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How to Lower the High Level of Jail Suicides

Until we sustainably invest in public health and health care both in and out of jail, preventable deaths will continue.

August 17, 2022

Jail suicides have been an overlooked national crisis for years. America needs to start learning from them in order to address the underlying problems that are causing so much needless death.

Twenty-five-year-old Dashawn Carter committed suicide immediately after being transferred back to New York City’s Rikers Island jail from a psychiatric hospital. He had been placed in a general population housing unit despite a long history of mental illness. Rising jail deaths under egregious conditions have spurred the New York Times to launch an independent database tracking these ongoing losses. Across the country in a San Diego jail, a similar story played out. Thirty-five-year-old Lester Marroquin drowned himself after being moved out of a “safety cell” — where he had been checked on every 15 minutes — despite a known history of suicide attempts.

These unnecessary losses of life are troubling but not rare. According to the latest Bureau of Justice Statistics report, suicides were the leading cause of jail deaths between 2000 and 2019, totaling 6,217 — 30 percent of all deaths in local jails. In 2019, the suicide rate in jails was over two times that of the general public.

Pathways for suicide: Structural jail conditions and people in crisis

Why are people in jail taking their lives so often? A 2020 Reuters investigation corroborates the Justice Department’s finding that suicides are a top cause of jail deaths and suggests three primary drivers.

First, a significant proportion of people who land in jail are from marginalized communities and grapple with symptoms of poverty, primarily substance abuse and mental illness, as well as unemployment and homelessness. According to the latest Justice Department data, 63 percent of people in jail experienced drug dependence or abuse, and 44 percent of people in jail reported having had symptoms of a mental health disorder in the prior year.

Second, the prevalence of detained people with serious mental health needs is at odds with the goals, design, operation, and resources in most jails. The near absence of mental health treatment or other types of behavioral health services is exacerbated by jail staff who are often not trained or equipped to prevent, detect, or respond to behavioral health crises. For example, only about one-quarter of New York City corrections staff reported completing suicide prevention training despite a surge in self-harm and suicides at Rikers. A recent investigation of Indiana jails, citing staff shortages with training or expertise, similarly found that many suicide attempts occur openly, including among people on suicide watch or those being monitored by video.

It is perhaps unsurprising then that according to the latest available data, the majority of people in jail with mental illness — 62 percent — were not receiving mental health care. Yet jails are often described as “de facto mental hospitals” because they have filled the vacuum created by a pervasive lack of adequate behavioral health services in the community and because behavioral health issues underlie many of the circumstances that land someone in jail.

Third, the conditions inside most jails are terrible and the treatment often abusive, making them unlikely to offer any respite for people experiencing crises or mental illness. Jails are typically characterized by loud and unpredictable noise, bright lights, unsanitary conditions, and in many places, an atmosphere of threat and violence.

Confronting an intrinsically isolating experience in an institution whose aim is to punish rather than treat or rehabilitate can also be traumaticHuffington Post investigation following Sandra Bland’s in-custody death quoted corrections expert Steve J. Martin, who described jail as “a total and absolute loss — immediate loss — of control over your being, over your physical being.”

Put together, it is understandable that jail may in fact exacerbate a person’s mental illness, and quickly. Indeed, according to the Justice Department, most jail suicides happen soon after admission, with nearly half of suicides occurring within seven days of arrival. A significant proportion of jail suicides — 77 percent — occur by detained people who are charged but not convicted of any crime and are therefore legally presumed innocent.

Research has shown that the risk of suicide ideation increases with the shock of initial confinement as people are cut off from medications, health care, and existing social supports and are flooded by an assortment of negative emotions, including powerlessness, trauma, shame, isolation, and fear.

Changing the status quo: Potential solutions

Correctional experts reiterate that suicides in jails are preventable through straightforward practices. These include holding private behavioral health screenings with a well-trained staff member who is a non-arresting officer or health care worker, outlining clear instructions and protocols for when to call health personnel, and conducting routine in-person monitoring of anyone at risk of suicide.

Improving health care in jails also requires coordination and integration with correctional and community-based systems. In one successful example, New York City piloted the Enhanced Pre-Arraignment Screening Unit in 2015 to serve the behavioral health needs of people in the court system. A Vera Institute of Justice study found that the unit’s enhanced, comprehensive screenings and increased medical care capacity led to rapid identification of arrested people’s needs, improved treatment, and greater coordination among the corrections system and community providers, along with increased use of diversions.

Referring people with behavioral health issues to diversion programs and community-based health services is another viable alternative to incarceration. In 2016, the Los Angeles Department of Health Services’ Office of Diversion and Reentry launched a program to provide supportive housing and resources instead of detainment for court-involved people who were homeless and had a mental health or substance abuse diagnosis. A RAND study showed 74 percent of participants had stable housing and 86 percent had no felony convictions one year after the program began. Despite the high need and promising research findings, a recent proposal to expand the program was not approved.

Much more needs to be done to stem the tide of jail deaths by suicide. The individual risk factors of many who are admitted to local jails, combined with environmental risk factors triggered by the stress of arrest and incarceration, place detained people at particularly high risk for self-harm.

With the current harmful state of our jails, we are left with the status quo: too many preventable deaths behind bars. Therefore, genuine change requires sustainable investments in public health, quality health care in jails and for communities most in need, and partnerships with impacted people and families.