Many of the issues and circumstances affecting the treatment of inmate suicidal behaviour are inextricably linked to those involved in its intervention and prevention. Since effective, pro-active intervention and prevention procedures and programs are not yet standard features within correctional facilities, any discussion of inmate suicide treatment tends to focus primarily on the problems and inadequacies. From this, however, it is possible to get an insight into what improvements are needed and what would constitute appropriate, effective treatment for suicidal inmates.
Inmates have been generally expected to cope with prison life in competent and socially constructive ways. Too often, however, the inmate has been confronted by a hostile or indifferent custodial environment in which denial of personal problems and manipulation of others are the primary ingredients in coping with daily life. Consequently, the "survivors" of penitentiary life become tougher, more aggressive and less able to feel empathy for themselves or others; the "non-survivors," meanwhile, become weaker, more vulnerable and less able to control their lives. A prevailing inmate attitude is one of "doing one's own time;" it places a taboo on admitting feelings and sharing them with others. Stoicism is valued and expressions of fear are equated with a stigma of "weakness." Maintaining distance from staff is also a dominant theme within "doing time." Adding to this has been the view, held by both inmates and their custodians, that proper treatment and humane compassion are seen as incompatible with security and correctional concerns. There have been indications that guards tend to dismiss incidents of self-injury as attention-seeking gestures; as a result they either go unreported or recorded in a subjective manner which downplays their seriousness. A more positive response by guards to inmates attempting suicide needs to be developed, and proper counselling must be ensured.
Too much of corrections policy has failed to seriously consider the social dimension of inmate suicide and, as a result, suicide treatment programs have not been effective because they are based on the view that suicide is strictly a medical problem for doctors to solve. However, it is being recognized more and more that greater significance needs to be given to the environment in which inmates and staff are expected to live and work, and to the importance of providing constructive activities to help inmates cope with anxiety and stress. The treatment and prevention of inmate suicide needs to be a joint responsibility, involving inmates, corrections staff, families, visitors and the administration, as well as consideration of the physical environment. Medical personnel need to recognize and accept a wider view of their tasks and responsibilities, including specific training in dealing with the inmate problems created by incarceration. Among the major difficulties that need to be overcome in order for corrections staff to respond more positively to incidents of inmate suicide are the lack of staff continuity, insufficient time for staff to spend with prisoners in an involved manner, and a lack of training, particularly in interpersonal relationships.