The Washington PostDemocracy Dies in Darkness

Epstein isn’t the only one. Too many people kill themselves in jail.

Conditions are dire, and jails lack the resources to address inmates’ mental health

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Last weekend, financier and convicted sex offender Jeffrey Epstein was found dead in his cell at a federal detention facility. One legal expert declared Epstein’s apparent suicide “unfathomable.” Attorney General William P. Barr said he was “appalled” and promised an investigation.

This may have been an appalling and tragic end for Epstein, and for his accusers who were seeking justice. But the fact that he died in custody, and possibly from suicide, is not surprising and not uncommon.

Barr should know: His Justice Department collects and analyzes statistics of inmate deaths from around the country. From 2000 to 2014, a total of 4,508 inmates committed suicide. Forty-seven percent were by inmates being held for nonviolent offenses. The median time served in jail for all suicides was nine days. An inmate awaiting trial is nearly five times as likely to kill himself or herself than someone on the outside. Most jails don’t even conduct reviews after suicides.

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Much has been made about the fact that Epstein was in a segregated unit away from the general population and was even on suicide watch for a period of time. Yet nearly half of all suicides happen while the inmate is held in the general population. Suicide and suicide attempts are common in American jails, but despite having the most imprisoned population on earth, few Americans know this.

In the Maryland county where I work, the jail has not had a suicide since 2017. The mental-health professionals there tell me that they have a low threshold for someone to be placed on suicide watch, and once they are on watch, there is constant monitoring by corrections officers and daily visits from mental-health staff. But even in a facility that seems to be getting many things right, what I have seen over the course of my work underscores the dire need for better mental-health resources in jails across the country.

In September 2017, I had just started as an assistant public defender. It was my first time in the medical unit at the county jail, and I was there to interview three clients who were being held in isolation. The medical unit has a male and female ward — large rooms that hold multiple defendants who pose little threat but are recovering from a medical issue — and one long row of 12 isolation cells for high-profile defendants, those on suicide watch and others who the jail feels uncomfortable placing in one of the larger, less supervised units.

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My first client was HIV positive and on suicide watch. He stepped out of the cell wearing the only clothing he was allowed: a coarse, rip-proof blanket. He explained, trembling and through tears, that his anxiety and mania were triggered by enclosed places and loud noise. His first two questions of me: What day is it, and what time is it? The three-inch-wide window on the back wall of his cell was frosted over, and the lights in the medical unit stayed on, hospital bright, 24 hours a day. In the isolation cell next to us, the inmate banged and screamed every few seconds. Each outburst made my client shudder. He had been charged with burglary for wandering into an abandoned house, looking for food. My more senior colleague told me that if I found the medical unit disturbing, just wait until I saw the segregation units.

When I first visited the segregation units, I immediately noticed the lack of inmates walking around and socializing. Everyone there is kept in their cell 23 hours a day, often without a cellmate. But the segregation unit can also be noisier than the other units, because so many inmates are banging on their cell doors and walls. Some yell inane threats; others beg for help; others scream for their mom; some stay silent and refuse to come out of their cell. The segregation unit is also darker and dingier than others. One time, when my client refused to respond to the corrections officer’s calls, we went to his cell and found him lying in the fetal position against the wall; the toilet was backed up, and the air was so thick and still with the smell of putrid water and body odor that I couldn’t step past the threshold without choking on my words.

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Sometimes the corrections officers will refuse to let an inmate out of his cell, and I have to have my “confidential” legal conversation, yelled through cracks in the door or the food slot. Other times, the officers will just raise their eyebrows, saying: “Oh, you want to talk to him? He’s crazy. Good luck.” But nearly every time, my client sits down calmly at the table in the middle of the housing unit and we talk. The conversations are sometimes unproductive, but they’re never violent or threatening. Most of my clients seemed calmed by the fact that they are talking to someone interested in getting them out.

If nearly half of jail suicides happen in the general population, then it’s clear that far too many people with suicidal tendencies and ideation are left in the general population. But that still leaves the 21 percent of suicides that happen in the segregation unit (which, in many jails, means solitary confinement — either as punishment for an infraction, or to isolate because of the nature of their crime). It also leaves the 25 percent of suicides that happen in the medical or mental-health unit, which are designed for close supervision and suicide watch. The “unfathomable” happens quite often. It happens even when the inmate is under closer supervision or after people have spotted warning signs.

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There are probably a number of reasons suicide is so common in jail, even when on suicide watch. Jails may be understaffed or have inadequately trained staff; guards can get distracted, grow uninterested or fail to follow proper protocol (which has been alleged in Epstein’s case).

But suicide is so common in jail, in part, because too many citizens with serious mental-health issues end up there. “Increasingly, officers are called on to be the first — and often the only — responders to calls involving people experiencing a mental health crisis,” says a recent Council of State Governments Justice Center study. Too often, officers do not know how to access resources, such as crisis stabilization services and mental-health hotlines. Even when officers are fully informed about the available alternatives to arrest, these services are often overwhelmed by the community’s need.

In too much of the country, jails have become de facto mental-health institutions. In the county where I work, the jail averages about 800 inmates at any given time. An estimated 31 percent are on psychotropic medications; 65 percent have a diagnosable mental-health disorder; and about 85 percent report significant substance abuse. Yet the jail has only one psychologist who works full time in the jail with the help of three social workers. If I want to bring a specialized doctor to the jail to evaluate my client, that can take days of administrative finagling.

Some of the solutions to the high rate of suicide in jail and even higher rate of mental-health issues go beyond what the criminal justice system can address. But the criminal justice system can start by giving law enforcement greater access to alternatives to incarceration and giving jails more resources to address mental-health issues.

We will probably never know exactly why Epstein killed himself. But we shouldn’t let what we don’t know about his death distract us from what we do know: Suicide in jail happens with disturbing frequency, and for many, it’s not a cynical ploy to avoid justice but the final act of an underaddressed mental-health crisis, exacerbated by inhumane conditions. Our jails have become what they were never designed or staffed to be: our country’s de facto mental-health institutions.