Suicide Prevention in Juvenile Facilities
by Lindsay M. Hayes

Lindsay M. Hayes, M.S., is Assistant Director of the National Center on Institutions and Alternatives. He has conducted research, provided technical assistance and training, and served as an expert witness in the area of jail, prison, and juvenile suicide for the past 20 years.
Nelson, a 16-year-old American Indian, was committed to the Valley Youth Correctional Facility in May 1996 as a disposition for a sexual assault.1 At an early age he had been physically abused by family members and sexually abused by neighborhood youth. Although he had never attempted suicide, Nelson had an extensive history of suicidal thoughts and tendencies. Psychiatric evaluation led to a diagnosis of conduct disorder and attention deficit hyperactivity disorder. The facility's psychiatrist saw him regularly and prescribed psychotropic medication. In October 1996, Nelson was placed on suicide watch after he had scratched his arms following an altercation with another youth. Nelson told the counselor that he often got depressed and mutilated himself after getting into trouble. Suicide precautions were discontinued several days later.

In June 1997, Nelson was placed in a quiet room for several hours after he was judged a risk to himself because he had inflicted superficial scratches on his arms and a risk to others because he threatened his peers. He later told unit staff that placement in the quiet room diminished his need to abuse himself (sometimes he would punch the walls to relieve his tension and anger). In July 1997, Nelson was again housed in a quiet room and placed on suicide precautions after threatening suicide. In December 1997, cottage staff referred him to a counselor as they were concerned about his depression and his questioning whether "life was worth living anymore." He was reportedly upset by the likelihood of being transferred to another facility because of his noncompliance with the treatment program. The situation was exacerbated by his mother's decision to stop visiting him in order to encourage his participation in treatment. The counselor believed that suicide precautions were unnecessary, and Nelson agreed to notify staff should he feel suicidal again.

On January 12, 1998, at approximately 5:30 p.m., Nelson was placed in a quiet room as a discipline for flashing gang signs in the dining room and making sexual comments about female cottage staff. Cottage staff returned Nelson—who appeared quiet and lonely to his peers—to his housing cottage at approximately 6:50 p.m. At approximately 10:30 p.m., cottage staff found Nelson in his room hanging from a ceiling vent by a sheet. Staff initiated cardiopulmonary resuscitation and called for an ambulance. Paramedics arrived shortly thereafter, continued lifesaving measures, and transported the youth to a local hospital where he died a few days later as a result of his injuries.

1To ensure confidentiality, the names of the victim and facility have been changed.

Juvenile Justice - Youth With Mental Health Disorders:
Issues and Emerging Responses
April 2000,
Volume VII · Number 1