Suicide prevention program decreases risks, saves lives among people recently released from jail

PROVIDENCE, R.I. [Brown University] — A federally funded clinical trial to evaluate an intervention to prevent suicides among people recently released from jail reduced suicide attempts by 55%.

That’s according to a new study in JAMA Network Open led by researchers from Brown University and Michigan State University.

In the United States, one in five adults who attempts suicide has spent at least one night in jail in the year prior. With more than 10 million admissions per year and many stays of just a few days, jails touch a significant number of people at high risk for suicide who are not well connected with other support services. This led psychologists to ask: What if trained professionals intervened while people were detained in jail to decrease suicide risk once they got out?

With funding from federal grants, the research team tested a safety planning intervention that involved an in-jail program and telephone check-ins over the course of six months. The trial was called Suicide Prevention for at-Risk Individuals in Transition and the results show that it reduced suicide attempts by more than half.

The researchers noted that while public discourse tends to focus on preventing suicides in jail, there has been little emphasis on decreasing risks before or after detention.

“We chose to focus on the period surrounding jail detention, including those first six months after return to the community, as a critical point of intervention for people who are at risk for suicide, and also one that had been largely ignored in the scientific literature,” said study author Lauren Weinstock, a professor of psychiatry and human behavior at Brown University.

Weinstock, a clinical psychologist, led the project in Providence, Rhode Island, while clinical psychologist Jennifer Johnson, a professor at Michigan State University and an adjunct professor of psychiatry and human behavior at Brown, led the project in Michigan. With other researchers, they partnered with the late psychologist Barbara Stanley from Columbia University and Greg Brown at the University of Pennsylvania, who had developed an intervention for suicide prevention that had been used in hospital emergency departments.

The research team conducted a randomized clinical trial of 800 at-risk individuals recruited in two mid-size jails: the Rhode Island Department of Corrections and Genesee County Jail in Michigan. Of this group, the researchers followed up with 655 people after release from jail.

Trained therapists met with study participants while they were in jail for a single safety planning session focused on strategies they could use to keep themselves safe while in jail and after they were released. After the participants returned to the community, the therapists followed up with regular phone calls for six months.

“The idea was to build that trust up front, as well as a shared understanding of what someone can do to stay safe,” Weinstock said.

During the follow-up calls, the clinician would provide support and assess suicide risk, connect the person to treatment or care (for example, making an appointment for mental health services), and help with problem-solving around life’s challenges, such as family conflicts or work issues.

According to the study, in the year after jail detention, the intervention reduced suicide attempts by more than half, and suicide events (including suicidal behaviors and suicide-related hospitalizations) by 42%, compared to the enhanced standard care people leaving jail typically receive.

The researchers showed that the safety planning intervention, which had been successful in emergency departments, could also translate to the jail setting.

“The number of stressors and strains encountered in the criminal and legal setting were very notable,” Weinstock said. “There were high rates of prior suicide attempts, substance use and trauma exposure, with people sharing stories of very difficult life circumstances. This was a population at an extremely high risk for suicide, so it was informative to see how effective this intervention could be with this particular group.”

Weinstock said that the next challenge is encouraging the adoption of the intervention on a wider scale. The team is using data from this study to prepare a cost-effectiveness analysis, and they intend to develop an implementation study as well. 

“We hope that correctional and community mental health systems can work in partnership to implement safety planning,” Weinstock said. “The goal is to provide these systems with the most important data they need to move towards change in their routine practices, in a larger effort to save lives.”

The study was funded by a grant from the National Institute of Mental Health (U01MH106660), with additional funding from the National Institute of Health Office of Behavioral and Social Sciences Suicide Prevention Research and the National Institute of Justice.