Newton Duncan, GUEST COLUMNIST
The circumstances surrounding Vanessa Wint’s November 21, 2012 suicide at the Horizon Adult Remand Centre were highlighted in recent Sunday Gleaner publications. Six months after this juvenile’s suicide, the Government and its juvenile correctional arm are generally unmoved by her tragic end.
A preventable tragedy repeats itself where there is paralysis of intervention.
Vanessa Wint’s suicide, within the walls of a prison configured for hardened criminals, if nothing else, is a Jamaica 50 poster event, capturing well the parlous state of the nation’s childcare and protection services. The average Jamaican is numb to the plight of its vulnerable children, even those who become victims of the ugliest acts of state injustice.
Vanessa Wint was repeatedly sexually abused as a preteen and was subsequently deemed uncontrollable by the courts and made a ward of the State. After she was committed to the Armadale home in St Ann, she survived a fire initiated by a security guard. This fire killed seven female adolescent wards of the State.
Her subsequent transfer to Stony Hill Girls’ Home, and then Fort Augusta, was followed by ultimate confinement at the Horizon Remand Centre (a prison for hardened adult criminals) where she hanged herself at age 16.
Vanessa had feelings of hopelessness in her final days which increased when her cry for help yielded no response from the resident magistrate who placed her in the care of the State. Her letter was conveyed to this court official by an investigator from the Office of the Children’s Advocate.
This cry for help was a rational response by Vanessa to inhumane punishment meted out to her after becoming a ward of the State. We are privy to one Armadale survivor’s statement, describing repeated rapes at that facility prior to the inferno and also the frequent practice of collective punishment, gratuitously dispensed in the form of arbitrary two- to three-week lockdowns, without toilet facilities. One Fort Augusta ex-inmate described frequent interaction between adults and minors, leading to minors being lured into sexual relationships with adults.
In January 2013, three adolescent girls were rushed from the Horizon Adult Remand Centre to the Kingston Public Hospital after overdosing on antidepressant pills.
A high-level team of psychiatric professionals and politicians responded to these acts of attempted suicide by visiting Fort Augusta and the Horizon Remand Centre. They spoke of the “clean, open and airy” nature of both facilities and ascribed Vanessa’s death to possible “accidental suicide”. One professional said that the occurrences of antidepressant overdose were simply acts of “attention-seeking behaviour”.
It remains instructive, however, that a 16-year-old survivor of the Armadale fire reported in The Gleaner that she, too, was struck by the flat “pristine landscape” of “perfect, green grass” on arrival at Armadale.
In short, the humanity or inhumanity of an institution cannot be gleaned from its environs. Armadale’s landscape gave no warning to those arriving that it was a Jamaican Government-funded concentration camp for uncontrollable juveniles.
There are approximately 400 children in the care of the Department of Correctional Services. Thirty-seven wards of the State are being housed in two adult penal institutions, 20 at the Fort Augusta prison and 17 at the Horizon Adult Remand Centre.
URGENT REVIEW NEEDED
The sad reports of one suicide and four attempted suicides by adolescents over the past six months requires an urgent review of the practice of forced incarceration of wards of the State within adult facilities. Equally urgent is the need to review whatever measures are in place to prevent adolescent suicides inside Jamaica’s correctional facilities.
Persons caring for juveniles in confinement should fulfil set criteria, proving their understanding of adolescent psychology. They should have an intimate knowledge of the peculiar factors causing adolescents to be in frequent conflict with authority and the law.
Juvenile institutions should be under the guidance of knowledgeable and uncompromising childcare professionals. Children should not be incarcerated along with adults; they are at least 36 times more likely to kill themselves in this setting than when they are held in dedicated juvenile facilities. In fact, suicide rates in properly run juvenile centres are less than rates for the general population.
There have been no reports of suicide attempts within the correctional services since January 2013, but this quiescent period should be viewed with suspicion, remembering that staff tenure at these institutions is served by under-reporting of rapes, abuses and suicides.
Knowledge of risk factors is the first step in suicide prevention. More than 90 per cent of adolescent suicide victims have one or a combination of the following: a psychiatric disorder (the main one being a mood disorder such as bipolar disorder or frank clinical depression), a personal or family history of previous suicide attempts, drug abuse or antisocial behaviour.
It is interesting that the recent suicide-related reports in the media have all involved females. The ‘Big Fact’ about depression is its earlier emergence in females during adolescence, leading to a higher prevalence among adolescent females relative to adolescent males. This female predominance has also been confirmed in the Jamaican setting by Wendel Abel, professor of psychiatry at UWI, Mona.
Vanessa Wint was sexually abused, and it is a known fact that childhood sexual abuse is an important independent risk factor associated with adolescent suicide. Childhood sexual abuse is an associated factor in 20-40 per cent of adolescent suicide cases.
Most juveniles who kill themselves within the correctional system do so during a period of enforced isolation imposed by authority, usually subsequent to some conflict – the chosen method being hanging in 90 per cent of cases, utilising a bed sheet (70 per cent) or clothing (15 per cent).
Vanessa Wint, who warned of her own suicide, had a typical lead-up, which involved interpersonal conflict, precipitating cell confinement by prison authorities. Her suicide was by the favoured route of imprisoned adolescents, the bed sheet.
The predominance of female-linked reports should not lead to complacency about boys within Jamaican state care, because although females attempt suicide more often, males generally have a higher suicide completion rate than females. This finding is applicable across all age groups. Abel, reporting on Jamaican figures, indicates a male-female suicide ratio of 10:1 for the period 2007-2010.
PREVENTION TRAINING NEEDED
If Jamaica is to reduce the number of suicides and attempted suicides among adolescents under state control, suicide-prevention training for correctional staff must be mandatory. Institutions should have written suicide-prevention protocols. It is important that all staff be taught what warning signs to look for.
Thorough intake screening and inquiry should be mandatory at the time of arrival at each facility and staff should home in on each juvenile’s mental status, past suicidal behaviour, and sexual-abuse history, bearing in mind other risk factors such as drug abuse and past inpatient psychiatric treatment.
Institutions must have open communication processes between juveniles, professionals and families, bearing in mind that juveniles are emotionally very dependent on supportive relationships. Juveniles also tend to have low problem-solving skills, and this predisposes them to feelings of hopelessness.
Enforced isolation of at-risk juveniles, therefore, should be avoided, and preference given to housing them with the general population. Observation protocols are important and should be in accordance with assessed suicide risk. Staff should be able to detect subtle changes in each juvenile’s mental state and behaviour and should alert other staff members of new developments along an established chain of command which involves mental-health professionals.
An in-house suicide attempt should trigger a mandatory preventive protocol. Despite the fact that only a small percentage of self-harm (self-poisoners or self-mutilation) cases end in suicide, this should not lead professionals to indiscriminately label cases as attention-seekers. Each self-harm case must be thoroughly investigated, weighing risk factors in order to properly implement individualised management interventions.
It must always be remembered that an episode of self-harm is associated with an (X50 to 100) increased risk of suicide within a 12-month period when compared to the general population.
In conclusion, the appropriate care of adolescents within the care of the state correctional services requires knowledgeable, proactive and sensitive childcare professionals manning institutions overseen by a governing arm which views the welfare of children as a priority. It is untenable to house juvenile wards of the State along with hardened criminals.
Since Armadale, the issue of humane treatment for adolescent wards of the State has become a gaping, festering wound in need of attention. This is not a time for empty press conferences and photo shoots. Jamaica should not wait on an epidemic of copycat suicides before demanding meaningful action.
Newton D. Duncan is professor of paediatric surgery, UWI, Mona, and head of Department of Surgery, Radiology, Anaesthesia and Intensive Care. Email feedback to email@example.com and firstname.lastname@example.org.Why child prisoners turn to suicide – Commentary – Jamaica Gleaner – Sunday | June 23, 2013.