Characteristics Of Juvenile Suicide In Confinement
U.S. Department of JusticeOffice of Justice ProgramsOffice of Juvenile Justice and Delinquency PreventionJeff Slowikowski, Acting AdministratorOffice of Justice ProgramsInnovation Partnerships Safer NeighborhoodsCharacteristics of JuvenileSuicide in ConfinementLindsay M. HayesAccording to the Surgeon General of theUnited States, youth suicide is a nationaltragedy and a major public health prob lem (Carmona, 2005; U.S. Department ofHealth and Human Services, 1999). Thesuicide rate of young people (ages 15 to24) tripled from 2.7 per 100,000 in 1950 to9.9 per 100,000 in 2001 (Arias et al., 2003).More teenagers die from suicide than fromcancer, heart disease, AIDS, birth defects,stroke, pneumonia and influenza, andchronic lung disease combined (U.S.Department of Health and Human Services,1999). In addition, a national survey foundthat more than 3 million youth are at riskfor suicide each year, with 37 percentof surveyed youth reporting that theyattempted suicide during the previous 12months (Substance Abuse and MentalHealth Services Administration, 2001).Although youth suicide in the general pop ulation has been identified as a significantpublic health problem, juvenile suicide inconfinement has received little attention.The Office of Juvenile Justice and Delin quency Prevention (OJJDP) awarded acontract to the National Center on Institu tions and Alternatives to conduct the firstnational survey of juvenile suicides in con finement. The primary goal of this effortwas to determine the extent and distribu tion of juvenile suicides in confinementFebruary 2009(i.e., juvenile detention centers, receptioncenters, training schools, ranches, camps,and farms).The study identified 110 juvenile suicidesoccurring between 1995 and 1999. Datawere analyzed for the 79 cases that hadcomplete survey information. Of these 79suicides, 42 percent occurred in trainingschools and other secure facilities, 37 per cent in detention centers, 15 percent inresidential treatment centers, and 6 per cent in reception or diagnostic centers.The survey gathered descriptive data onthe demographic characteristics andsocial history of each victim, the charac teristics of the incident, and the featuresof the juvenile facility in which the suicidetook place. Particular attention was paidto each facility’s implementation of sui cide prevention programming. This Bul letin presents findings from the surveyand offers recommendations for address ing this tragic problem.Victim’s DemographicCharacteristicsRace, Sex, and AgeMore than two-thirds of the suicide victimsidentified in the survey were Caucasian.Access OJJDP publications online at www.ojp.usdoj.gov/ojjdpwww.ojp.usdoj.govA Message From OJJDPSuicide is always tragic, but it is particularly so when the victim is young.The tragedy of young lives cut shortby suicide poses a significant publichealth challenge. According to datafrom the Centers for Disease Controland Prevention, suicide is the thirdleading cause of death among youth15 to 24 years old.While experts recognize the need tointervene on behalf of vulnerableyouth, little research has been conducted on the suicides of youth heldin detention. To address this deficiency, the Office of Juvenile Justice andDelinquency Prevention has sponsored the first national survey of juvenile suicides in confinement.This Bulletin examines 110 juvenilesuicides that occurred in confinementbetween 1995 and 1999. It describesthe demographic characteristics andsocial history of victims and examinesthe characteristics of the facilities inwhich the suicides took place. Drawing on this data, the researchers offerrecommendations to prevent suicidesin juvenile facilities.The findings reported in these pagespresent serious challenges for healthcare and correctional professionalswho work with confined youth and foradministrators charged with ensuringthe security and safety of youth indetention. Preventing juvenile suicides in confinement is a criticalresponsibility. The information provided in this Bulletin is intended toinform such endeavors.
About the SurveyIn August 1999, the National Center onInstitutions and Alternatives was awarded a grant from the Office of JuvenileJustice and Delinquency Prevention toconduct the first national survey onjuvenile suicide in confinement.a Theprimary goal of the project was to determine the extent and distribution of juvenile suicides in confinement and togather descriptive data on the demographic characteristics of each victim,the characteristics of the incident, andthe characteristics of the juvenile facilitythat sustained the suicide. A report ofthe survey’s findings would serve as aresource for juvenile justice practition ers to expand their knowledge and forjuvenile correctional administrators tocreate and/or revise policies and training curriculums on suicide prevention.Data collection occurred in two phases.Phase 1During phase 1, a one-page surveyinstrument and cover letter was sentto directors of 1,178 public and 2,634private juvenile facilities in the UnitedStates.b Each of the 3,812 facilitydirectors was asked to complete thesurvey if the facility experienced a juvenile suicide between 1995 and 1999.cSimilar to OJJDP’s Conditions of Confinement study (Parent et al., 1994), theproject surveyed facilities that housedjuveniles in more traditional types ofThis finding is consistent with suicidesthat occur each year in the general popu lation (Arias et al., 2003). One previousstudy found that Caucasian youth held indetention attempted suicide at a rateapproximately 3.5 times that of AfricanAmerican youth (Kempton and Forehand,1992). Although African American andHispanic youth comprised approximately39 percent and 18 percent, respectively, ofthe confined juvenile population through out the country (Sickmund and Wan,2001),1 they represented only 11 percentand 6 percent of the victims in this study.Caucasian and American Indian youth, onthe other hand, comprised approximately1.For comparative purposes, data collected fromOJJDP’s Census of Juveniles in Residential Placementwas limited to the following: gender, age, race, place ment authority, most serious offense charged, andadjudication status.confinement—juvenile detention centers,reception centers, training schools, ranches, camps, and farms—operated by stateand local governments and private organizations.d Excluded from the project wereopen, physically unrestricted residentialprograms for juveniles such as shelters,halfway houses, and group homes. Phase1 identified 110 juvenile suicides occurring between 1995 and 1999. The suicides were distributed among 38 states.Phase 2Once facilities that had experienced a suicide during the 5-year study period wereidentified, phase 2 of the survey processwas initiated. It included dissemination ofa seven-page survey instrument to thedirectors of the facilities that sustainedsuicides. The survey instrument wasdesigned to collect readily available dataon three types of characteristics: Demographic and other victim characteristics including age, sex, race, livingarrangement, current offense(s), prioroffense(s), legal status (detained, committed, other), length of confinement,drug/alcohol intoxication at confinement,history of room confinement, substanceabuse history, medical/mental healthhistory, physical/sexual abuse history,and history of suicidal behavior. Incident characteristics including date,time, and location of suicide, and38 percent and 2 percent, respectively, ofthe confined juvenile population through out the country, but 68 percent and 11percent of the victims in this study. Thecauses of these disproportionate relation ships are outside the purview of thisanalysis.A substantial majority (80 percent) ofthe victims were male. Given the fact thatmore than 80 percent of all juvenilesconfined in the United States are male(Sickmund and Wan, 2001), these findingsare not surprising.More than 70 percent of the victims werebetween the ages of 15 and 17 (figure 1).The average (mean) age was 15.7, withone victim as young as 12 and another asold as 20. These findings are consistentwith data from the Census of Juveniles inResidential Placement (Sickmund andWan, 2001).2housing assignment, (e.g., single ormultiple occupancy) room confine ment status, method and instrumentused, time span between last contact and finding victim, and possibleprecipitating factors of the suicide. Facility characteristics including facil ity type, facility ownership (e.g.,state, county, private), capacity/pop ulation at time of suicide, and suicideprevention components in use (writ ten policy, intake screening, stafftraining in suicide prevention andcardiopulmonary resuscitation,observation levels, safe housing, andmortality review).The phase 2 survey instruments andcover letters were mailed to directors ofthe 83 facilities that sustained the 110suicides. Respondents provided com pleted surveys on 79 suicides.Data LimitationsGiven the epidemiological data regarding youth suicide in the community,coupled with the increased risk factorsassociated with confinement, thereported number of suicides in thisstudy would appear low. However, thisstudy identified more deaths per yearthan a contemporary national censusof juvenile facilities (OJJDP, 2002),and many experts believe that facilityLiving Arrangement BeforeConfinementMore than a third (38 percent) of suicidevictims were living with one parent at thetime of their confinement. Slightly lessthan one quarter (23 percent) of the vic tims were living with both parents. Otherliving arrangements included communityplacement (11 percent), other relative(9 percent), foster parent or guardian(8 percent), or adoptive parents (5 per cent). Two victims were living on theirown (3 percent), and the living arrange ments of the other three victims wereunknown (4 percent).
“self-reporting” of juvenile suicides incustody results in underestimates ofthe problem (Sullivan, 1995; Twedt,2001b). Despite concerted efforts byproject staff to locate all possiblejuvenile suicides during the 5-yearstudy period, whether every deathwas identified remains uncertain.Approximately 13 percent of thereported suicides in this study wereidentified through nontraditionalsources (including newspaper articlesand the project director’s consultationwith facilities sustaining the deaths).In addition, more than one-third of thereported suicides were unknown toany state agency (e.g., departmentsof juvenile corrections or agenciesresponsible for licensing and regulatory services). Most of the deaths thatwere unknown to state agenciesoccurred in either county detentioncenters or private residential treat ment centers.e Many of the reportedsuicides in this study were alsounknown to many child advocacyagencies. The fact that any suicideoccurring within a juvenile facilitythroughout the United States couldremain outside the purview of aVictim’s Offense andConfinement Statusregulatory agency should be cause forgreat concern within the juvenile justicecommunity.letter was co-signed by officials of both the NationalJuvenile Detention Association and the Council ofJuvenile Correctional Administrators, and businessreply envelopes were enclosed with the surveyFor More Informationinstruments.For more information about the surveymethodology, including copies of thephase 1 and phase 2 survey instruments,see the OJJDP report, Juvenile Suicide inConfinement: A National Survey (Hayes,2006). The report is available on theOJJDP Web site www.ojp.usdoj.gov/ojjdp.d. By definition, detention centers hold juveniles forshort periods of time in a physically restrictive environment pending juvenile court action, or followingadjudication pending disposition, placement, or transfer. Reception centers are short-term facilities thathold juveniles committed by courts and conductscreening and assessment to assign them to appro-Notespriate facilities. Training schools are long-term facili a. The National Center on Institutions and Alternativesed in an environment with strict physical and staffwas assisted on the project by two prominent nationalcontrols. Ranches, camps, and farms are long-termjuvenile justice organizations (the National Juvenileresidential facilities that do not require the strictDetention Association and the Council of Juvenile Cor-confinement of a training school, often allowingrectional Administrators) and a consultant team com offenders greater contact with the community. Thisposed of four prominent juvenile justice practitioners andlast category includes “residential treatment centers”researchers (G. David Curry, Ph.D., Robert E. DeComo,and “boot camps.”ties in which treatment and programming are provid Ph.D., Barbara C. Dooley, Ph.D., and David W. Roush,Ph.D.). In addition, Cedrick Heraux, a doctoral student ate. Although the study found that 27 percent of theMichigan State University, provided both data entry andtotal number of suicides (N 110) occurred in privatedata analysis support to the project.facilities, many of which were residential treatmentcenters, two-thirds (67 percent) of private facilities didb. Facilities were identified through OJJDP’s Census ofnot respond to survey requests.Juveniles in Residential Placement (OJJDP, 1999). Asmall percentage of facilities were either closed or couldnot be located, and thus presumed to be closed.Figure 1: Suicides in Juvenile Facilities 1995–1999, by Age of Victim35A significant majority (70 percent) ofvictims were confined for nonviolent (i.e.,302.25Percent of VictimsMost Serious Offense2For purposes of this study, offenses were brokendown into six categories: property offenses includedburglary, grand larceny, petty larceny, auto theft, rob bery (other), receiving stolen property, shoplifting,arson, breaking and entering, entering without break ing, counterfeiting, forgery, embezzlement, vandalism,and carrying a concealed weapon; person offensesincluded murder, negligent manslaughter, armed rob bery, rape, indecent assault, assault, battery, sexualassault, aggravated assault, and kidnapping; statusoffenses included running away, truancy, incorrigibility,curfew violation, and loitering; probation violationoffenses included any technical violation of the termsof probation and/or parole; public order offensesincluded alcohol-related charges (intoxication, liquorlaw violation, driving under the influence), resistingarrest, disorderly conduct, prostitution, sex offenses(other), vagrancy, unauthorized use of a motor vehi cle, and minor traffic offenses; and drug offensesincluded possession, use, and distribution of anydangerous controlled substance or narcotic.c. To encourage a high rate of response, the cover201510501213141516Age317181920
nonperson) offenses, with propertyoffenses accounting for the highest per centage of victim confinement (figure 2).In addition, the status, probation viola tion, and public order categories com bined represented more than a third (34percent) of the offenses. Person offensesaccounted for 30 percent of victim con finement; only 3 percent of victims wereconfined on drug offenses. Approximately40 percent (13 of 33) of victims housed ina training school or other secure facilitywere confined for a person offense.Figure 2: Suicides in Juvenile Facilities 1995–1999, by Victim’s MostSerious Offense3530Percent of Victims25With only slight variance, these findingswere consistent with data on the confinedjuvenile population throughout the coun try. For example, person offenses account ed for 35 percent and property offensesaccounted for 29 percent of all confinedjuveniles throughout the country (Sick mund and Wan, 2001). However, whereasthe status, probation violation, and publicorder categories combined represented 27percent of all confined juveniles, thesecategories represented 34 percent of thevictims in this study.At confinement, 39 percent of victims hada second charge. Property offensesaccounted for the majority (52 percent)of the additional charges, followed byperson offenses (19 percent). Status, pro bation violation, and public order offensescombined represented 29 percent of addi tional charges.A substantial majority (79 percent) of sui cide victims had prior offenses. Of the vic tims who had a history of offenses, mostcommitted crimes of a nonviolent nature,with property offenses the most common(50 percent). Status, probation violation,and public order offenses combined repre sented 23 percent of the most seriousprior offenses; person offenses accountedfor 23 percent of victims’ prior offenses.Confinement StatusTwo-thirds (67 percent) of victims werecommitted at the time of death (figure 3).This finding was significantly differentfrom a national study on jail suicides thatfound the overwhelming majority of vic tims were on detention status at the timeof death (Hayes, 1989). The finding was,however, somewhat consistent withnational data on confined juveniles thatfound 74 percent of youth were commit ted (Sickmund and Wan, 2001). Not sur prisingly, the vast majority (79 percent) ofvictims held in detention centers wereon detention status and all ionViolationStatusOffenseschool/secure facility victims were com mitted at the time of death.Less than 4 percent of juvenile suicidesoccurred within the first 24 hours ofconfinement (and all of these deathsoccurred in detention centers). This find ing significantly differed from a nationalstudy on jail suicides that found morethan 50 percent of suicides took placewithin the first 24 hours, with almost athird occurring within the first 3 hours(Hayes, 1989). The deaths reported in thisnational survey of juvenile suicide in con finement were distributed fairly evenlyduring a more than 12-month period. Forexample, the same number of suicides(13) occurred within the first 3 days ofconfinement as occurred after more than10 months of confinement.3 Nearly a third(32 percent) of suicides occurred within 1to 4 months of confinement. However, alldetention center suicides occurred withinthe first 4 months of confinement, withmore than 40 percent occurring within thefirst 72 hours, while a significant majority(73 percent) of training school/secure3.The average length of confinement prior to suicidefor the 10 victims who died after more than 12 monthsin custody was 21.8 months.4PublicOrderDrugOffenseFigure 3: Suicides in JuvenileFacilities 1995–1999, byVictim’s Confinement Status32.9 percent67.1 percentCommittedDetainedfacility suicides occurred 3 months ormore following confinement.44.For comparative purposes, although lengths of staywithin juvenile facilities throughout the country varyconsiderably, earlier OJJDP research has shown theaverage length of stay in the four facility types to beas follows: detention center (15 days), training schoolor other secure facility (7.5 months), reception ordiagnostic center (34 days), and residential treatmentcenter (6.5 months) (see Parent et al., 1994).
Victim’s HistoryMore than one-quarter (28 percent) of vic tims had a history of sexual abuse, withan equal number of victims whose historyof sexual abuse was unknown. For thosewho were abused, an immediate familymember (e.g., father or stepfather) wasthe perpetrator in many cases.Somewhat less than half the victims (44percent) had a history of emotional abuse.The most frequent types of abuse wereexcessive punishment, neglect/abandon ment, verbal abuse, and other types offamily dysfunction. The victim’s historyof emotional abuse was unknown inalmost one-quarter of the cases.A significant majority (73 percent) of vic tims had a history of substance abuse.Approximately one-third of victims witha substance abuse history used alcohol,marijuana, or cocaine before their confine ment. This finding was consistent withother recent data suggesting that twothirds of confined youth have one or morealcohol, drug, or mental disorders (Teplinet al., 2002).Many suicide victims (66 percent) had ahistory of mental illness, and a majority
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