KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Later in the broadcast we will sit down with Dr. Monica Goldson, the CEO of Prince George's County Public Schools. But first just a warning to our listeners, today's conversation focuses on suicide behind bars. If you want to listen later, you can do so at kojoshow.org. If you or someone you know needs help, you can reach the National Suicide Prevention Lifeline at 800-273-8255.

KOJO NNAMDISuicide has long been the leading cause of death in American jails. In Virginia, 51 inmates have died by suicide in the past five years. And in just one county more than 500 inmates have been put on suicide watch since June 1st. So what's causing these increasing numbers of suicides and what can be done to prevent them? Joining me in studio is Nora Eckert, Reporter with the University of Maryland's Capital News Service. Nora Eckert, thank you so much for joining us.

NORA ECKERTThanks for having me.

NNAMDIYou partnered with the Associated Press this summer on an investigation into jail suicides. What did you find in your reporting?

ECKERTYeah. So we started off with examining a collection of about more than 400 lawsuits that alleged mistreatment of mentally ill inmates. And through mining that sample set we actually narrowed our reporting to the issue of suicide in jails. And that's long been a leading cause of deaths in jails as you said, but we found a few specific trends that we highlighted in the process of that reporting. And some of the main ones were in about a third of that sample set the inmate was denied prescribed medication. And in about half of those suicides and attempts they occurred in the first week. So that's a really critical period for the inmate. And often most of those were in the first 48 hours, a very tumultuous time for them.

ECKERTAnd probably the most devastating thing that we found was that 80 percent of these inmates were awaiting trial at the time of death or attempt. So they hadn't been convicted at that point.

NNAMDIWhat are the conditions at some of these jails that could be contributing to the high number of suicides?

ECKERTI think the biggest thing that we saw at these jails is understaffing and underfunding. And that is the underlying problem I think for most of the issues that we eliminated in our analysis. So if guards are supposed to monitor an inmate every 15 or 30 minutes if they're on suicide watch or in a mental health ward, if there's understaffing at the facility, they don't have the people to do that. Often there's video monitoring in place as well. But if there's guards not staffed to monitor that video camera that's also an issue. But perhaps some of the most frustrating things were how preventable these were. Many of the inmates hung themselves with sheets.

NNAMDIBed sheets.

ECKERTBed sheets exactly, with materials that were given to them in their cell. That is they were properly identified as a suicide risk they wouldn't have had access to those. In fact, in some of these cases, inmates who had previously attempted suicide had access to razors in their cell. So these are entirely preventable conditions.

NNAMDIJoining us now by phone is Christine Tartaro, a Professor of Criminal Justice at Stockton University and author of "Suicide and Self-harm in Prisons and Jails." Christine Tartaro, thank you very much for joining us.

CHRISTINE TARTAROThanks for having me.

NNAMDIYou wrote about this very issue in your book "Suicide and Self-harm in Prisons and Jails." Can you tell us some of the reasons behind these rising numbers?

TARTAROWell, I think it would not be a surprise to anyone to say that incarceration in a jail is a very traumatic event in one's life. And being put in there is met with a tremendous amount of uncertainty. People don't know about their immediate safety, their immediate health needs. For example, if they are drug addicted, they're worried about when they're going to get their next fix. Then they're worried about their long term problems such as whether they're going to lose their job, what to tell their loved ones, whether they're going to face a sentence. So at all points in history initial incarceration has always been a very scary and stressful experience.

TARTAROIn terms of why some areas might be seeing some increases now it is difficult to know for certain without doing extensive research on each of these areas. But things that I would wonder about are what are their initial screening procedures and then following a positive screen what then happens with that information. And what kind of supervision in housing procedures are put in place, because failing to do any of those things properly can open the door for the opportunity for people to commit suicide undetected.

NNAMDINora Eckert, why are the first days of incarceration so critical for intervention?

ECKERTThat's a really tumultuous time for the inmate. And if you take into account medication if that's a factor, if the inmate has a prescribed mental health medication, being without that even for 48 hours can be devastating. We saw that in several cases where someone was off their bipolar disorder medication or schizophrenia medication and their parents would call in desperately to the jail and say, my child needs his medication. And it wasn't provided for a variety of reasons. I think just being in that new environment if medication even isn't a factor someone struggling with a mental illness that's a change that can be very jarring for them.

NNAMDIChristine, can you describe the mental state of inmates entering jail perhaps for the first time? Why is this such a vulnerable period?

TARTAROWell, there's first security concerns. A person is put inside a jail and there is a real fear for one's own immediate safety, because the person is around other inmates. Second one of the things that's very unique about jails that we don't see in the prison system is that people come off the street into the jail and some of them are high or otherwise under the influence at the time. And so the person is probably not thinking rationally given the mind altering substances, but even if the person is starting to come off of that then the person is entering the withdrawal period. The withdrawal period whether the person is inside or outside a correctional facility is a very difficult time and a high risk period for suicides for everyone.

NNAMDIChristine, how has the number of mentally ill inmates changed in the past 40 to 50 years especially as psychiatric hospitals began to close their doors?

TARTAROUnfortunately the number of people -- or the proportion of inmates who are mentally ill has gone up quite a bit over the past 40 to 50 years. In the 60s and 70s we decided to partake in the great deinstitutionalization movement, which was inspired by our confidence that we could handle mental illness through medical management. And we were concerned about the abuses and civil rights violations that were occurring inside these psychiatric institutions. So we closed them and the promise was that we were going to then open up corresponding mental health centers in the communities. Unfortunately we did not follow through that step. And so when people were released they did not have access to the mental healthcare that they needed. They did not have access to housing resources.

TARTAROAnd this lead to a great number of people who were mentally ill being unable to care for themselves and provide themselves out in the community, some became homeless. And when people who are mentally ill are behaving in a strange way out in the community usually the first response for somebody who sees it is to call the police and say that's there's somebody who maybe is under the influence of drugs -- because that's usually the assumption -- being aggressive. And then when the police get involved and unfortunately at that point people who are mentally ill are more likely than others to wind up being arrested by the police when the police arrive. And then they wind up in jail.

NNAMDIChristine, one of the more high profile and recent jail suicides was that of Jeffrey Epstein, the American financier and convicted sex offender. The New York Times reported that two guards failed to check on Epstein for three hours even sleeping through their shift. I'm wondering, Christine, how -- and I'll ask Nora this question also. But I'll start with you, Christine, how does staffing figure into this problem?

TARTAROStaffing is such a key element of any suicide prevention technique or plan, because the staff are ultimately the people are going to carry out that plan. And if there's no adequate staffing things such as suicide watch or just the watch of inmates who are not identified as being at risk for suicide are going to fall by the wayside. The thing about the Federal Bureau of Prisons, which is where Epstein was held in custody that was a Metropolitan Correctional Center, is that they had been subject to massive staffing and otherwise budget cuts in the past two years to the point where their staffing levels are down 12 percent in two years. So my understanding is those two individuals were working major amounts of overtime during the week, which is probably why they wound up falling asleep on the job.

NNAMDISame question to you, Nora.

ECKERTYeah. I think that was a really telling event. If someone as high profile as Jeffrey Epstein could be a victim of that understaffing if you want to say a victim. It's something that we've seen a lot in rural jails as well. I did a lot of my reporting for this in Oregon, when I was looking at data collection efforts. And that's another thing that's lacking in this area is the last year we have data on jail suicides is 2014. And the highest rate of data that the Bureau of Statistics has. So we kind of have this black box of data.

ECKERTBut going back to this understaffing issue, I talked to some of the jail commanders in these rural communities and they said, look. We're strapped just to take care of what we have right now. And we don’t have the staff to monitor people and we're not equipped to handle the mentally ill population that's been kind of thrust upon us. So I think that what happened in the Jeffrey Epstein case is a symptom of that.

NNAMDIChristine, people behind bars don't get a whole lot of sympathy from the general public. Our phone lines aren't exactly being flooded with people expressing concerns at this point. What role does empathy play in this situation?

TARTAROThis has been a problem for decades. And -- forgive me for not knowing the criminologist, who coined this term, but the term for this is principle of least eligible and it's the concept that inmates should never get more than what the poorest member of free society has. So whereas people in free society have to pay for their college education, so should inmates. People in free society don't have universal access to healthcare so inmates should not either. And there is a tremendous lack of empathy and sympathy. And this also rears its ugly head whenever distribution of tax dollars occurs. Many of these jails are run at the county level. And they have to compete with all the other county level services for that precious budget money. So do we want that money to go toward schools and community parks or roads or do we want it to go towards what is perceived as just making criminals comfortable?

NNAMDIWe got an email Katherine who says, my son was in jail for two days and was not given his medication, which was very necessary. When someone enters jail he should be asked what medication he is on. But you reported, Nora Eckert, that in a lot of cases in jails people don't get the medications they're on because apparently some jail officials feel that it's not a problem withholding medication for short periods of time.

ECKERTYeah, that was the finding. Speaking with some jail commanders, of course, that's not -- we don't want to say that's the opinion of all. We heard differently from others. I think that intake procedures are difficult for us to look at because they vary so much from institution to institution. And I think that that's really the problem is it's hard to standardize these types of intake procedures. Oftentimes in the reporting that we did there was a need for medication identified at intake. But it wasn't fulfilled for whatever reason. Whether it was funding or it slipped through the cracks or some other issue. So even if intake procedures are correct and thorough there needs to be follow-through from the staff on those as well.

NNAMDIGot to take a short break. When we come back, we'd be interested in hearing from you, 800-433-8850. Have you been an inmate at a local jail? What do you think should be done to reduce the number of inmate suicides? 800-433-8850. I'm Kojo Nnamdi.

NNAMDIWelcome back. Today we're talking about suicides in jails. We're talking with Nora Eckert, Reporter with the University of Maryland's Capital News Service. Christine Tartaro is a Professor of Criminal Justice at Stockton University and author of the book "Suicide and Self-harm in Prisons and Jails." And now joining us by phone is Colonel Alisa Gregory, under sheriff for Henrico County in Virginia. Alisa Gregory, thank you for joining us.

ALISA GREGORYThank you for having me.

NNAMDIIn Virginia in particular the number of suicides is staggering. Over the past five years 51 inmates have died by suicide behind bars. And in the county where you serve as under sheriff more than 500 inmates have been put on mental health watches since June 1st. What does a mental health watch entail?

GREGORYSo a mental health, there are various levels. So the first level being a one on one, meaning there is a deputy assigned to watch the inmate, constantly watch the inmate and notate all observations. A level two watch would be -- and to reiterate on the level one watch based on mental health clinician's referrals they could be placed in a cell where they are restricted where their clothing is restricted, where the things that we give them based on whether they get a bag lunch or they won't have any utensils or things that can harm them on that level one watch. But that would be based on the clinician's instructions. A level two watch, you have them placed in observation and the staff would notate their observations of the inmate every 15 to 30 minutes.

GREGORYAnd then a level three watch would be they could be in general population and staff would have to notate their activities every 30 minutes.

NNAMDIWhy have so many inmates been put on these watches? Is 500 a typical number for Henrico County?

GREGORYNow that's rather high, but right now based on just the normal anxiety that comes when a person is first incarcerated and in addition to the rise in mental health -- inmates with mental health conditions that we're seeing. And what increases that is the fact that some folks are coming in that have mental health issues that also have substance abuse issues. So that's a double edge sword. So having to deal with those folks to keep them safe and keep the other inmates that we are housing safe means that sometimes they have to be separated and observed.

NNAMDIHow would you describe the resources for mental health support in Henrico County? Are they in your view adequate?

GREGORYI believe they're adequate. However, in the community and the jail we try to provide wrap around services meaning to continue the services that are started in the jail and the community. However, the increase in the number of inmates right now our jail is overpopulated. We're finding that it's beyond -- we're exceeding our resources.

NNAMDIHow often are jail employees left to deal with inmates, who could potentially be struggling with mental illness without support from medical professionals?

GREGORYWell, we are staffed 24-7 with LVN and RNs in both of our jail facilities. So there's always medical staff on duty. However, the medical staff are usually the first responders and they assess the inmates on their initial intake. So they may be sending referrals to mental health. So oftentimes our medical staff come into contact with some folks that are in crisis. And they have to intervene by having staff place them on a watch until we can get mental health in.

NNAMDIHere is Nicole in Fairfax County, Virginia. Nicole, you're on the air. Go ahead, please.

NICOLEHi, Kojo. Thanks for taking my call. Well, I was an inmate at the Fairfax County Adult Detention Center two times for a period of six months each time. And I was on psychiatric medication both times. The second time I was there, which was just last year -- no. Two years ago now, 2017, I got a letter from the jail psychiatrist, Dr. Wilson, saying that they were withdrawing me from my psychiatric medication, because of an alleged incident that had occurred at my first period of incarceration two years prior.

NNAMDIAnd what was the consequence of your medication being withdrawn?

NICOLEWell, I never got it again after that. I did suffer physical withdrawals and my mood did change. I definitely noticed a change in mood by the end. I was definitely heading towards mania. And I mean, I did my best to keep it under control, because I was off my medication.

NNAMDIWow. Well, thank you very much for sharing your story with us, Nicole. Here is Alison in Fairfax, Virginia. Alison, you're on the air. Go ahead, please.

ALISONHi. Thanks so much for taking my call. I just wanted to comment or inquire on any group activities or programs that the county might be providing that would incorporate mental health like control strategies. I'm an occupational therapist and we work often with groups of people with mental health issues and providing coping skills and other interventions that are nonmedicinal. I was just wondering if the county provides anything like that.

NNAMDIAnything like that provided in Henrico County, Alisa Gregory?

GREGORYYes. Our mental health staff provides not only coping skills. They provide conflict resolution, anger management. There's an array of courses that they provide all volunteer, of course. And the fact that they're available, the staff makes them available to the inmate population. However, the inmate population has the ability to choose whether or not to participate.

NNAMDINora Eckert, I'm wondering if in your reporting you saw any of that kind of support being offered to guards or officers at county and local jails.

ECKERTYeah. It really depends on the place that you are. There are some really innovative programs that we found. There was one where inmates were given access to the local library through tablets in order to help with any mental health issues, but those are pretty few and far between I'll say. I mean, I haven't reported comprehensively on those, but it seems that most local jails especially in rural areas are struggling to provide basic care.

NNAMDIAnd in your own experience, Christine Tartaro, what have you found?

TARTAROI completely agree with what Nora just said that there really is a problem nationally, but much more at the rural level. These smaller jails just struggle with the resources and it's difficult for them to have activities. It's difficult for them to hire and retain mental health and medical staff. Partially because, let's face it, a lot of the correctional environments are not desirable environments for people to work or people would prefer to go work in a nice doctor's office. And second a lot of these rural facilities are not in an area where you have high populations and big pools of potential employees to choose from.

NNAMDIWe go a tweet from Rihanna who says, I was arrested for a minor change and held for just about 10 hours from intake to release, a short time for most people, but my bipolar condition made that process so horrifying. Why so little focus on rehab for inmates in the U.S. Inmate suffering is not justice. Alisa, Virginia requires inmates to be evaluated upon arrival. What happens when that evaluation shows a high risk of suicide?

GREGORYWell, there is a series of questions in reference to their past and current mental health condition. They also use observations. They note the conversations and so those observations are put into the medical management system and depending on their answers and the notes that are put in, it will automatically generate a mental health referral. So there's protocol for how you handle certain situations. If the person expressed that they have suicidal ideations, then they are placed on a watch and referred to mental health staff and they will be seen by mental health staff. We have weekend staff as well as Monday through Friday staff.

NNAMDIWe reached out to the Virginia Board of Corrections, which oversees the jail system in the Commonwealth. They declined to join us in this conversation and offered no statement. Here is Zita in Silver Spring, Maryland. Zita, you're on the air. Go ahead, please.

ZITAYes. Thank you. You had mentioned a lack of empathy. As someone who has raised teenagers into now thriving adults there were times when both could have been in jail. Both require chronic medication. And it's, you know, there by the grace of any higher power go all of us. And I think it's really critical to think of all people, who've become incarcerated as somebody's kid. And the jail folks, the police, everyone if they can just keep thinking of all of these folks as potentially your child perhaps the treatment of everyone would improve.

NNAMDIZita, thank you very much for your call. Lloyd emails us, are the majority of suicides first time arrests or recidivist? I wonder about the role of general despair. Care to respond to that, Nora?

ECKERTYeah. I don't have a stat on that at the ready, but I can say that we did see in a lot of our cases that they were kind of in and out of the criminal justice system repeatedly and there's a few reasons for that. One is that jails have become for of the new mental health treatment facility in the U.S. And because they're not equipped to handle inmates with mental illnesses often they'll cycle in and out of that cycle. I'm thinking of Cook County Jail, which is actually one of the biggest mental health providers in the entire country. So I don't think it's a stretch to say that often inmates are repeat offenders are arrested for multiple offenses. However we did see some inmates who had a manic episode, had a mental health crisis and were arrested for the first time. So it's across the board.

NNAMDIA lot of people remember the Sandra Bland case, the African American woman who was roughed up by a police officer in Texas over a traffic offense. So what is the Sandra Bland Act and could something like that be implemented around here?

ECKERTYeah. So Sandra Bland, like you said, a 28 year-old, African American woman who was arrested during a traffic stop in Texas. And one of the most striking things about her case was she died hung in her jail cell three days later. So we talk about that first week especially first 48 hours being critical. We see that in her case. And the investigation that launched later revealed that there were inadequacies in that institution. There weren't regular time checks. There wasn't mandated mental health training.

ECKERTAnd what that launched was the Sandra Bland Act, which went into effect a couple of years ago, which mandated de-escalation training for police officers and general diversion of those struggling with mental illnesses away from criminal justice system. So in terms of that being implemented more locally I know we do have some measures in place in Maryland and Virginia. In Virginia, there's a push to add minimum requirements for mental healthcare that's going through the legislature. I haven't followed that closely enough or reported on it in depth to comment.

ECKERTBut I know that there is an effort on that front. And I know there's also an effort about adding mental health courts and beds in Maryland and Virginia. But I haven't seen the sort of statewide implementation that we saw in Texas. Although perhaps the sheriff or Christine can comment on that if they know otherwise.

NNAMDIChristine?

TARTAROWell, in terms of mental health courts it really is a state and local decision. And so it really is varying in terms of the extent to which they are popping up. I know that New Jersey really doesn't have many. And Texas, I don't know specifically what they're doing with mental health courts. But Texas has actually been ironically leading the way in trying to find non-incarceration solutions for all offenders including those with mental illness, because given the number of fiscal conservatives in Texas people are realizing that incarceration, it just doesn't pay.

NNAMDIHere is Jack in Baltimore, Maryland. Jack, your turn.

JACKHi. I only want to tell you a couple of things. First of all, I was a correctional officer for over 10 years. And I was a correction officer during the time when Harry Hughes was governor. And they started closing down the mental institutions. And we noticed an increase population coming to the jails and we were woefully understaffed and woefully untrained in these pieces. Though the medical piece kind of expanded it didn't expand to the part where the population didn't come down because we would get third time offenders and things like that with people who obviously are not well. And there was no place to put them.

NNAMDIThank you very much for sharing that story with us. We don't have a great deal of time left. So I'd like to go around the table on this question. This is clearly a systemic issue. But what can be done to change our current trajectory and reduce this incidence of inmate suicides? I'll start with your Christine.

TARTAROThere are two things that I could think of. One is to reduce our overreliance on incarceration. As I'm sure you probably know that we use incarceration more than any other country in the entire world. The second thing would be to carry out the promise that we made in the 1960s when we closed down the psychiatric institutions and actually provide mental health treatment in the community.

NNAMDII go next to you, Alisa Gregory.

GREGORYSo I think we need to do a better job at diversion. Finding a way to divert these people away from our jails in the beginning, you know, prior to their incarceration, because like I've heard everyone mention even the callers that the people that are winding up in our facilities more often than not would be better suited in a mental health facility that's equipped and has trained personnel to deal with them.

NNAMDINora Eckert.

ECKERTI think at the base of this we need data, because right now we don't know. We're in the dark. The last year we have data on suicides from a federal level is 2014 and that's when that rate reached its peak. So it could have gotten worse for all we know. Some local jurisdictions have taken upon themselves to collect their own data. But I think that we need really a push to evaluate how widespread this problem is before we look at solutions for it. And that is data collection.

NNAMDIAnd finally we got an email from Austin, my wife teaches a volunteer inmates arts program in Fairfax County. She's been told by several of her students that suicide was definitely a consideration without her program. I think we need more community involvement with volunteer programs like this to show that inmates are still valued members of society. Several students have gone on to get schooling in the arts, I should say and are looking at how they can give something back. I'm afraid that's all the time we have, but if you or someone you know needs help, please call the National Suicide Prevention Lifeline at 800-273-8255. Nora Eckert, thank you for joining us.

ECKERTThank you.

NNAMDINora Eckert is a Reporter with the University of Maryland's Capital News Service. Colonel Alisa Gregory, thank you for joining us.

GREGORYThank you for having me.

NNAMDIAlisa Gregory is Under Sheriff for Henrico County, Virginia. And Christine Tartaro, thank you for joining us.

TARTAROThanks for having me.

NNAMDIChristine is a Professor of Criminal Justice at Stockton University and the author of "Suicide and Self-harm in Prisons and Jails." Taking a short break, when we come back, we'll be talking with Dr. Monica Goldson, the CEO of Prince George's County Public Schools. If you have questions or comments for her, you can start calling now 800-433-8850. I'm Kojo Nnamdi.