Suicide Assessment Manual for Inmates

The Suicide Assessment Manual for Inmates (SAMI) is a new instrument designed to assess risk for suicide attempts among individuals admitted to a pretrial remand center or jail. The SAMI is a 20-item clinical checklist of risk factors derived from the suicide research literature. Initial research on the SAMI has focused on its factor structure and predictive validity.

Suicide is the leading cause of death of inmates in jail facilities. Research on suicide prevalence rates indicates that the rate of suicide in an incarcerated population is higher than that in the general population, with some estimates indicating the prevalence to be as much as nine times higher in incarcerated populations. In addition, the prevalence of suicide may be higher in a population of remanded (pretrial) offenders than in a population of sentenced offenders. Suicide is a low base rate behavior; therefore, it is difficult to predict which individuals will attempt to commit suicide. It is, however, important to be able to identify those inmates who are at an increased risk for suicide on admission to a correctional facility so that they may be classified and housed accordingly.

Structured clinical guidelines are useful in attempting to determine which individuals are at an increased risk for suicide. The SAMI was developed to provide a framework of important variables that should be assessed for each individual admitted to a pretrial remand center or jail to determine that individual’s risk for suicide within the next 24 hours. The SAMI is a clinical checklist of risk factors for institutional suicide attempts. It consists of 20 items that were identified by a review of the literature on suicide in general as well as suicide in jails and prisons. The purpose of the SAMI is to guide evaluators through important information and variables that should be assessed to determine an inmate’s risk for institutional suicide. The SAMI was developed for use as a way to structure professional judgment in the assessment of institutional suicide risk.

Each of the 20 items contained in the SAMI can be rated on a 3-point scale, with a score of 0 being associated with low risk, a score of 1 being associated with moderate risk, and a score of 2 being associated with high risk with respect to the particular item. It is important to note, however, that like many instruments developed to structure professional judgment, the item scores on the SAMI are not to be added but, rather, are to be considered within the full context of the individual, the institution, and the circumstances. Both the self-report of the inmate as well as the observations and professional judgment of the evaluator are to be considered for each item.

Extensive and thorough literature reviews have identified numerous variables that are associated with risk for suicide in general as well as in jails and prisons, including age; sex; marital status; history of drug or alcohol abuse; psychiatric history; history of suicide attempts; history of institutional suicide attempts; family history of suicide; arrest history; history of impulsive behavior; high-profile crime or position of respect within the community; current intoxication; concern about major life problems; feelings of hopelessness or excessive guilt; presence of psychotic symptoms or thought disorder; symptoms of depression, stress, and coping; social support; recent significant loss; suicidal ideation; suicidal intent; and suicide plan. The SAMI includes an assessment of each of these variables, with the exception of age and sex given the low variability on these factors since the vast majority of jail inmates are males in their 20s and 30s.

The SAMI is a new instrument, and research examining its reliability and validity is limited. Results of a preliminary study in which the SAMI was administered to 138 pretrial defendants indicate acceptable levels of interrater reliability. In addition, this research indicates that scores on the SAMI items are related to institutional category of risk for suicide (low, medium, high), need for mental health services, and need for monitoring within the pretrial facility. Factor analysis of the SAMI items identifies six factors: affective disturbance, suicide history, current cognitive state, current situa-tional variables, impulsivity, and support and coping. The first three factors (affective disturbance, suicide history, and current cognitive state) are strongly associated with institutional category of risk for suicide, need for mental health services, and need for monitoring within the institution. The sixth factor, support and coping, is also strongly associated with need for mental health services. Regression analyses with the SAMI have indicated that Factors 1 and 2 (affective disturbance and suicide history) are predictive of referral to mental health services within the institution, whereas Factors 2 and 3 (suicide history and current cognitive state) are predictive of category of institutional suicide risk. Further research investigating the predictive utility of the SAMI is currently underway.

Reference:

• Zapf, A. (2006). Suicide assessment manual for inmates. Burnaby, BC: Mental Health, Law, and Policy Institute.

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