The Prisoner Suicide Puzzle

8-15-2013 Washington DC:

Three inmates in Washington, D.C.'s city jail have killed themselves in the last two months. Add in a fourth, who took his own life in November, and that's a staggering figure for a lock-up system that hadn't previously seen a suicide in three years.

A pair of reportedly self-inflicted deaths in June was enough to spark a comprehensive plan to address the situation, including immediate efforts to make it physically more difficult for the more than 1,700 inmates regularly housed in the city's central detention facility to hurt themselves behind bars.

"One suicide is one suicide too many," says Dr. Forrest Daniels, health services administrator for the D.C. Department of Corrections.

The corrections department announced that jail guards would double security check efforts, making rounds every 15 minutes, up from the previous 30-minute check system. Director Tom Faust also said that his staff would undertake a comprehensive review of the jail's suicide prevention protocols.

The moves did not stop another inmate, 56-year-old alleged sex offender Mike Johnson, from hanging himself in his cell last week. Jail officials said they would immediately require all prisoners to share cells, in the wake of the latest incident, and would no longer issue razor blades to new inmates until they have completed a mental health evaluation. Paul Mannina, a Labor Department lawyer who killed himself just five days after being locked up for allegedly attacking a female co-worker in her home in Northwest D.C., reportedly cut his throat with a jail-issued razor. The three other inmates believed to have committed suicide since November died by hanging.



While the new procedures may give inmates less of an opportunity to physically take their own lives, they don't address the underlying mental health issues that may lead a prisoner to commit suicide. Roughly 40 percent of the jail's inmate population currently suffers from or has previously been affected by a psychiatric disorder, according to Faust. Just like Rikers Island in New York, Chicago's Cook County Jail and the Los Angeles County jail system, Faust said that makes D.C.'s jail "the largest de facto psychiatric facility in the District."

Corrections workers in cities and states across the country are facing similar issues. In California, a court-appointed mental health expert tasked with recommending steps to reduce suicides in the state prison system quit his post earlier this year, blasting corrections officials for what he called indifference to the issue. The state system averaged nearly 24 suicides per 100,000 inmates last year, an uptick from 2011 and 50 percent more than the national average of 16.

Three suicides and another attempt by Philadelphia prison inmates in less than a week last summer prompted city jailers to implement a number of preventive measures similar to those recently put in place in D.C. Meanwhile, four inmates in local and state lockups in Idaho attempted to hang themselves using bed sheets in separate incidents last month alone.

Prisoner advocates in Massachusetts say jails have significantly increased their inmate mental health treatment since the state corrections department settled a lawsuit challenging the practice of placing prisoners with mental illnesses in segregation for up 23 hours a day. Studies across the country have shown segregated prisoners are significantly more likely to take their own lives. The department has since implemented a mental health classification system and added maximum security mental health treatment units as alternatives to segregation for those with serious mental illness.

"They've got their problems, but they have saved lives," Leslie Walker, executive director of Prisoners' Legal Services of Massachusetts, says of the units. Not only are self-injuries and prisoner attacks on guards down, but Walker says the program has reduced the money paid to send wounded prisoners to outside hospitals and settle wrongful death lawsuits.

Just how D.C. jailers will adjust their approach to inmate mental health treatment remains to be seen. Daniels, who was recently named co-chair of a joint behavioral health task force created to address suicide prevention, said the department takes the issue very seriously, but did not offer specific mental health-related changes.

"We must make sure that every inmate has access to the services that are available to them," Daniels said.

Currently, a person sent to jail in D.C. undergoes an initial screening process in which the inmate answers upwards of a dozen questions related to his mental health background and family history of illness, treatment and suicide. Jail liaisons from the city's mental health department also look to identify incoming prisoners who have previously had contact with community mental health treatment providers, but much of the responsibility lies with the inmate.

"It's up to the individual to provide full disclosure," Daniels says, acknowledging that the self-reporting nature of this process poses a challenge. He also argues that screening efforts can be enhanced using a "global" approach that draws on information from other people who may know about the prisoner's state of mind, including arresting officers, family members, employers and other city agencies.

One of the best ways to identify prisoners who need treatment is to check whether the person has been treated by a local mental health agency, according to Jim Parsons, director of the Vera Institute of Justice's substance use and mental health program."Part of the challenge is to identify people who need support," he explains. "Mental health and justice systems often don't communicate well with each other."

Parsons says D.C. is already "ahead of the curve" in sharing information between mental health agencies and law enforcement to identify persons with mental health needs, despite a number of "missed opportunities" for cross-communication pointed out in a 2008 Vera Institute study. He specifically touts the jail liaison system, as well as an intervention program aimed at getting at risk individuals treatment before they commit a crime. Through its crisis intervention officer initiative, the District has formally trained more than 500 of its police officers to identify people who show signs of mental illness but are not subject to arrest, deescalate situations and refer individuals to mental health support services.

The Vera Institute also promotes alternatives to incarceration for individuals with serious mental illness, particularly those who commit relatively minor, non-violent crimes. Diversion wouldn't likely have been available for the four prisoners who killed themselves in D.C., three of whom were behind bars facing sex crime charges and the fourth locked up after allegedly stabbing a friend. For these and other inmates, the jail setting creates a number of challenges in obtaining adequate mental health treatment. In addition to the omnipresent limited resources issue, the setting can make it harder for professionals to engage those needing treatment.

Whether it's beefing up security rounds, strengthening communications among agencies or increasing the mental health services available, most suicide prevention efforts will require more money. In cash-strapped cities and states, that means more money that would otherwise go elsewhere. Even in D.C., where a booming local economy netted the city a $417 million budget surplus last year, some taxpayers may be less than enthusiastic about their hard-earned cash going to treat people charged with heinous crimes.

But there are public benefits to treating the mental illnesses that may drive an inmate to death by his own hand. "Ninety-seven percent of all prisoners are released," Walker says. "If they are treated and medicated and taught how to live with their illnesses, they are going to be a public safety positive, instead of a public safety risk." ..Source.. by Chris Opfer