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Suicide watch is an intensive monitoring process used to ensure that an individual cannot commit suicide. Usually the term is used in reference to inmates or patients in a prison, hospital, psychiatric hospital, or military bases. Individuals are placed on suicide watch when it is believed there is a good chance they will attempt to cause bodily harm to themselves.
Various forms of suicide watch exist. These generally involve the subject being under continuous or very frequent watch of a guard, such as a prison officer or orderly, who will intervene if they attempt to harm themselves. The main forms are:
Periodic suicide watch, known at many facilities simply as suicide observation or suicide watch, involves the subject being monitored through frequent periodic checks.
Intense suicide watch or observation, involves the subject being observed continually by a person who may be employed in one of several possible capacities, sitting or standing in direct sight or arm's reach of the subject.
People under suicide watch are put into an environment where it would be difficult for them to hurt themselves. In many cases, any dangerous items will be removed from the area, such as sharp objects and some furniture, or they may be placed in a special padded cell, which has nothing outcropping from the walls to provide a place for a ligature to be attached, and with only a drain-grill on the floor. They may be stripped of anything with which they might hurt themselves or use as noose, including shoelaces, belts, neckties, bras, shoes, socks, suspenders and bed sheets. Such precautions are taken because suicide may be attempted with those items. In extreme cases the inmate may be undressed entirely.
In even more extreme cases, inmates may be placed in "therapeutic restraints" which is a four or five point restraint system. Inmates are placed on their backs on a mattress. Their arms and legs are tied down, and a belt will be placed across their chest. In a five point system their head is also restrained. Inmates are allowed range of movement every 2 hours. They are released one limb at a time, and allowed to move it for a short period of time, they are then restrained again and they move on to the next limb. This process is repeated until all areas restrained have been moved. This process usually continues in 8 hour shifts, and inmates have to have a face to face encounter with a mental health professional at least once in each 8 hour interval. This cannot continue for more that 16 consecutive hours. The inmate is continually watched by staff during this time.
However, and only in the most extreme cases of self-harm, and only when all other avenues have not worked or are impracticable there is "chemical restraint" drugs used to sedate the inmate. In order for a facility to administer chemical restraint they have to have the approval/recommendation of a licensed mental health professional, the facility Warden, and a court order. This is only used in the most extreme of cases.
Suicide watch regimes, particularly in jail cells, have been criticized for being too restrictive and dismissive of privacy, socially functioning as a form of legal torture rather than being for the good of the detainee. Inmates are often placed naked in suicide cells, which are usually bare concrete, often without bedding (to prevent hanging by using bed sheets), and under frequent or continuous observation by guards. Unsanitary conditions are also common since toilet paper, underwear, and tampons (all potential means of choking) are restricted. Being exposed without any way of covering oneself, coupled with being under constant observation can aggravate mental distress, particularly if the inmate has been a victim of sexual abuse in the past. These harsh conditions came to light in 1998 when Elizabeth B., an inmate of Framingham prison in Massachusetts, USA, called a radio talk show to describe how she had been treated while on suicide watch:
I was ... put on eyeball status, stripped of belongings, clothing, placed naked in a room with nothing but a plastic mattress on the floor. Watched 24 hours a day by a man or woman. I was on my period but because of my status not allowed to have tampons or underwear. I was very humiliated, degraded. Being on eyeball status with male officers, my depression intensified. I didn't want to be violated any more than I already was, so I put the mattress up against the window. When I did that I was in violation because they couldn't see me. The door was forced open, I was physically restrained in four point restraints - arms, legs spreadeagled, tied to the floor, naked, helmet on head, men and women in the room.
Being on suicide watch does not guarantee an individual will not kill themselves. Ashley Smith, a female inmate at a facility in Canada, killed herself while under suicide watch in October 2007. The circumstances surrounding her death were the subject of the Ashley Smith inquest.