Suicide Prevention (SUI)

As of April 1, 2024

The pending summarized recommendations listed below reflect the most current information and actions taken since the previous Board Study Session. Summarized recommendations marked as audited or pending review have been updated for the May 7, 2024 Board Study Session.

Suicide Prevention is a subject area that touches 3 of the categories: Jail Facilities, Custody Hiring, Staffing, and Training, and Inmate Healthcare.

SUI 1: Designate specific cells that will be utilized to house suicidal inmates, and ensure that inmates on suicide precautions are housed in suicide-resistant and protrusion-free cells. Modifications include vents, ducts, grills, lights, drains, telephone cords, clothing hooks, toilets, beds, smoke detectors, desks, benches, stools, shelves, and modesty walls.

Steps Taken: On August 16, 2016, the Board approved a capital improvement project in the amount of $1.384 million for design and construction of suicide prevention measures at Main Jail North (MJN) and Elmwood. For the cells designated as suicide resistant, part of this project includes:

Remove upper bunk beds where they exist. Grind smooth, and patch holes/imperfections.
Remove clothes hangers. Grind smooth, and patch holes/imperfections.
Replace existing stainless steel sink/toilet combinations or plumbing so that there are no splash guards or anti-splash slits.
Remove lower bunk beds and replace with heavy molded plastic or solid concrete slab with rounded edges.
Remove stools, and beds will be used as a seat.
Triangular corner tables are preferred where existing tables do not meet requirements.
Vents and the perforated metal cones that protect the smoke detector need to be changed to a screen that cannot be used to thread a noose through.

Designs were projected to be completed by February 2017, but now construction is estimated to start at a time later than November 2018 in order to incorporate and evaluate the incorporation of ADA features in suicide prevention cells and phase the work as housing units are available.

On September 25, 2018, the Board approved the recommendation by the Facilities and Fleet Department to award the construction contract for the Correctional Suicide Prevention Cells and ADA Improvements Project. The Correctional Suicide Prevention Cells Project involves renovation of certain Main Jail North and Elmwood cells and repurposes them as suicide prevention cells. Construction started December 2018. The scheduled completion date is 2024 due to the inability to access housing units during the pandemic that were needed by Custody staff for COVID-19 isolation and quarantine and phasing of work throughout the jail facilities.

As of October 2023, Facilities and Fleet has completed 13 ADA/Suicide Prevention Design and Construction projects to date.

As of October 2023, Facilities and Fleet has 3 active ADA/Suicide Prevention construction projects. These projects are scheduled to be complete by Spring 2024. These projects include:

CP16029 – ADA Repairs at Elmwood: 90% complete (June 2024)
CP17030 – MJN/Elmwood Suicide Prevention Upgrades: 90% complete (June 2024)
CP22003 – Elmwood Barracks 2: 50% complete (November 2023)

Budget Status: This summarized recommendation was budgeted for design and construction in August 2016 in the amount of $1.384 million.

On September 25, 2018, the Board approved an additional $1,592,900 as Supplemental Work Allowance and transferring funds of $11.8 million relating to the Main Jail North and Elmwood Americans with Disabilities Act (ADA) Improvements and Suicide Watch Cells Project of which $5,500,000 will be used to augment the Correctional Suicide Prevention Cells Project.

On September 27, 2022, the Board approved an increase of $2.4 million in the supplemental work allowance for the Main Jail North and Elmwood ADA Improvements and Suicide Watch Cells Project contract.

Source Report(s): Suicide Prevention Gap Analysis - Hayes

Responsible Department(s): Facilities and Fleet

Master List Nos.: 261-271, 280-286, 288-296, 302-303

Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

SUI 2: Use audio and video to monitor for suicide attempts and hear calls for distress from the suicide resistant cells, and provide higher visibility both day and night.

Steps Taken: As a result of the referral from FGOC on August 26, 2016, this functionality is being considered as part of the design process for suicide prevention cell modifications.

As of November 2017, staff is providing information to the Board about audio and video functionality for jail surveillance, and how much audio surveillance is reasonable to allow in medical and mental health treatment areas.

Budget Status: The capital project for cell modifications was budgeted for design and construction in August 2016 in the amount of $1.384 million.

Responsible Department(s): Facilities and Fleet

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Master List Nos.: 276-279, 287

Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

SUI 3: Modify doors and windows of designated suicide-resistant cells to increase visibility for staff, sunlight for the inmates, and minimize protrusions that could be used to commit suicide.

Steps Taken: On August 16, 2016, the Board approved a capital improvement project in the amount of $1.384 million for design and construction of suicide prevention measures at MJN and Elmwood. Part of this project includes replacing existing wooden and steel doors in the designated suicide resistant cells with large vision panel doors without protruding handles and beveled hinges.

Designs were projected to be completed by February 2017, but now construction is estimated to start at a time later than November 2018 in order to incorporate and evaluate the ADA features in suicide prevention cells and phase the work as housing units become available. On May 9, 2017, the Board approved a capital improvement project in the amount of $1.6 million for design and construction of suicide prevention barriers in various jail housing units for inmates with serious mental illness. Installation of temporary suicide prevention barriers in various housing units has begun. Permanent suicide prevention barrier designs are complete and the construction contract was awarded in October 2017. Permanent suicide prevention barriers have been completed in several housing units at Elmwood, and the entire project is projected to be completed in December 2018.

On September 25, 2018, the Board approved the recommendation by the Facilities and Fleet Department to award the construction contract for the Correctional Suicide Prevention Cells and ADA Improvements Project. The Correctional Suicide Prevention Cells Project involves renovation of certain Main Jail North and Elmwood cells and repurposes them as suicide prevention cells. Construction started scheduled to start December 2018. The scheduled completion date is 2024 due to the inability to access housing units during the pandemic that were needed by Custody staff for COVID-19 isolation and quarantine and phasing of work throughout the jail facilities.

As of October 2023, Facilities and Fleet has completed 13 ADA/Suicide Prevention Design and Construction projects to date.

As of October 2023, Facilities and Fleet has 3 active ADA/Suicide Prevention construction projects. These projects are scheduled to be complete by Spring 2024. Projects include:

CP16029 - ADA Repairs at Elmwood: 90% complete (June 2024)
CP17030 – MJN/Elmwood Suicide Prevention Upgrades: 90% complete (June 2024)
CP22003 - Elmwood Barracks 2: 50% complete (November 2023)

Budget Status: This summarized recommendation was budgeted for design and construction in August 2016 in the amount of $1.384 million. An additional $1.6 million was allocated in May 2017 to address additional suicide prevention issues.

As part of the FY 2019 Adopted Budget, the Board approved an additional $2,120,000 in funding for suicide prevention measures in various housing units.

On September 27, 2022, the Board approved an increase of $2.4 million in the supplemental work allowance for the Main Jail North and Elmwood ADA Improvements and Suicide Watch Cells Project contract.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Facilities and Fleet

Master List Nos.: 253-260, 297-299

Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

SUI 4: Make adjustments to lighting and electricity in designated suicide-resistant cells that make the fixtures tamper-proof and allow staff to identify movements and forms at night. Adjustments would allow for enough darkness for inmates to sleep at night and also be able to read during the day.

Steps Taken: On August 16, 2016, the Board approved a capital improvement project in the amount of $1.384 million for design and construction of suicide prevention measures at MJN and Elmwood. Part of this project includes relocating all electrical switches outside of the cells designated for suicide prevention. Light fixtures would also be recessed and caulked with tamper-resistant caulk.

As of October 2023, Facilities and Fleet has completed 13 ADA/Suicide Prevention Design and Construction projects to date.

As of October 2023 Facilities and Fleet has 3 active ADA/Suicide Prevention construction projects. These projects are scheduled to be complete by Spring 2024. Projects include:

CP16029 - ADA Repairs at Elmwood: 90% complete (June 2024)
CP17030 – MJN/Elmwood Suicide Prevention Upgrades: 90% complete (June 2024)
CP22003 - Elmwood Barracks 2: 50% complete (November 2023)

Budget Status: This summarized recommendation was budgeted for design and construction in August 2016 in the amount of $1.384 million.

On September 27, 2022, the Board approved an increase of $2.4 million in the supplemental work allowance for the Main Jail North and Elmwood ADA Improvements and Suicide Watch Cells Project contract.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Facilities and Fleet

Master List Nos.: 272-275

Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

SUI 5: Ensure reasonable privacy during Custody Health screenings and assessments

Steps Taken: On March 1, 2016, the Board approved $250,000 for the Main Jail North Reconfiguration project to address reasonable privacy issues during screenings and assessments at the intake booking area.
There are currently 3 separate capital projects related to privacy in the booking area. The first is men’s intake counter, which was completed in February 2017. The second is the women’s intake counter, which was completed Spring 2017.
The third is the intake partitions and room configurations, which was completed in January 2018. Currently, staff are ensuring that assessments are conducted in a reasonably private location.

This Summarized Recommendation is pending review by the Office of Correction and Law Enforcement Monitoring (OCLEM) as part of the Jail Reforms Audit to assess the status of implementation.

Budget Status: This summarized recommendation was budgeted for design and construction in the various capital projects described above in the amount of $250,000.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Facilities and Fleet

Master List Nos.: 300-301

Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

SUI 6: Implement a Suicide Risk Assessment tool that is used when an inmate is referred to CHS for possible suicidal behavior. This tool will also be used to initiate suicide precautions and discharging from suicide precautions. The Assessment should be conducted in an area with reasonable sound privacy. The Sheriff’s Office and CHS should initiate a mental health referral if an inmate had possible mental illness or suicidal behavior during previous incarceration.

Steps Taken: The new Suicide Risk Assessment tool (SRA) was implemented on October 24, 2016. The recommendations by the suicide prevention expert, along with the screening questions, are done in booking in as private of a setting that is available in the Jail booking area while the facility improvements related to privacy are in process. The SRA is built on a two tier system. The first tier assesses medical and mental health emergent conditions, then the second tier is used if needed for an extensive assessment.

This Summarized Recommendation is pending review by the Office of Correction and Law Enforcement Monitoring (OCLEM) as part of the Jail Reforms Audit to assess the status of implementation.

Budget Status: No additional resources are needed.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Sheriff’s Office, Custody Health Services, Facilities and Fleet

Master List Nos.: 220, 221, 223, 224, 226, 238 - 240

Review Date: FGOC reviewed on December 19, 2016.

SUI 7: CHS should develop suicide prevention policy that enhances communication between suicidal inmates and staff and incorporates the following factors: (1) Screening process at intake booking should include referral to medical or mental health staff. (2) Permit both DOC and CHS staff to initiate suicide precautions, and the CHS can discontinue precautions only after conducting an assessment. (3) Ensure inmates on suicide precautions are located in close proximity to staff. (4) CHS staff perform an assessment before the scheduled release of an inmate on suicide precautions. (5) Implement a continuous quality improvement plan. (6) The behaviors that warrant an appropriate level of observation. (7) Description of appropriate clothing for inmates on suicide precautions, and avoid if possible the use of restraints and cancellation of privileges Training and mock drills for resuscitation with appropriate equipment available.

Steps Taken: The Sheriff’s Office has a protocol in place for initiating suicide precautions. For CHS, all of the above recommendations started as of October 24, 2016. This includes the start of data collection for the quality assessment/quality monitoring. The CHS policies have been updated.

This Summarized Recommendation has been audited by the Office of Correction and Law Enforcement Monitoring (OCLEM) and has been found to be implemented.

Budget Status: No additional resources are needed.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Sheriff’s Office, Custody Health Services

Master List Nos.: 132, 222, 225, 228 - 233, 235, 237, 244, 245, 396

Review Date: FGOC reviewed on December 19, 2016.

SUI 8: With regard to suicide precautions, develop a triage system for mental health referrals. Length of stay on suicide precautions should be determined by CHS staff. Establish levels of supervision for suicidal inmates. Inmates discharged from suicide precautions get a treatment plan and follow-up assessments by CHS staff.

Steps Taken: The CHS Triage System provides guidelines to clinicians and nurses concerning estimation of the time-sensitivity of an evaluation by an appropriate provider in an appropriate setting, according to a patient’s mental health conditions. The goal of triage is to rapidly assess and identify life threatening emergencies and to activate emergency responses in a timely fashion.
Triage is a system for assigning prioritization to groups of patients according to the time-sensitivity of their health needs and the expected response. Patients with health needs may present to CHS staff through intake, self-referrals (e.g., white cards), and staff referrals. Triage is an iterative process since some health needs improve or worsen over time.
Timeframes for current practice of clinician response:

Emergent mental health (MH) conditions: patient requires a MH clinician to respond within 15 minutes and intervene within an hour.
Urgent mental health (MH) condition: patient requires a MH clinician to assess and to intervene within 2 hours.
Routine mental health (MH) condition: patient requires a MH clinician to assess and to intervene within 24 hours.

The Suicide Risk Assessment tool (SRA) is built on a two tier system. The first tier assesses medical and mental health emergent conditions, then the second tier is used if needed for an extensive assessment. The Tier 2 assessment for mental health includes the questionnaire associated with the tool used at the California Department of Corrections and Rehabilitation, and SRA will be conducted by mental health professionals. Suicide precautions will be noted in the medical record. For the current system, CHS will continue to document on current paper and electronic medical record systems. All of the above recommendations are being incorporated and built into the triage system.

This Summarized Recommendation has been audited by the Office of Correction and Law Enforcement Monitoring (OCLEM) and has been found to be implemented.

Budget Status: No additional resources are needed.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Custody Health Services

Master List Nos.: 227, 234, 236, 241, 242

Review Date: FGOC reviewed on December 19, 2016.

SUI 9: CHS staff should be trained on Suicide Risk Assessment form and development of treatment plans. Training should be developed for new and existing custody and custody health employees, along with regular refresher training. Training should include avoiding negative attitudes, impact of correctional environments on suicidal behavior, predisposing factors, high-risk time periods, warning signs, suicide prevention policy and liability issues. Any staff involved in a critical incident should be offered a stress debriefing. Custody Administration should ensure a compliance rate for CPR/AED training for custody staff.

Steps Taken: Training for existing Custody Health staff on the new Suicide Risk Assessment tool is complete. New CHS employees will be trained as part of orientation, and refresher training will be provided to all staff.

All Sheriff’s Office employees are offered the Emergency Assistance Program (EAP) following a critical incident. The Sheriff’s Office is expanding its peer support program so employees have a resource in addition to EAP. The Sheriff’s Office also monitors CPR/AED training and has maintained a high level of compliance.

This Summarized Recommendation has been audited by the Office of Correction and Law Enforcement Monitoring (OCLEM) and has been found to be implemented.

Budget Status: No additional resources are needed.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Sheriff’s Office, Custody Health Services

Master List Nos.: 246, 249, 252, 304 – 309

Review Date: FGOC reviewed on December 19, 2016.

SUI 10: Establish a single multi-disciplinary death review committee that includes custody and custody health staff. Adopt a policy that sets forth appropriate procedures for this committee. Every suicide and serious suicide attempt should be examined. There should be a focus on continuous quality improvement and the monitoring of the implementation of recommendations by the Death Review Committee.

Steps Taken: The Sheriff’s Office and CHS have a quality committee to review suicide attempts and deaths that was implemented prior to August of 2016.

This Summarized Recommendation is pending review by the Office of Correction and Law Enforcement Monitoring (OCLEM) as part of the Jail Reforms Audit to assess the status of implementation.

Budget Status: No additional resources are needed.

Source Report(s): Suicide Prevention Gap Analysis – Hayes

Responsible Department(s): Sheriff’s Office, Custody Health Services

Master List Nos.: 217 - 219, 247, 248, 250, 251

Review Date: FGOC reviewed on December 19, 2016.

Suicide Prevention (SUI)

As of April 1, 2024

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