Burdened jails a risk to suicidal inmates

Oregonian – January 16, 2008 – not available elsewhere online.

One inmate was so intent on killing himself that a Multnomah County sheriff’s deputy watched him every minute of every day for his safety, a monthlong effort that cost the jail about $40,000 in extra staffing.

Another inmate nicknamed “Jimmy the Jumper” twice plunged off the second floor of a cellblock to try to kill himself. The county paid his medical bills and later spent about $500,000 fencing off the jail balconies to prevent future jumps.

And then there was the lanky 18-year-old with a mop of blond hair who arrived at the downtown jail in November on a heroin charge.

He said he heard voices pushing him to hurt himself and had attempted suicide six times. Though the jail normally would have released him right away because the charge against him was relatively minor, the worried staff decided to hold him overnight on suicide watch before a judge freed him.

In the first two cases, the men survived. But the third man –Joshua Shane Overstreet –threw himself off a nearby parking garage shortly after his release, dying in the shadow of the jail.

Overstreet’s death was a blow to jail staff who have worked mostly successfully over the past decade to reduce inmate suicides, bringing the rate below the national average for big city jails.

But it’s also a reminder that the jail still must make improvements. An independent consultant has expressed concern about reports that jail workers might be pressured not to diagnose inmates as suicidal because of the extra cost and time for supervision. Jail leaders say that pressure continues today.

And Overstreet’s family wants some answers about why the suicidal teen was released.

About 45,000 people pass through Multnomah County’s jails each year. Some spend a night sobering up, others serve short misdemeanor sentences or await trial for more serious felony charges.

One of the jail staff’s most important responsibilities is to keep the people alive, sometimes against an inmate’s best attempts to thwart the effort.

“If someone really wants to commit suicide even a roll of toilet paper is a weapon,” said Gayle Burrow, head of the health care operation at the county’s two jails. “You can try to do everything you can to keep someone from hurting themselves or commit suicide. Sometimes you don’t have the ultimate say.”

Nationwide, suicide accounts for one-third of deaths among jail inmates. Inmates are more than four times as likely to kill themselves as members of the general population, according to federal statistics.

In Multnomah County, officials have worked to keep suicides down, twice hiring an outside expert to take stock of the system after several suicides in quick succession raised questions about prevention. They have made physical as well as procedural changes and placed hundreds of inmates each year under the supervision of guards through “suicide watch.”

Despite Overstreet’s death, the results have been promising, said Health Department Director Lillian Shirley. Over the past nine years, three inmates have killed themselves in county jails, an average of about one for every 142,000 admissions or a rate of about 36 per 100,000 inmates. Nationally the rate was 47 per 100,000 inmates in 2002, the last year statistics were available.

The figure is also an improvement from recent history: In the five years ending in 1998, the county jails recorded six suicides.

“When you look at the magnitude of what we’re trying to prevent, we’re doing a pretty good job,” Shirley said.

Inmates are at highest risk of harming themselves shortly after being brought to jail, particularly first-time offenders such as Overstreet who may feel overwhelmed by the loss of freedom and the stigma of arrest.

About 14 percent of jail suicides occur on the first day in custody and about half occur within the first week, according to national jail statistics.

So, the jail intake staff immediately screens all inmates for suicidal tendencies: Have they attempted suicide before? Do they have a family history of suicide?

An affirmative answer to any of the questions brings a more thorough screening by a member of the jail’s four-person mental health team.

Overstreet raised nearly every red flag as he came into the jail system Nov. 1. That afternoon, a day after he dropped out of a residential drug and alcohol treatment program, police say they found him using heroin in a downtown Starbucks bathroom.

Overstreet told jail staff that he had tried to kill himself a half-dozen times, most recently a month earlier. “He said that he hears voices and they sometimes tell him to hurt himself,” the agency files note. “He said that he wanted to hurt himself this morning but is OK now.”

His mother, contacted by jail staff that night, warned that he was unstable and begged to have him held for his own protection, jail records show. One of the mental health specialists agreed.

As is standard for new inmates put on suicide watch, Overstreet was strip-searched, clothed in a special smock and put in a single-person cell. He didn’t get any sheets or utensils with his meals.

In 2006, jail staff put 372 inmates on suicide watch, an average of about 30 a month.

Occasionally, people are such a risk that guards must watch them nonstop while in custody as happened in a handful of cases last year. More frequently, as in Overstreet’s case, deputies check inmates every 15 minutes.

As many as four inmates are on watch at a given time, most for less than a day.

Overstreet was taken off suicide watch the next morning after a mental health team member deemed him no longer a risk to hurt himself. County health officials said they could not discuss the reasons for the decision, citing medical confidentiality, but Burrow said jail staff followed all regular procedures.

Neither jail deputies nor space are dedicated specifically to the suicide watch. That forces administrators to juggle resources at a time when corrections deputies and jail staff have been sharply cut back.

That system strain was identified as a risk to suicidal inmates in a report by Lindsay Hayes, an independent consultant called in when the jail had two suicides in two months in 1998 and again in 2005 after two suicides in less than a month.

Hayes expressed concern with reports that jail staff members were under pressure to take inmates out of suicide watch because of the extra cost and time.

“If accurate, such a practice is dangerous, unprofessional and must be corrected immediately,” Hayes wrote in 2005. He is project director of the National Center on Institutions and Alternatives and the leading national expert on inmate suicides.

That pressure continues, according to front-line staff. Burrow concedes she has confronted top sheriff’s office leaders about such pressure on members of the mental health team, who are the only ones who can take someone off suicide watch.

“We can’t lose our focus of what’s right because of the money, even though it’s prime in everybody’s mind,” she said.

A recent study of jail staffing recommended having one deputy assigned specifically to suicide watch at all times to relieve the system of relying on overtime to staff the watches. Sheriff Bernie Giusto considers it a priority, but no changes are immediately planned, said Christine Kirk, his chief of staff.

Others have argued that the county should offer specialized, consolidated housing for inmates deemed a threat to themselves.

“We have a system where suicide watch is an additional burden,” said Steven Sutton, the manager of the jail’s mental health program. “Suicide watch needs to be planned for every day.”

It’s not clear why the jail’s health evaluator on duty that night decided Overstreet should no longer be on suicide watch.

After the decision, Overstreet went to court for his arraignment. The judge authorized his release, and jail staff decided not to put a “peace officer hold” on Overstreet, which allows suicidal inmates to be moved to a hospital for treatment rather than let go.

Shortly before 9 p.m., he was released. Just after 10 p.m., he was found dead on the sidewalk, steps from the jail.

Leaders at the sheriff’s office and health department say they did the right thing, going out of their way to protect Overstreet. The young man’s family is not so sure.

“One question we keep wondering was why that decision was made,” said Kevin Bermingham, Overstreet’s uncle. “Especially when it was stressed over and over that he was suicidal.”