Nurse. Intake screening and assessment provide
invaluable information in identifying suicide risk factors.
1. The Intake/Receiving Screening Form shall include a question
regarding any history of mental health problems and/or treatment,
hospitalizations, and/or current or previous thoughts of self-harm.
2. A notice has been posted in the intake area requesting that
arresting/transporting officers advise intake staff if they have
knowledge of any relevant information indicative of an arrestee's
mental or medical well-being (including suicide risk).
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
B. The Booking Nurse may make the recommendation to medically reject the
arrestee if the arrestee is mentally unstable or otherwise urgently in need
of medical/mental health attention that cannot be managed at the Jail.
1. The nurse may contact a mental health clinician for a second opinion
on the arrestee's suicide risk level.
2. The nurse may refer the arresting/transporting officer to the
Community Regional Medical Center (CRMC) so the arrestee may be
examined, stabilized, and returned with medical clearance. (This
clearance may be obtained prior to transportation to the jail.)
C. Correctional staff members should be alert and aware of the basic signs
and symptoms of suicidal behavior. Incarcerated people displaying signs
of suicide risk shall be emergently referred to a licensed mental health
clinician for an evaluation. (Refer also to Section VI/Intervention.)
D. Mental health clinicians shall complete a comprehensive Suicide Risk
Assessment form for all incarcerated people who display signs of suicide
risk to determine if they present a low, moderate, or high risk of suicide,
and create a corresponding ALERT (i.e., L-Suicide, M-Suicide, H-Suicide)
in Offendertrak. This information is available to all staff with access to
Offendertrak (i.e., court staff, correctional officers, medical/mental health
staff).
E. Mental health clinicians shall complete a new Suicide Risk Assessment
form if there are indications of any modification of risk factors, including
but not limited to any suicide attempts or expressions of suicidal ideations.
F. A suicide prevention screening shall be provided to incarcerated people
and documented in the following special situations:
1. Placement into restrictive housing
2. Following a hearing
3. After a transfer or change in classification
G. Due to the possible life-altering information incarcerated people may
receive while attending court, a mental health consultation may be
conducted as determined by the mental health director upon the
incarcerated person's return from court.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
III. HOUSING
Housing recommendations for people at risk of suicide shall balance safety
and environment. The least restrictive environment should be considered.
A. Incarcerated people determined by a licensed mental health clinician to
be a low-risk for suicide shall be housed with other people or, if they
cannot be housed with other people, in housing where they can be
frequently monitored by correctional staff. Such incarcerated people shall
be reassessed at least monthly by mental health staff. The reassessment
shall occur in a private interview setting, whenever possible.
B. Incarcerated people determined to be a moderate-risk for suicide shall be
housed with other people unless they pose a safety and security threat to
other people. Moderate-risk people shall also be housed in locations that
allow correctional staff to observe and communicate with these people on
a daily basis. Such incarcerated people shall be reassessed at least
weekly by licensed mental health staff. Once the licensed mental health
clinician reassigns the incarcerated person to low-risk for suicide, the
person will be reassessed monthly. The reassessments shall occur in a
private interview setting, whenever possible.
IV. COMMUNICATION
A major component of a successful suicide prevention program is effective
and timely communication.
A. An incarcerated person may report suicidal ideation to any health care
personnel, mental health professional, or custody staff. Custody staff is
responsible to:
1. Emergently notify Mental Health (or the on-duty charge nurse) and the
supervising sergeant.
2. Document the circumstances in an incident report.
B. A licensed mental health clinician will evaluate the incarcerated person,
complete a Suicide Risk Assessment form, and proffer their
recommendation to the on-duty Watch Commander. If an incarcerated
person is at high risk of attempting self-injurious behavior, the mental
health clinician will complete a Crisis Management Plan form, which will
be provided to the Watch Commander.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
C. The Watch Commander will convey his/her decision to the Facility
Sergeant and ensure that-
1. All Crisis Management Plans are scanned into the Incarcerated person
Management Plans folder in the G-drive (G/RefMat/Custody/
Incarcerated Person Management Plans).
2. An email is sent to all Sergeants and Lieutenants, notifying them of the
newly effected plan.
3. If Mental Health staff was not involved in the recommendation and
placement of the incarcerated person into the safety cell, the Watch
Commander shall ensure that Mental Health staff has been emergently
notified.
D. If an incarcerated person is to be transferred to a safety cell on Main Jail
1st Floor, the Facility Sergeant will be responsible to notify the sergeant
overseeing booking/records and the affected housing floor of the
impending transfer. The sergeant overseeing booking/records shall notify
appropriate personnel in Booking and Population Management.
1. Population Management will initiate a HOUSING ALLOCATION
movement into the appropriate safety cell.
2. The Booking I Officer shall ensure that the medical staff assigned to
Booking has been notified.
3. The incarcerated person's name, booking number, reason for
placement, additional precautions (e.g., "yellow suiter, "spitter," etc.),
and any items to be withheld from the incarcerated person shall be
written on the board posted outside of the safety cell in which the
person is placed.
E. If the safety cell is located on the same floor as the impending transfer,
then the Facility Sergeant or their designee shall make all necessary
notifications to Population Management and medical staff.
F. If an incarcerated person is to be placed on restrictions, the Facility
Sergeant will be responsible to:
1. Print all newly enacted Crisis Management Plans, Behavior
Management Plans (BMP's), and Administrative Action Reports, as
applicable. Copies of all current/applicable forms shall be placed into
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
the "Incarcerated Person Management Plan" binder located in the
security station of the affected housing floor. The only exception is the
South Annex 2D housing unit, where the plans are immediately
accessible outside of each individual cell door.
2. Ensure the affected housing floor officers are notified and aware of any
newly effected incarcerated person management plan(s).
3. Purge the binder of expired forms, as necessary.
H. Appropriate staff is notified when a person is removed from a safety cell
and reassigned to a housing unit. Mental Health provides follow-up for
incarcerated people within twenty-four (24) hours of safety cell removal.
They will receive subsequent mental health evaluations at designated
intervals, until Mental Health determines that the incarcerated person no
longer needs such monitoring (as defined under III/Housing).
V. SUICIDE RESTRICTIONS
A. If an incarcerated person is at moderate risk of attempting self-injurious
behavior, but is not in immediate danger, a licensed mental health
clinician may recommend that the person be placed on Suicide
Precaution/"no sharps." The clinician will be responsible to:
1. Complete a Crisis Management Plan that documents their
recommendation and indicates the possessions and clothing items
that should be removed or kept. The form is submitted to the Watch
Commander.
2. Create an ALERT ("Restriction — Mental Health") in Offendertrak.
B. If the incarcerated person is placed on "no sharps," the person's
belongings shall be searched by correctional staff and all items that could
be used for self-harm shall be removed from their possession (pencils,
razors, staples, eating utensils, etc.).
C. Regular jail clothing and bedding may be removed, if recommended by
the examining licensed mental health clinician. In such cases, the
incarcerated person will be dressed into a safety garment and given an
all-in-one bed to replace the traditional blanket and mattress (if
determined safe to do so). These items are made of a special fabric that
is impervious to being ripped and used for hanging.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
D. Intermittent direct visual/verbal supervision shall be provided and
documented at least once each hour at staggered, random intervals. The
documented visual inspections shall be recorded via computer, utilizing
the Safety Check System.
E. The use of physical restraints (i.e., restraint chairs and handcuffs) are
avoided and used only as a last result (e.g., to eliminate the risk of the
incarcerated person engaging in self-destructive behavior, such as head
banging, etc.).
VI. INTERVENTION
A. Any time staff suspects a suicide attempt is imminent, they shall-
1. Take reasonable and appropriate precautions to mitigate the ability of
the incarcerated person to injure him/herself.
2. Promptly report unusual behavior exhibited by the incarcerated person
and any other pertinent information concerning the potentially suicidal
incarcerated person to the on-duty charge nurse and the Facility
Sergeant as soon as possible.
3. Consider establishing and maintaining a non-threatening emotionally
supportive conversation with the incarcerated person while awaiting
assistance. Many times, staff's verbal interaction and availability will
be enough to get an incarcerated person over the initial crisis of
incarceration.
4. While awaiting appropriate health care and housing decisions, the
incarcerated person should be handcuffed and either placed into a
secure location or remain under direct and constant supervision. If
necessary to restrain a pregnant incarcerated person, the application
of restraints shall be restricted to handcuffs to the front of the
incarcerated person only.
B. If a qualified health care professional is not immediately available, the
incarcerated person should be placed in an appropriate and safe location
until health care is available. If the incarcerated person does not remain
under constant supervision, the incarcerated person shall be visually
checked at least twice every thirty (30) minutes at staggered, random
intervals.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
C. An incident report shall be written (1035/Mental Health Interview, or other,
as appropriate). The report shall include:
1. The incarcerated person's symptoms/behavior.
2. The action taken.
3. The notifications made, specifically the date, time, and the names of
the health services staff and Sergeant notified.
VI1. RESPONSE TO SELF-INJURIOUS BEHAVIOR OR SUICIDE ATTEMPT
Self-injurious behaviors cause, or are likely to cause, physical self-injury. A
suicide attempt is an intentional act that is deliberately designed to end one's
own life. Both are medical emergencies that require immediate and
appropriate responses.
A. In medical emergencies, the primary objective is to preserve life. Officers
are required to provide immediate life support. The responding officer
must assess and ensure it is reasonably safe to perform life support by
effecting the following actions:
1. Notify the Security Officer.
a. State the circumstances and request necessary medical personnel
and/or additional officers.
b. Request another officer respond to the location with applicable
emergency equipment (e.g., body fluid protective suits, cut-down
knife, Ambu-bag, first aid kit).
c. Depending on the seriousness of the situation, the discovering
officer should call for a Code 33 (emergency — clear the radio
channel) and Code Blue (medical emergency).
2. If the incident occurs in a housing unit, direct the remainder of the
incarcerated people to return to their cells/bunks.
3. Determine and respond appropriately to any exposed bloodborne
pathogens.
a. It is suggested and preferred that staff members carry disposable
gloves at all times for use in emergency situations.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
b. When handling incarcerated people who are bleeding, appropriate
personal protective equipment should be worn to prevent
unnecessary exposure.
4. Take appropriate action to intervene. Determine if there are any
significant security threats to self or others (including any
circumstances causing harm to the involved incarcerated person),
evaluate the risks, and take appropriate action to terminate/resolve the
emergency situation.
5. Check the incarcerated person for signs of respiration, heartbeat, level
of alertness, etc., and initiate the appropriate lifesaving measures.
6. Although the scene appears to be an attempted suicide, protect and
maintain the area as a possible crime scene. (An attempted murder
may have occurred and made to appear as a suicide.) Preservation
of life shall take priority over preservation of a crime scene.
B. The Security Officer shall be responsible to:
1. Immediately call for medical staff and inform them of the
circumstances.
2. Immediately call Central Control and advise them of the medical
emergency. (Central Control will route the elevator in readiness of
responding medical staff.)
3. Emergently call and notify the Facility Sergeant.
4. Note the time of notifications, as well as the time of arrivals.
C. Officers responding to the scene will coordinate securing the scene, if
necessary.
D. Responding medical personnel will relieve/direct correctional staff and
assume primary responsibility for the provision of medical attention and
lifesaving efforts.
1. Medical/correctional staff will determine if an ambulance is needed.
2. Central Control will coordinate the call for an ambulance.
3. Medical personnel will coordinate the ongoing CPR/first aid. Custody
and medical personnel together are responsible for the continuance of
lifesaving efforts for as long as necessary.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
4. The CPR/first aid will continue until staff is relieved by medical
staff/emergency personnel, the incarcerated person is resuscitated,
staff is too exhausted to continue, or the scene becomes unsafe.
E. If the incarcerated person needs to be taken to the hospital, the
Administrative Sergeant will arrange for an officer to accompany the
incarcerated person and notify Population Management. Population
Management will initiate a HOUSING ALLOCATION transfer to UM.
F. The incarcerated person shall receive a medical and mental health
evaluation immediately upon their return to the Jail.
G. If death results from a suicide attempt, the Jail Watch Commander will
contact the Patrol Watch Commander and request that a detective
respond to the Jail.
Vill. APPARENT SUICIDE
A. When an incarcerated person has apparently committed suicide and there
are no life signs present, the emergency shall be handled the same as an
attempted suicide, utilizing normal first aid and CPR procedures. Unless
the incarcerated person shows obvious signs of irreversible death, the
determination cannot be made at the scene as to whether the incarcerated
person is in fact dead, without doctor certification. Signs of irreversible
death include:
1. Decapitation
2. Decomposition
3. Postmortem lividity
4. Postmortem rigidity
5. Burned beyond recognition
B. The Sergeant notified shall be responsible to retrieve the Safety Check
log and maintain it as evidence.
IX. POST-SUICIDE ATTEMPTS OR COMPLETED SUICIDE
A. The location where a suicide or attempted suicide has occurred should be
treated as a crime scene after the incarcerated person has been removed
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
from the area. The area should be secured and access controlled to
preserve evidence until the appropriate investigation can be completed.
B. The on-duty Watch Commander shall be responsible to notify jail
medical/mental health providers to have mental health clinicians respond.
Incarcerated people who have been affected by the incident will be
provided mental health checks and scheduled for follow-up appointments,
as deemed necessary.
C. All suicides or attempted suicides shall be documented in an incident
report.
D. Following the incident, the victim's family shall be notified in accordance
with policy B-145/Notification of an Incarcerated Person's Family or Friend
in the Event of Serious Illness or Injury [FILE: NOTIFY-ILLNESS].
E. All in-custody deaths, including those resulting from suicide, shall be
investigated and documented in accordance with policy B-
140/Incarcerated Person Death [FILE: DEATH]. Dependent upon the
circumstances, either the detectives or the Coroner's Unit will be
responsible to notify the relatives or friends of the incarcerated person's
death.
F. Involved staff members shall attend the incident debriefing conducted by
the Watch Commander.
X. ADMINISTRATIVE REVIEW
A. A multi-disciplinary administrative review of every completed suicide, as
well as any serious attempt (i.e., requiring hospitalization or transfer to a
behavioral health facility) shall be conducted to create a corrective action
plan to address deficiencies. Participants will be determined by one of the
Jail Division Bureau Commanders.
B. The review will include:
1. The circumstances surrounding the incident.
2. All Jail Division policies and procedures relevant to the incident.
3. Identification of any training-related issues.
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
4. Pertinent medical and mental health reports involving the victim.
5. Safety Check logs.
C. The psychiatric medical director, in coordination with the Health Services
Administrator, will organize the medical chart and compile a summary of
the health events to evaluate if appropriate risk factors were assessed.
The treatment plan will be evaluated and assessed. In the event of an
actual suicide, a psychological autopsy will be performed by a psychiatrist.
D. Jail Command Staff will review the summaries within thirty (30) days and
make recommendations, if any, for changes in policy, training, physical
plant, medical or mental health services, and operational procedures.
E. The Compliance Team will be responsible to monitor and track the
progress and completion of any recommended changes.
XI. AFTER CARE
Although the goal of this policy is to significantly reduce the risk of in-custody
deaths, the ongoing care of suicidal incarcerated people after release must
also be considered.
A. Sentenced incarcerated people who have been identified as a moderate
or high level of suicide risk on their most recent comprehensive suicide
risk assessment form shall receive an evaluation by a mental health
clinician prior to their release to the community (or treatment program) for
appropriate referrals or initiation of an involuntary psychiatric hold
pursuant to Welfare and Institutions Code Section 5150. (Refer to policy
C-210/Release from Custody [FILE: RELEASES] for procedures.)
B. The same services will be provided to unsentenced incarcerated people
provided adequate time is available prior to a legally mandated release.
XII. ADDENDUMS
Key Suicide Risk Factors (Addendum A)
Persons at High Risk for Suicide (Addendum B)
Signs and Symptoms of Suicidal Behavior (Addendum C)
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FRESNO COUNTY SHERIFF'S OFFICE
JAIL DIVISION POLICIES AND PROCEDURES
TITLE: SUICIDE PREVENTION NO: D-260
FILE: SUICIDE
Do's and Don'ts (Addendum D)
Suicide Risk Assessment form (Addendum E)
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