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Yıl:2017; Cilt: 7; Sayı: 1>> Özet
Psikiyatride Güncel; 2017;7(1):73-81
Cezaevi nüfusunda intihar davranıșı ve müdahale ilkeleri
BR Erim
Balıkesir Devlet Hastanesi, Balıkesir
İntihar cezaevlerinde ölümün en sık önlenebilir nedenidir. Psikiyatrik hastalıklar mahkumlar arasında genel popülasyona göre çok daha yaygındır. İntiharla ilgili araştırmalar ağır psikiyatrik bozuklukların intihar düşüncesi ve intihar için güçlü bir risk etmeni olduğunu göstermiştir. Önceki çalışmalarda geçmişteki intihar davranışının planlı intihar edenlerde yüksek olduğu bildirilmiştir. Mahkumiyetin ilk dönemi intihar için en riskli dönemdir. İntihar davranışlarını yordayan diğer etmenler arasında temyiz aşaması, psikiyatrik hastalık öyküsü, tekli hücrede izolasyon, kalabalık koğuşlarda küçük alanlarda kalma, şiddet suçları sonrası uzun süren mahkumiyet, alkol ve uyuşturucu madde kullanımı ve suçluluk hisleri sayılabilir. Kendine zarar verme davranışı ile intihar davranışı çok yakından ilişkilidir ve psikiyatrik öyküde özenle üzerinde durulması gerekir. Tekrarlayıcı kendine zarar verme davranışını bir intihar öncülü olarak tedavi etmek gerekmektedir. Cezaevinde intiharı önleme pek çok ülkenin cezaevi programında yüksek önceliklidir. Bununla birlikte cezaevi günlük yaşantısında bu durumu tahmin etmek hayli güçtür. Bu sebeple her intihar girişimi dikkatle incelenerek tedavi edilmeyi hak eder. Yeni bir intihar girişimini engellemede risk etmenlerinin ortadan kaldırılması en önemli adımlardan biridir. Ayrıca intihar girişiminin altında yatan psikiyatrik bozukluklar da mutlaka belirlenmelidir. İntiharı önlemek için düzenlenecek tedavi planı hasta onayı alınarak hazırlanmalı ve uygulama sırasında cezaevi tedavi ekibiyle işbirliği yapılmalıdır. Bu bağlamda cezaevi hekimi ve sosyal servisle yapılacak işbirliği öne çıkmaktadır.
Suicidal behavior and the intervention principles in the prison population
Suicide is the most common preventable cause of death in prison. Mental disorders are significantly more common among prisoners than in the general population. Suicide research in general shows that severe mental disorders are a strong risk factor for suicidal ideation and suicide. In previous studies, a history of suicidal behaviour (suicide attempts, suicide threats) has been reported in highly rates of inmates who committed suicide. The first phase of imprisonment has the highest risk of suicide .Other factors that have been reported as predictors of suicide in prisons are the remand phase, history of psychiatric illness ; history of suicidal behaviour, isolation in a single cell, overcrowding in small cells, long-term sentences after violent crimes , alcohol and illicit drug use , and feelings of guilt. Self-mutilation is closely associated with the suicide behavior and need to focus on clinical story. Repeater self-mutilation behavior on a predecessor to the treatment as a suicide. Prevention of prison suicides has a high priority in most countries’ prison programmes; however the predictors are difficult to deal with in daily prison life. Fort that reason each suicide attempt deserves to be treated by examining carefully. Elimination of risk factors is one of the most important steps.for blocking a new attempt to commit suicide. In addition, the underlying psychiatric disorders of the suicide attempt must also be specified. Patient approval must be obtained for the planned treatment plan to prevent suicide and cooperation with the prison treatment team is required during administration. In this context, cooperation with the prison physician and social service is the forefront.

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