Inmate Suicide An Ongoing Problem Despite Series of Reforms

Marion County Jail, now facing federal investigation, had adopted expert’s recommendations on prevention

By Naseem Sowti Miller
Ocala Star-Banner
Thursday, March 19, 2009


When Lindsay Hayes finished studying suicides in jails across the United States back in the 1970s, he was struck by what he found.

A lot of suicides were not reported and no one paid much attention to the issue, said Hayes, a project director at the National Center on Institutions and Alternatives, a nonprofit organization.

The attitude back then, he said, was, “Yes, we know they [commit suicide], but that’s part of the difficulty of running a jail.”

Over the past 30 years, that attitude has improved, partly due to Hayes’ studies, which led to development of suicide prevention manuals and trainings, and partly because more and more jail accrediting organizations have added suicide prevention to their protocol.

This week, the U.S. Justice Department announced it would begin an investigation of the Marion County Jail’s suicide prevention efforts as well as its use of force.

Since that first study by Hayes, the rate of suicides in jails has dropped from 107 cases in 100,000 inmates to 38 in 100,000.

But that rate is still much higher than the suicide rate in the community, which stands at 11 cases in 100,000 people.

Hayes repeated his study on jail suicides again in the mid-1980s and found very similar data: Not only had jails not changed their attitudes toward suicides, but many inmates continued to commit suicide 24 hours after arrest and many were intoxicated.

“At that point I thought we’d done enough research, and we knew who does it and when. So we said let’s try and look to see where we can reduce the risk,” he said.

The answer boiled down to two things: staff training and a thorough inmate screening at intake. The recommendations have been since put in a suicide prevention manual.

One of Hayes’ jobs now is going to various jails across the nation and offering recommendations for reducing their suicide rates.

“Nine times out of 10 I get calls from jails that have had a rash of suicides and they’re concerned, because they’ve looked at it internally and they just want a fresh pair of eyes,” said Hayes.

He got such call from the Marion County Sheriff’s Office in March 2008 – three months after Ocala Community Care, a local nonprofit organization, took over Prison Health Services in delivery of medical care to inmates.

The jail had three suicides in 2007, the highest number since 2000. And its rate over the past nine years is higher than the national jail suicide average.

It is unclear what prompted the federal investigation into the county jail’s suicide prevention efforts, which is expected to take several months – but officials say it was not based on any single incident.

“They haven’t really divulged a whole lot of information other than that they’re going to come investigate our jail,” Sheriff’s Office spokesman Jimmy Pogue said Wednesday. No legal counsel has been appointed yet to guide the Sheriff’s office through the process, he added.

Chief Assistant Public Defender William Miller, who previously represented one of the inmates who committed suicide at the jail in 2007, said news of the investigation caught him by surprise.

“It seemed to me, based on the information that I had, that things had improved since the changes were made [in 2007],” he said.

Many of the improvements, officials say, were based on Hayes’ recommendations.

In his visit to the Marion County Jail, Hayes made a list of 25 recommendations – most of which have been implemented, jail officials say. Among them was staff training.

One of the focuses of the training, which he recommends to many jails across the nation, is changing the attitude of staff members who simply believe suicides are not preventable.

“If you go in with that negative attitude at any task, then you won’t be successful,” said Hayes. “But if you go in saying that I won’t tolerate suicide in my system, hopefully that will result in reduction of suicides. That mantra became a part of my training – the most important part.”

Officials at the Marion County Jail said Tuesday that since Hayes’ visit last year, they have implemented a suicide prevention training for new staff and annual refresher for all the staff.

Hayes also recommends that jails change the intake form.

“One of the worst questions on the screening form was if inmates’ behavior suggested suicidal tendency,” said Hayes. “Now, if you have an arrestee walking in, that’s not a good way to assess them.”

The new form, which Marion County Jail officials said they’re now using, asks more detailed questions so the intake nurses can assess the inmates better. Those questions inquire about family history, experiencing significant loss and past suicide attempts.

One of the reasons that suicides occur at higher rates in jails than in the community is the jail environment – or in Hayes’ words, “separation and isolation.”

In addition, “We get a high-risk population,” said Capt. Mike Forte, a watch commander at the Marion County Jail. “There is the isolation from family and friends. A change for a person from being free. The shame and embarrassment of charges, or a long prison sentence. And the feeling of hopelessness and helplessness, not knowing what the future is going to hold.”

In a jail where the average population is currently around 1,600, between three and nine inmates are on suicide watch at any time, according to local officials.

Many are put in a suicide pod or are on watch after making a verbal threat, making nonverbal gestures, or indicating their intentions in letters to family and friends, Forte said.

Inmates in the suicide precaution unit get checked every 15 minutes.

The most common method of suicide in jails is hanging, according to Hayes.

Loretha Tolbert-Rich, who works for the Sheriff’s Office and is the medical liaison for the jail, said that based on Hayes’ recommendations, the jail is nearing completion of a special housing unit for inmates who come out of suicide pods. The idea is to gradually reintroduce them back to the general inmate population.

“We’ve also increased the communication between the jail staff and the officers,” she said.

More than a decade after his last study, Hayes is getting ready to release a national study, commissioned by the Department of Justice, based on 2005-2006 data.

Although he couldn’t release all the details of the study, Hayes said that the trend of suicides for the first time has changed since the 1970s, when he released the very first study on suicides in jails.

“More of the suicides are now occurring a couple of days into incarceration, and even in the first couple of weeks… So now we’re trying for figure out why. Maybe we’re doing such a good job at intake, and we’re finding people early on and putting them on suicide watch, perhaps that leads to delaying and preventing suicides.”

The data also shows that the suicide rates are decreasing.

“The wind has changed. If you go in a jail today and ask them about inmate suicides, I would hope that they say that suicide prevention is an important part of their operation – and they no longer have the attitude that it doesn’t matter.”