Richard Craig, PhD, CCHP, served as the Chief Psychologist for the Idaho Department of Correction until his recent retirement. He has over 20 years of correctional experience. Dr. Craig spoke about Conducting a Psychological Autopsy at the 2016 National Conference on Correctional Health Care.

Although used in forensic practice for over 60 years, psychological autopsies still lack a standardized definition or process for completion. This form of autopsy is performed when the psychological state of the victim of an equivocal death is uncertain. This is particularly true for a suspected suicide where the investigation is performed to determine whether the individual purposefully took their own life or the event was an accident or homicide.

 

History of Psychological Autopsies

The psychological autopsy process originated in Los Angeles (LA) in the late 1950’s. At that time, the LA Coroner’s office was concerned about the increase in drug-related deaths. In these situations the cause was questionable. Was the death a suicide or an accident? The coroner’s office partnered with a suicide prevention agency to develop criteria for use in these situations. By the late1960’s the process began to be used in military situations.  The initial goal of the military was to gathering statistics concerning suicides thus aiding is the development of prevention programs.  Unfortunately, there were no standards as to how they were completed, who performed them or how the findings were to be disseminated.  Commonly the results of the psychological autopsy were forwarded to the Base Commander who lacked the training to interpret the findings. New guidelines were issued by the military in 2001 standardizing training, format, and chain of command for initiating, overseeing and reviewing psychological autopsies. Although currently used in many venues, a psychological autopsy is now most commonly done in correctional settings.

 

Psychological Autopsy Process

A psychological autopsy is a multi-disciplinary process lead by a mental health professional such as a psychologist or psychiatrist. It most often includes one-on-one interviews and a documentation review. Nurses, providers, officers and other inmates are interviewed. The process requires a degree of skepticism, inquiry and detective work.

In the case of a suspicious death, six determinants are used to develop a professional judgment regarding the psychological state of the deceased.

• Cause of death
• Motive
• Contributing stressors
• Intent of the individual
• Lethality of the act
• Past history

The volume of information usually available in a correctional suspicious death makes the psychological autopsy evaluation challenging. For example, an investigator may review 20-30 hours of recorded telephone calls and video related to cell entry and the attempts to revive the individual. There is information on conditions of confinement, eating patterns, and recreation use. Both central and medical files are reviewed. The most relevant information involves the events and psychological state of the person 30-60 days prior to the death.

Having thoroughly investigated these six areas, a hypothesis (or at times several possible hypotheses) regarding the mode of death is determined. The following options are available.

• Suicide
• Accident
• Homicide
• Natural causes

The findings of the psychological autopsy go beyond the hypothesis as to the mode of death but makes recommendations designed to be integrated into the CQI process in an effort to improve overall offender treatment and safety.

 

Tips for Correctional Nurses

If you are interviewed in a psychological autopsy process, consider your recent interactions with this patient. For example, what do you remember about his or her demeanor during a sick call or medication pass? Did they talk about themselves in a way that may have seemed unimportant at the time but now has bearing on their mental state at the time of death? Have you had any interaction with family members about the patient? Reflecting on the patient in this way may reveal cues of importance in determining the mode of death.

 

 

Have you been involved in a psychological autopsy? Share your thoughts in the comments section of this post.