Corrections_Today_Winter_2025-2026_Vol.87_No.4

COMMITTEES

Navigating the “wicked problem” and “prevention paradox” In Craig Bryant’s 2022 book, Rethinking Suicide , he identifies how suicide can be viewed as a “wicked problem,” a term for social issues that are notoriously difficult to solve given the complexity of the problem. Suicide and SDV in corrections are incredibly complex problems with unpredictable outcomes and sometimes, well-intended efforts to intervene can have significant iatrogenic effects for the incarcerated person and the rest of the correction al setting or system. The nuances of SDV in this environment make the problem even more intricate. Ultimately, the focus should be on building competencies that help clinicians identify effective interventions and supports, not just on predicting future risk. The complexity of SDV in correc tions is further compounded by the “prevention paradox,” a phenom enon where the majority of suicides occur in people at low risk, while the high-risk group, being so small in number, accounts for a smaller proportion of total suicides (Rose, 1981; Turner et al., 2022). Given the inherent difficulty in predicting such a low-base-rate event (suicide

combat staff burnout. A critical first step is to adopt a more descriptive language. The term “self-directed violence (SDV)” is more compre hensive than traditional terms like “suicidal behaviors” or “self-harm” (Crosby et al., 2011). It encompasses the full spectrum of thoughts and actions — from suicidal ideation and non-suicidal self-injury to behav iors with underlying instrumental motives — providing a shared vocabulary that facilitates clearer communication and more consistent practices across different disciplines (Silverman et al., 2007). For correctional BHCs, training on risk assessment must be flex ible enough to account for this full range of behaviors. It must prepare them to evaluate cases that involve suicidal intent, non-suicidal intent, and even ulterior motives, such as seeking secondary gain (e.g., a trans fer to a different unit). This requires training that integrates functional behavioral assessment, a key clinical skill that helps a clinician under stand the purpose a behavior serves for an individual. Correctional BHCs must demonstrate cogni tive flexibility in their approach to case and risk formulation, and their training should reinforce this (Neal et al., 2022; Neal & Brodsky, 2016). Ultimately, the focus should be on building competencies that help clinicians identify effective inter ventions and supports, not just on predicting future risk. While risk is important, a universal focus on rehabilitation and helping people find “reasons for living” is a more foundationally sound approach, es pecially when using a system-based perspective.

death), it’s not surprising that the United Kingdom’s National Insti tute of Health and Care Excellence (NICE) has recommended against using risk assessments to predict potential for suicide. This does not mean, however, that there is no util ity in self-injury risk assessments or in identifying groups of indi viduals at higher risk, but rather it highlights the issues with a primary focus on risk prediction (fluctuating risk, death by low-risk individu als, restricting care to high-risk only, etc). Instead, NICE advocates for a risk formulation process that focuses on understanding an individual’s unique risks and needs to create a collaborative treatment plan (NICE, 2022). This approach is highly compatible with the risk needs assessments and collaborative treatment planning that are already familiar to many corrections profes sionals (Cramer et al., 2022b). When confronted with the com bination of a wicked problem and a prevention paradox, a fundamental shift in perspective is needed. In stead of focusing solely on “mental health issues” and trying to predict or “catch” suicide through screening alone, we must embrace a multidis ciplinary, systems-level approach. This means promoting wellness, so cial connectedness, productive use of time, and meaningful preparation for life after incarceration (if being released) — values that are already part of many prison system mission statements. This holistic approach focuses on improving the “hay stack” (the overall environment) rather than just searching for the “proverbial needle” (the high-risk individual) in that haystack. →

Winter 2025-2026 | Corrections Today

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