Signs that a prisoner may be at risk of suicide include giving away valued possessions, speaking as if they are not going to be around much longer even though they are not scheduled for release, withdrawing, becoming acutely intoxicated, having a recent history of severe addiction, being threatened or assaulted by other prisoners, having a history of psychiatric hospitalizations or suicide attempts, talking about death, having recently been arrested for an offense punishable by a long sentence or actually sentenced to a lengthy term, or having impulse-control problems. Prisoners who have recently received bad news from home or are demonstrating an inability to adapt to the institutional environment may also be at higher risk. Objective tests such as the Beck Depression Inventory are of limited usefulness because a malingerer may fake signs of being suicidal while a prisoner who does not want to be stopped from committing suicide may hide signs of being suicidal. Prisoners with illnesses are at higher risk of suicide, with prisoners with AIDS have a suicide rate between 16 and 36 times higher than that of the general population.
Prisons in the United Kingdom had a sharp rise in suicides between 1972 and 1987, with hanging being the most common suicide method. A study found that 47% of the deaths in Finnish prisons were suicides. Large percentages of those who commit suicide in prison do so after having recently received mental health services, although only one-third of prison suicides are found to have a psychiatric history, as opposed to 80-90 percent of suicides in the general community. The suicide rate in U.S. federal prisons is lower than the nationwide average. Pretrial detainees tend to have higher rates of suicide than other inmates, with about a third of all prison suicides occurring within the first week of custody. Custodial suicide is the leading cause of death among detainees housed in jails.
Suicides occur most commonly in isolation cells. The most common time for suicides to occur is in the early morning hours. Suicidal inmates are sometimes put on suicide watch. The suicide rate among prisoners is four times as high as among the general population, but it is unknown whether this is because of the prison environment or because persons with marked suicidal tendency are more liable to be imprisoned for crime. The apparent motivation for prison suicide appears to be fear of other inmates, of the consequences of one's crime, or imprisonment, and the loss of a significant relationship.
In the United States, liability can arise under 42 U.S.C. § 1983 and the Eighth Amendment to the United States Constitution if jail and prison officials demonstrate deliberate indifference toward a prisoner's suicidal tendencies, as suicidal inmates are regarded as being in need of medical care. In Farmer v. Brennan, deliberate indifference was established as a standard between negligence and acting with purpose or intent, thus amounting basically to recklessness. The Farmer decision has created difficulties for plaintiffs in proving suicide liability as a violation of constitutionally established civil rights. The burden of proof appears to be higher than in malpractice cases. Case law provides that liability only exists if prison officials had subjective knowledge of (or at least willful blindness to) an inmate's serious medical need. I.e., they cannot be held liable if they merely should have known, but did not actually know.
Mere negligence is not enough for there to be a constitutional violation. The federal courts seldom allow recovery based on section 1983 absent extreme instances of deliberate indifference to a suicidal prisoner or a clear pattern of general indifference to suicidal inmates. There has to have been a strong likelihood rather than a mere possibility that a suicide would occur. Courts have also found that there is no duty to screen every prisoner for suicide potential, unless it is obvious that an inmate has such tendencies or propensities. Further, even if prison officials are aware of the inmate's suicidal tendencies and he does commit suicide, they are not liable if they took reasonable actions to prevent the suicide. In determining deliberate indifference, the practical limitations on jailers in preventing inmate suicides must be taken into account.
Examples of failures that can give rise to claims related to suicide in correctional settings include inadequate mental health and psychiatric examination, failure to consider obvious and substantial risk factors in assessing potential for suicide, failure to place an inmate on suicide precautions upon recognizing the obvious and substantial risk, failure to communicate the action taken to other providers or to custody and jail staff, failure to adequately monitor an inmate on suicide watch and maintain an appropriate observation log, discontinuation of suicide watch despite prior knowledge of suicidal behavior of the inmate and potential continued risk, failure to follow policies and procedures related to suicide risk assessment, intervention, and prevention, failure to provide training to correctional staff, abrupt discontinuation of psychotropics in an inmate who is known to have made a serious suicide attempt in the recent past, and grossly inadequate treatment by professional standards or the lack of treatment plans, policies, procedures, or staff, creating a grossly inadequate mental health care system, and repeated examples of delayed or denied medical treatment.
One criticism of the current case law is that prison officials are incentivized to avoid screening inmates for suicidal tendencies, because if the screening is ineffective, or the jail fails to deter the suicidal attempt of a prisoner it knows is suicidal, the governmental entity and the jailer may be at greater risk of being held liable than if they had conducted no screening. Nonetheless, some jails screen anyway, since jail suicides are difficult on staff and on the municipality and often lead to legal action, and because some states mandate screening procedures and impose tort liability for failure to follow them. Elected officials may face political ramifications if they become the scapegoat for a prisoner suicide.
Another factor that has led to more screening of inmates for suicide is that research has shown that suicide tends to be the result of a plan rather than impulsive, which makes the suicide potentially more foreseeable if proper screening is done.