Were it not for the troubling circumstances surrounding her arrest, the nation would have never heard about the preventability of her death. In the late afternoon of July 10, 2015, 28-year-old Sandra Bland was driving through Texas on her way to a new job when pulled over by a Texas Department of Public Safety trooper for failing to signal a lane change. According to the trooper, only a written warning was going to be issued but when Ms. Bland refused his request to put out a cigarette, he opened the driver’s side door and ordered her out of the vehicle. She initially refused and was forced out of the car by the trooper. Ms. Bland was eventually charged with resisting arrest and transported to the Waller County Jail in Hempstead, Texas. Following recent media coverage of other similar events, it was not surprising to learn that the trooper was Caucasian and Ms. Bland was African-American. From here, the story turned from egregious to tragic. Ms. Bland was booked into the Waller County Jail several hours later and asked several routine questions during the intake screening process. According to those records, although denying any current suicidal ideation, she reported attempting suicide in the last year by drug overdose following a miscarriage, as well as experiencing the recent loss of her godmother. She also reported experiencing depression in the past, as well as feeling depressed regarding her current predicament. Booking officers who were subsequently interviewed adamantly denied that Ms. Bland was suicidal and she appeared “fine” following the booking process, ignoring all of these suicide risk factors and simply relying on her denial of any current ideation. Ms. Bland was cleared for general population housing, placed in a holding cell, and never referred to a mental health clinician for further assessment. According to two female inmates who befriended Ms. Bland during her three days in the Waller County Jail, she appeared distraught and was often crying after apparently failing to reach friends and family for assistance with her $5,000 bond. Finally, at approximately 9:00am on July 13, 2015, a jail officer found Ms. Bland hanging from a plastic garbage can liner tied to a post in her cell. She had not been seen by any jail staff for over 90 minutes. A subsequent autopsy ruled the death a suicide and found that Ms. Bland had approximately 30 parallel cuts on her left forearm that predated her arrest, a likely indicator of recent self-injurious behavior. Was Sandra Bland’s suicide preventable? Of course it was. Absent her acknowledgment of being suicidal during the booking process, all of the relevant red flags were there for jail staff to place her on suicide precautions and call for a mental health assessment. But as happens far too often in correctional facilities throughout the country, the booking officers embraced her denial of suicidal ideation and ignored everything else. Why did Ms. Bland initially deny that she was suicidal during the booking process? We will never know, but perhaps she did not become suicidal until fearing she was never getting out of jail and/or believing that her continued confinement would jeopardizing her new job. Experience shows us that suicidal individuals deny that they are suicidal for various reasons, including: they want to end their life and not be stopped; they are unable or unwilling to articulate their thoughts; the lack of privacy when the questions are asked; the manner in which the questions are asked; the perceived punitive aspects of suicide precautions (e.g., placed alone in a sterile cell clothed only in a safety smock, loss of possessions/privileges), and the aforementioned circumstance that they are not suicidal at the exact time the question is asked but become suicidal shortly thereafter. Properly trained correctional and medical staff working in any correctional facility should know that an individual who denies they are suicidal, yet still possess other suicide risk factors, such as recent history of suicidal behavior, recent significant loss (of a family member or close friend, job, etc.), signs of depression (e.g., distraught, crying etc.), should still be considered suicidal, placed on suicide precautions, and immediately referred to a mental health clinician for further assessment. If asking an inmate whether they were currently suicidal was the only indicator of suicide risk it would be unnecessary to ask any other questions. The fact remains that properly trained staff should never exclusively rely on the direct statements of an inmate who denies they are suicidal and/or have a prior history of suicidal behavior, particularly when their behavior, actions, and/or history suggest otherwise. Finally, in the midst of such tragedy it is important to realize there has been a dramatic decrease in the rate of suicide within jails during the last 25 years. The nearly threefold decrease from 107 suicides per 100,000 inmates in 1986 to approximately 40 suicides per 100,000 inmates in 2012 is extraordinary. There are several possible explanations for this decrease, including: greater general awareness of the issue resulting in national correctional (and some state) standards requiring comprehensive suicide prevention programming; better training of all correctional, medical, and mental health staff; more in-depth inquiry of suicide risk factors during the intake process; better physical plant design; and continued threat of litigation. Although the jail suicide rate has declined, it still remains higher than in the community (where the rate holds steady at 12 deaths per 100,000 citizens). There are several reasons for this higher rate. Jail environments are conducive to suicidal behavior and an individual entering a jail is at increased risk of facing a crisis situation. From an inmate’s perspective, certain features of the jail environment may enhance suicidal behavior: fear of the unknown; distrust of an authoritarian environment; perceived lack of control over the future; isolation from family and significant others; shame of being incarcerated, and perceived dehumanizing aspects of incarceration. In addition, certain factors that are common among inmates facing a crisis situation could predispose them to suicide: recent excessive use of alcohol and/or drugs, recent loss of stabilizing resources, severe guilt or shame over the alleged offense, current mental illness, prior history of suicidal behavior, and approaching court date. Some inmates simply are (or become) ill-equipped to handle the common stresses of confinement. These are all basic tenants of suicide prevention and found in all nationally-recognized jail suicide prevention curricula. They should have been exercised in Sandra Bland’s case and, either through indifference, ignorance, or both, they were not. The result was a preventable death. When we eliminate preventable deaths we will continue to lower the rate of suicide in jails throughout the country. Over the years, people have often asked me why we should care about an inmate committing suicide. My answer has always been and continues to be: Because Sandra Bland could be our daughter, our sister, our loved one, our friend. Lindsay M. Hayes July 30, 2015
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