Understand the Concerning Trend of Inmate Suicide in Local Jails

In a 2021 report commissioned by the U.S. Department of Justice, Bureau of Justice Statistics Statistician E. Ann Carson, PH. D, provided notice of a negative trend within the U.S. corrections system:

• The total number of suicides in state, federal and local correctional facilities increased from 499 in 2001 to 695 in 2019.

This statistic mimics another concerning nationwide trend:

• Overall suicide rates have increased by more than 30% in 25 states since 2019, and suicide has become a leading cause of death in the U.S.

The impacts of suicide often create lasting ripples through families and communities that are difficult to contend with by those left behind for many years, including the families of incarcerated persons.

While we might be quick to assign blame to mental health conditions as the cause of upward trends in suicide, the Centers for Disease Control (CDC) points out that a single factor rarely causes suicide.  In fact, according to the CDC, many people who die by suicide are not known to have a diagnosed mental health condition at the time of death. Other problems often contribute to suicide, such as legal troubles or stress related to relationships, substance abuse, physical health, job, money or housing.

Using Data to Help Identify Inmates at Risk

Dr. Carson’s work provides rich details that enable us to focus on critical aspects of incarcerated person populations and environments. Dr. Carson makes the following significant observations in the 2021 report:

• From 2001 to 2019, suicides accounted for 5% to 8% of all deaths among state and federal prisoners and 24% to 35% of deaths among local jail inmates.
• In 2019, a total of 355 local jail inmates died by suicide. That makes up 50% of the total number of suicides in correctional facilities.

Concentrating on statistics won’t prevent all suicides, but it does provide a starting point. Understanding the data, such as demographics, circumstances and characteristics of local jail suicides can help identify those at risk.

Inmate Demographics

• Although males accounted for 90% of local jail suicides from 2000 to 2019, female inmate suicides rose by nearly 65%.
• 60% of inmates who died by suicide from 2000 to 2019 were 25 to 44 years old.
• The average suicide rate from 2000 to 2019 for white inmates was 86 per 100,000, which is more than 5 times the rate for black inmates (16 per 100,000) and almost 3.5 times the rate for Hispanic inmates (25 per 100,000).
• At 78 deaths per 100,000, local jail inmates aged 55 or older had the highest average suicide rate among all age groups from 2000 to 2019.
• Most jail inmates and state and federal prisoners who died by suicide were males, were non-Hispanic whites and died using suffocation, including hanging and self-strangulation.

Criminal Justice Characteristics

• Unconvicted inmates accounted for almost 77% of those who died by suicide in local jails from 2000 to 2019.
• Inmates held for a violent offense accounted for the largest portion of suicides in local jails.
• From 2010 to 2019, about 92% of jail suicides were of persons held by local law enforcement agencies or courts, 6% for state or federal prisons or other authorities, 2% for the U.S. Marshals Service and 1% for U.S. Immigration and Customs Enforcement.
• From 2015 to 2019, about 18% of suicides in local jails were of persons held for assault, and almost 10% were of those held for murder or nonnegligent manslaughter.

Circumstances of Suicide Deaths

• Suicides in local jails were less common between 6:00 a.m. and noon than at other times of the day.
• From 2010 to 2019, almost 73% of jail suicides occurred in the person’s cell and 8% occurred in jail segregation units.
• From 2010 to 2019, almost 14% of inmates who died by suicide had at least one overnight stay in a mental health services unit since entering jail.
• More than half of all suicides in local jails occurred within the first 30 days of incarceration, while the overwhelming majority of suicides in state and federal prisons took place after the prisoners had served more than a year of their sentence.

Characteristics of Jail Facilities in 2019

• In 2019, a total of 282 local jail facilities, representing 278 jail jurisdictions, reported at least one suicide (tables 8 and 9).
• 12% of jail facilities operated by a private company reported at least one suicide in 2019, compared to 11% for regional jails, 9% for jails operated by counties and almost 7% for city-operated jails.
• Among jail facilities that reported work or prerelease as one of their jail functions in 2019, 91% did not have any suicide deaths during that year.
• The median rated capacity of jails that had two or more suicides in 2019 was 1,296 beds, compared to a median capacity of 305 beds in jails with one suicide and 110 beds in jails with no suicides.
• Almost 13% of jails operating above 100% capacity at midyear 2019 had a suicide during the calendar year, compared to about 8% of jails operating at 100% capacity or less.
• More than half of all jail jurisdictions with an average daily population (ADP) of 1,000 or more inmates in 2019 had at least one suicide that year and more than 35% of these jurisdictions reported two or more suicides.
• Almost 13% of jails operating above their rated or design capacity had one or more suicides, compared to approximately 9% of jails operating at or below capacity.

Suicide Prevention Considerations for Correctional Professionals

With the data in mind, we can begin to draw additional distinctions for consideration in prevention:

At-Risk Inmates

• White male inmates ages 25 to 44, that are unconvicted and being held by local law enforcement agencies on charges of a violent offense.
• The level of risk increases for these inmates with at least one overnight stay in a mental health services unit since entering jail.
• White non-Hispanic males are more likely to attempt suicide by hanging and/or self-strangulation.

At-Risk Circumstances

• The chances for suicide attempts begin to increase around noon and continue to increase throughout the evening and overnight until around 6 AM the following morning.
• Suicide is most likely to occur in the inmate’s cell as opposed to a segregation unit.
• Suicides are more likely to occur in local jails and within the first 30 days of incarceration.

At-Risk Facility Characteristics

• Jail facilities operated by private companies and/or regional jail facilities, are more likely to have a suicide when compared to county and city-operated jails.
• Jails with work or prereleases are less likely to have suicides.
• Jails with larger capacities are more likely to experience multiple suicides.
• Jails operating above designed/rated capacity are more likely to have one or more suicides.
• Jails with an average daily population of 1,000 or more are more likely to have one or more suicides.

In the wake of each suicide follows the question of how it could have been prevented. In addition, there can be a perception that additional responsibilities/duties are needed for corrections personnel to interrupt the suicide attempt before death/negative impact on health can occur because the inmate is under the care of the government at that time.

It’s not uncommon for allegations of negligence to be made after a suicide. This legal activity can bring additional costs to society in terms of financial obligations resulting from legal proceedings.

Suicide Prevention in Jails

Preventing jail suicides becomes complex when considering the multiple contributory variables that lead to the very act of suicide, along with the corresponding level of controllability of each variable. The scale of control for these factors can easily range from “well controlled” to “no controls.”

Increases in nationwide jail populations coupled with a shortage of viable candidates for employment in corrections is not a variable that can be easily controlled. However, our research data tells us that jail facilities that are experiencing overcrowding are more likely to experience one or more suicides. To most, this might appear to be a “no win” situation, and perhaps it might be.

Rather than looking at the data to dismiss reasons to attempt to control seemingly “uncontrollable” variables, it might be effective to utilize the data in the areas that are more favorable for control within the jail facility and staff. For instance, it can be rather difficult for some counties to allocate adequate capital budget dollars to build/remodel jail facilities in short-order, making new construction and/or remodeling an unlikely solution. Even if counties did have excess capital budget dollars for new jail facility construction, how long would it take for the new facility to become overcrowded if the upward trend in inmates does not level out and/or enter decline?

It’s most likely that there are a series of controls that work together to help prevent suicides. If this is true, then it is critical for everyone responsible to perform related job tasks to understand the importance of their work and how to adequately complete their tasks. It’s equally important for the creation and review of proactive metrics to establish accountability. Once this is done, jails can be successful in preventing suicides.

Steps to Implementation

Just as there’s not a single cause of suicide, there’s also not a single method of preventing correctional institution suicide. Rather, the solution is likely to include multiple “controls” that are organized into a program. The program can only be successful when the controls are properly implemented.

1. Facility Review

Using research presented by the Department of Justice, perform a thorough assessment of your facility and staff to identify potential exposures that could lead to suicide. Consider the following:

• The assessment should be conducted by multiple staff members representing significant operational areas and departments from within the jail.
• The assessment should include both a table-top exercise and a physical assessment of the following:
  • All areas of the building
  • All processes conducted within the jail on all shifts
• While the data should guide toward specific areas of concentration, it is important to assess everything so that other significant exposures are not missed.
• Every potential exposure should be recorded on a list.

2. Assess the Risk

It’s conceivable that each potential exposure area could have different levels of risk when compared to others. Therefore, it is important to organize each exposure into a list in order of risk importance. Importance should be based on the following:

• Frequency – How often is this exposure present during operations, and does this frequency change depending on circumstances during a 24-hour period?
• Severity – How severe is the consequence(s) of this exposure when it occurs?

Exposures classified as high frequency and high severity should be prioritized over those of low frequency and low severity. Below is an example of a risk assessment matrix:

3. Develop Exposure Controls

Now that the exposures have been identified, organized and prioritized according to risk, move forward with the development of controls for each specific exposure, beginning with the highest priority and ending with the lowest.

It’s important to note that not all controls are as effective as others. There’s a traditional hierarchy of controls that should be followed. For instance, the most effective method of controlling exposure is to eliminate the exposure from the environment. The issue is that eliminating the exposure might not be feasible because it could prohibit the operation period, thereby preventing the intended outcome from occurring altogether. This is why a hierarchy is needed so that the most feasible control can be identified.

The traditional hierarchy of controls in order of most effective to least effective is as follows:

• Elimination
• Substitution
• Engineering
• Warnings
• Administrative Controls
• Personal Protective Equipment

The philosophy behind control effectiveness pertains to the amount of human involvement, along with the potential for exposure to happen. It is commonly held that increased human involvement in control effectiveness, combined with an increase in propensity for the control itself to fail, results in less effectiveness.

Examples of Controls

Examples of controls can include, but are not limited to, the following:

Inmate Screening - Thoroughly screen inmates for risk of suicide. Using research data found in the Department of Justice's 2021 report, the identification of at-risk inmates can be made based on actual data. As part of booking/intake, every inmate should undergo this screening and should be given a score that indicates the likelihood to attempt suicide. The score should be recorded, filed and communicated to staff and should follow the inmate if transferred to other facilities.

Standard Operating Procedures - Establish standard operating procedures for inmates based on the screening score. Inmates with a higher score may require more effective controls when compared to others who score low. Examples of standard operating procedures include, but are not limited to, the following:

• Placement in cells designated for at-risk inmates, such as the following:
• Increased visibility of the inmate
• Removal of items that can be used to facilitate suicide
• Increased level of observations and interactions by corrections staff and supportive resources This should especially be maintained during at-risk hours of the day and night

• Increased access to supportive services, such as the following:
• Use of psychotropic medications
• Involuntary medications
• Involuntary medical treatment and care
• Inpatient hospitalization of mentally ill inmates

• Conduct initial and ongoing training of all staff based on their level of involvement with at-risk inmates. Training should include identifying warning signs of suicidal behavior and the resulting protocols.
• Establishment of a uniform method of communication for all staff members regarding at-risk inmates.

If a suicide occurs, a thorough investigation should be conducted to determine how and why the suicide was able to occur. The results of the investigation should be considered and incorporated into the established controls.

Video Cameras – Video cameras should be installed in such a manner that the entire cell is always visible (with zero blind spots). While the use of video camera systems can be an effective tool in maintaining the observation of inmates, camera systems should never take the place of regular and consistent in-person observation and interaction.

Suicide Prevention Resources

Basics and Beyond: Suicide Prevention in Jails

Suicide in Corrections

The Journal of the American Academy of Psychiatry and the Law

Suicide Prevention and Recommended Practices

National Suicide Prevention Lifeline