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Letter to BOC, Request for rule-making with respect to suicide prevention, Prisoners' Rights Project, 2015

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Prisoners' Rights Project
199 Water Street
New York, NY 10038
T (212) 577-3530
F (212) 509-8433
www.legal-aid.org

Blaine (Fin) V. Fogg
President

July 10, 2015

Stanley Brezenoff, Chair
Members of the Board of Correction
51 Chambers Street
New York, N.Y. 10007

Re:

Seymour W. James, Jr.
Attorney-in-Chief
Adriene L. Holder
Attorney–in–Charge
Civil Practice
John Boston
Project Director
Prisoners' Rights Project

Request for rule-making with respect to Standard 1-03,
Personal Hygiene (suicide prevention)

Dear Chair Brezenoff and Members of the Board::
We agree that the Board should initiate rule-making with respect to suicide
prevention. However, we strongly disagree with the DOC proposal merely to adapt parts of
the pre-existing variance on this subject.
Suicide Prevention: What Is Needed Now
There have been far too many suicide deaths in our City jails over the past several
years. In some cases no suicide watch was initiated after ordered by clinical staff.1 In
several cases, individuals were not in locations that provided adequate access to clinical
staff including intake areas and punitive segregation.2 In some cases there was a lack of
adequate monitoring of the individual in crisis.3
There is a need for the Board to amend the Standards more broadly to implement
best practices concerning individual in our jails who are experiencing psychiatric crisis
1

For example, the death of Fabian Cruz on January 1, 2015, the Death of Horsone Moore on October 13, 2013
and the death of Ariel Castro in September, 2013.
2
For example, the death of Quannell Offley on December 3, 2013 in punitive segregation, and the death of
Horsone Moore on October 13, 2013 in a decontamination room at AMKC. Consider also the failure to
respond to the ingestion of poison by Jason Echevarria while housed in the Mental Health Assessment Unit
for Infracted Inmates (“MHAUII”) at the George R. Vierno Center on August 19, 2012, and the reports by
Kalief Browder (who committed suicide on June 6, 2015 after he was released from Rikers in 2013) about the
callous and uncaring response to suicide attempts while at Rikers including returning him to solitary
confinement after a hanging attempt (reported in numerous media including the first report about Mr. Browder
in The New Yorker available at: http://www.newyorker.com/magazine/2014/10/06/before-the-law).
3
For example, the death of Jerome Murdough on February 15, 2014.

_______
Stanley Brezenoff, Chair, Board of Correction
Members of the Board of Correction

Page 2

including suicidality. The current DOC proposal lacks the necessary substance and
consideration that this topic requires. Limiting hygiene items and providing special clothing
and bedding to persons on suicide watch are not sufficient. If the Board is going to take up
the question of suicide prevention, it should do so much more broadly.
The Consensus Project of the Council of State Governments identifies eight
essential steps for an institutional suicide prevention plan:
1. Training of correctional staff, who are the primary observers of behavior when
mental health staff are unavailable;
2. Immediate screening at intake and ongoing assessment;
3. Communication between transport officer and corrections officer, facility staff and
mental health staff, and facility staff and inmate;
4. Placement in housing appropriate to the situation, emphasizing use of general
population settings instead of isolation;
5. Establishing appropriate levels of supervision, including close and constant
observation;
6. Rapid and correct response to suicide attempts;
7. Reporting of suicide attempts throughout the chain of command; and
8. Follow-up and administrative review, including attending to the effects of critical
incidents on staff stress.
The problem of suicide prevention is for the most part not adequately addressed in
the existing Standards in light of current knowledge. The Mental Health Minimum
Standards (MH Standards) require that DOHMH establish a mental health program that
provides for suicide prevention. MH Standard § 2-01(b). Training of correction and clinical
staff on suicide prevention is required. MH Standard § 2-02(c)(vii). There is a required
program of “observation aides.”4 MH Standard § 2-02(d). And MH Standard § 2-04
designates that appropriate treatment environments which reduce the risk of suicide need to
be available. This section of the MH Minimum Standards includes language about special
housing, appropriate space, trained steady staff and individualized treatment planning.
However, although it mentions “facilities appropriate for the observation, evaluation and
treatment of acute psychiatric episodes,” it does not make a connection to suicide watch or
suicide prevention. MH Standards § 2-04(c)(4).5
4

Current best practices emphasize that incarcerated persons should not be used as a substitute for staff
monitoring. (Standards for Health Services in Jails, National Commission on Correctional Health Care, 2008,
p. 102) Observation aides should only be used in addition to trained staff.
5
Research indicates that suicidal individuals should be housed in general population, mental health units or
infirmary in the closest proximity to clinical staff. The intention is to maximize the ability of staff to interact
with the individual and minimize isolation and confinement. Correction Officers should be trained on how to
interact with incarcerated individuals who are suicidal. Emphasis should be placed on listening to the person,

_______
Stanley Brezenoff, Chair, Board of Correction
Members of the Board of Correction

Page 3

The language of the MH Standards should be improved to require suicide screening at
intake, and periodic assessments (at least every 90 days).6 The Standards should reflect
requirements for communication channels between correction staff and clinical staff, including
through the chain of command to some designated Central Office level. The requirements for
levels of suicide supervision (periodic watch, constant watch), and requirements of clinical
staff oversight at each level should be spelled out.7 These are some of the steps that would
bring the Standards in line with the current best practices.

We do not propose specific language or other detail at this early point because more
thought and research will be required. However, we urge the Board to commence
rulemaking on the subject of suicide prevention as a whole, and we will certainly contribute
to such an effort.
The Department’s Proposed Amendments
DOC’s proposed amendments are grossly inadequate even in their own terms—in
part because they omit some of the essential conditions the Board imposed in granting the
variance in the first place. DOC’s proposed amendments to the Standards would authorize
DOC to require individuals on suicide watch to wear suicide resistant smocks and
remaining with him or her if there is a change in behavior or indication of immediate danger and maintaining
constant contact with the individual. (Hayes, Lindsay M., “Guide to Developing and Revising Suicide
Prevention Protocols Within Jails and Prisons.” National Center on Institutions and Alternatives, 2011, p. 1-2,
http://www.ncianet.org/services/suicide-prevention-in-custody/publications/guide-to-developing-and-revisingsuicide-prevention-protocols-within-jails-and-prisons/)
6
An initial screening is not sufficient. “The intake screening process should be viewed as similar to taking
your temperature, it can identify a current fever, but not a future cold. Therefore, following the intake
screening process, should any staff hear an inmate verbalize a desire or intent to commit suicide, observe an
inmate engaging in any self-harm, or otherwise believe an inmate is at risk for suicide, a procedure should be
in place that requires staff to take immediate action to ensure that the individual is constantly observed until
appropriate medical, mental health, and/or supervisory assistance is obtained.” Hayes, Lindsay M., “Guide to
Developing and Revising Suicide Prevention Protocols Within Jails and Prisons.” National Center on
Institutions and Alternatives, 2011, p.1 available at: http://www.ncianet.org/services/suicide-prevention-incustody/publications/guide-to-developing-and-revising-suicide-prevention-protocols-within-jails-and-prisons/.
See also, Standards for Health Services in Jails, National Commission on Correctional Health Care, 2008, p.
102 (Patients are reassessed regularly to identify any change in condition indicating need for a change in
supervision level or required transfer or commitment. The evaluation includes procedures for periodic followup assessment after the individual is discharged from suicide precautions); and STIPULATED
SETTLEMENT AGREEMENT AND ORDER CONCERNING SUICIDE PREVENTION AND RELATED
MENTAL HEALTH ISSUES, U.S. v. Erie County, NY, 09-CV-0849 (W.D.N.Y 2010) at p. 5 (requiring reassessment post sentencing), available at:
http://www.justice.gov/crt/about/spl/documents/erie_suicide_mh_settlement_06-18-2010.pdf.
7
An effective policy would require that mental health professionals have daily interactions with suicidal
individuals as well as that they complete daily evaluations of the person’s behavior and disposition.
Furthermore, the policy should include an individualized plan for each person placed on suicide watch. Hayes,
Lindsay M., “Guide to Developing and Revising Suicide Prevention Protocols Within Jails and Prisons.”
National Center on Institutions and Alternatives, 2011, p 3 available at:
http://www.ncianet.org/services/suicide-prevention-in-custody/publications/guide-to-developing-and-revisingsuicide-prevention-protocols-within-jails-and-prisons/)

_______
Stanley Brezenoff, Chair, Board of Correction
Members of the Board of Correction

Page 4

undergarments inside their housing area and uniforms outside except for court, and
substitute suicide resistant bedding. However, according to the Board website, the above
variances from §1-03(g) and (i) were granted starting in September 2003 subject to
conditions. The conditions are as follows, with the bold lettering indicating whether or not
the DOC petition includes the condition that was in place for the grant of the variance:
•

•

•

•

•

•

Only mental health providers may place a prisoner on suicide watch and require the
use of a suicide smock and bedding; The petition does not indicate that only
mental health providers may place an incarcerated person on suicide watch.
The language “with the approval of a mental health provider” does not address
how the prisoner was placed on suicide watch or by whom.
Officers assigned to areas where prisoners are on suicide watch must make frequent,
irregular observations of these prisoners (at least four per hour). The petition does
not require irregular observations at a rate of at least 4 per hour.8
Unless inappropriate for compelling security or medical reasons, prisoners on
suicide watch should be housed in dormitories. Dormitory prisoners may be
required to wear smocks only in dormitories where all other prisoners are clothed in
suicide smocks. The petition is silent as to location (dormitories) and is silent as
to “all prisoners” in like circumstances.
Unless prohibited in writing by the provider, prisoners on suicide watch must be
permitted personal hygiene items and personal items, including reading materials
and photographs. The petition is silent about personal hygiene items, personal
items, reading materials and photographs.
Prisoners wearing suicide smocks shall be provided with daily exchanges of clean
smocks and undergarments. Disposable undergarments will be provided with a
uniform whenever prisoners leave their cell. The petition includes this condition.
Suicide watch prisoners shall be permitted to wear civilian clothing when inside a
court room for trial. The petition includes this condition.

All of the conditions imposed by the BOC for the grant of the variance are reasonable and
in line with suicide prevention protocols. Yet DOC left out the necessity that clinical staff
be involved in the decision-making about whether to implement a suicide watch and what
deprivations are required for maintaining safety of a particular individual.

8

Checking four times per hour may not be in line with current standards. The National Center on Institutions
and Alternatives (NCIA) recommends two levels of suicide watch, close observation and constant
observation. Close observation is for individuals on suicide watch who have suicidal tendencies or a past
history of self-destructive behavior. These inmates should be observed at staggered intervals not to exceed ten
minutes. Constant observation is for inmates who are actively suicidal and need to be continuously monitored.
Moreover, the NCIA indicates that it is essential that the monitoring is completed by trained individuals. See
Hayes, Lindsay M., “Guide to Developing and Revising Suicide Prevention Protocols Within Jails and
Prisons.” National Center on Institutions and Alternatives, 2011, p. 1-2, p. 3, available at:
http://www.ncianet.org/services/suicide-prevention-in-custody/publications/guide-to-developing-and-revisingsuicide-prevention-protocols-within-jails-and-prisons/)

_______
Stanley Brezenoff, Chair, Board of Correction
Members of the Board of Correction

Page 5

The Standards must incorporate the need for mental health staff to be involved in
determining the deprivations and in assuring that the smallest amount of deprivations are in
place that will maintain the safety of the individual. Best practices include increasing access
to amenities as quickly as possible – including personal items, regular clothing and regular
bedding, and such judgment can only properly be made by mental health professionals.9
Equally disturbing is the fact that there is no requirement in the rulemaking petition that the
location of suicide watches should be in a location where “all” are held under similar
circumstances as is required by the Board in the existing variance condition. Suicide
prevention smocks and bedding are methods of dealing with a crisis, they are not pleasant
conditions and should not be public (and thereby a possible source of ridicule by others).
Someone in crisis and required to wear a suicide prevention smock should not be housed in
an area where others are able unnecessarily to observe their experience.10
For these reasons, at a minimum the conditions promulgated initially by the Board
should be included in any conversion of this variance to an amendment. There should also
be some enhancement of those conditions. Not only should there be specified areas for
persons on suicide watch, it should be specified that the area should have suicide proof
fixtures.11 Suicide watch should also be held in a clinical setting that provides a high-level
of care and presence of clinical staff such as in the CAPS and PACE units. This need is a
real and present one. At an earlier Board meeting Dr. Venters indicated that suicide watches
would occur in the Restricted Housing Units (RHU). The RHU, where individuals with
mental illness who are not deemed to be in need of the CAPS level of care, serve punitive
segregation time, should never have someone on suicide watch. If an individual is in a
9

See Standards for Health Services in Jails, National Commission on Correctional Health Care, 2008, p. 102
(Patients are reassessed regularly to identify any change in condition indicating need for a change in
supervision level or required transfer or commitment. The evaluation includes procedures for periodic followup assessment after the individual is discharged from suicide precautions); Hayes, Lindsay M., “Guide to
Developing and Revising Suicide Prevention Protocols Within Jails and Prisons.” National Center on
Institutions and Alternatives, 2011, p.3 available at: http://www.ncianet.org/services/suicide-prevention-incustody/publications/guide-to-developing-and-revising-suicide-prevention-protocols-within-jails-and-prisons/
(“To every extent possible, suicidal inmates should be housed in the general population, mental health unit, or
medical infirmary, located close to staff. Further, removal of an inmate’s clothing (excluding belts and
shoelaces) and the use of physical restraints (e.g., restraint chairs or boards, leather straps, handcuffs,
straitjackets) should be avoided whenever possible, and used only as a last resort when the inmate is
physically engaging in self-destructive behavior. Housing assignments should be based on the ability to
maximize staff interaction with the inmate, not on decisions that heighten depersonalizing aspects of
confinement.”).
10
Despite the current Board condition on the location of suicide watches, the current practice does not require
that suicide watches be only conducted in specified areas in our jails.
11
Current research suggest that incarcerated persons who require suicide watch should be housed in suicideresistant housing with clear visibility and free of protrusions that would enable hanging. Ideally, the cell
should also be free of devices or objects that could serve as an anchor for hanging. Hayes, Lindsay M., “Guide
to Developing and Revising Suicide Prevention Protocols Within Jails and Prisons.” National Center on
Institutions and Alternatives, 2011, p.3 available at: http://www.ncianet.org/services/suicide-prevention-incustody/publications/guide-to-developing-and-revising-suicide-prevention-protocols-within-jails-andprisons/)

_______
Stanley Brezenoff, Chair, Board of Correction
Members of the Board of Correction

Page 6

psychiatric crisis – requiring implementation of a suicide watch – they do require a high
level of care, removal from a restricted housing area such as RHU, and placement in a
designated area in close proximity to clinical staff.
As we stated initially, reform of suicide prevention practices should not be limited
to tinkering with the existing variance and conditions; it should be approached from scratch
with the benefit of all that has been learned in the more than two decades since the MH
Minimum Standards were promulgated.

Very Truly Yours,
SARAH KERR
Staff Attorney
JOHN BOSTON
Director
The Legal Aid Society
Prisoners’ Rights Project
(212) 577-3530
ELLEN YAROSHEFSKY
Clinical Professor
Director-Youth Justice Clinic
Cardozo School of Law
55 Fifth Ave
New York, NY 10003
(212) 790-0386

JENNIFER J. PARISH
Director of Criminal Justice Advocacy
Mental Health Project
Urban Justice Center
40 Rector Street, 9th Floor
New York, NY 10006
(646) 602-5644

LISA SCHREIBERSDORF
Executive Director
Brooklyn Defender Services
177 Livingston Street, 7th Fl.
Brooklyn, NY 11201

NYC JAILS ACTION COALITION
c/o Urban Justice Center
40 Rector Street, 9th Floor
New York, NY 10006
www.nycjac.org

MIK KINKEAD
Director of Prisoner Justice Project
Sylvia Rivera Law Project
147 West 24th St., 5th floor
New York, NY 10011

BETH HAROULES
Senior Staff Attorney
New York Civil Liberties Union
125 Broad St.
New York, NY 10004
(212) 607-3325

 

 

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