Why Jails Pose Such a High Suicide Risk

By
Image

We’ll never know exactly what happened to Sandra Bland, the 28-year-old black woman who police said was found hanged to death in her Texas jail cell last week following her arrest after a traffic stop. Even though the last two days’ worth of news — the official autopsy, the fact that Bland had told prison officials she had attempted suicide earlier this year, and a video in which she had recounted her struggles with depression and post-traumatic stress disorder — do point to suicide, there’s still a formal investigation to be done. And even if that investigation further confirms the official story, it won’t bring us any closer to knowing what was going on in her head when she decided to take her life.

But if Bland did in fact kill herself, her death followed a jailhouse suicide pattern that’s tragically common.

In any case in which someone commits suicide, it’s important not to reduce the act to any one precipitating cause. “Suicide is complex behavior and results when a variety of biological, psychological and environmental factors come together, and is often triggered by stressful events,” said Jill Harkavy-Friedman, vice-president of research at the American Foundation for Suicide Prevention. But unfortunately, imprisonment — especially sudden imprisonment — can serve as exactly the sort of precipitating event that can raise someone’s risk of suicide, particularly if they have other risk factors. “If you’ve never really been in the criminal justice system, never been locked up, never been in jail, it isn’t anything like you might imagine,” said Dr. Thomas W. White, an expert on prison suicide who works with both correctional facilities and mental-health specialists. “As a person in the free world, you don’t have any idea what it’s like to have no freedom.”

That’s part of the reason why the first few days in prison are so risky, said White. “There’s a lot of research suggesting that many suicides are pretty impulsive, that people do it within five minutes of thinking about it,” he said. “So it’s not surprising it happens in jails.” When you combine preexisting risk factors with a sudden, jarring, terrifying transition, the results can be fatal, especially given, as Harvay-Friedman put it, that “Research shows that suicidal behavior often emerges quickly with as little as five to ten minutes between the thought and the action.”

This can help explain the fact that the suicide rate in jails, which are usually (relatively) short-term stops for people before and during their trial, or after they have been convicted of minor offenses, are so much higher than rates in prisons. A person’s time is jail is when they’re at their most shocked, scared, and vulnerable. By the time you’re in prison, “the shock has worn off,” as White put it.

Jails know this, and that’s why they often put a premium on suicide-risk assessment. In Bland’s case, she was asked both during her initial booking and a subsequent mental-health check, both detailed in booking documents released by the police, whether she had attempted suicide in the last year, and whether she was suicidal at the moment. Some people online have noted discrepancies in her responses on the forms, but White said it’s not unusual for there to be inconsistencies between a prisoners’ response to initial and follow-up suicide questions. When you’re asked the question during your initial booking, he explained, “You may be there with five other people and they’re trying to rush you through the process and get you through the cell.” This could cause either the booking officer to rush through the questions, or incentivize the person being questioned not to answer fully or honestly. In many cases, the subsequent mental-health evaluation offers an easier setting in which to be honest, leading to less than perfect agreement in responses.

In Bland’s case, both times she was asked about suicidal thoughts, she noted a suicide attempt from earlier this year as a result of a miscarriage, but said that she wasn’t suicidal at the moment. This was an important juncture, said White: Generally speaking, jail officials aren’t going to find it all that noteworthy if someone has one or more risk factors for suicide, like a previous attempt. “Half the population has risk factors, but you can’t put everybody on suicide watch,” he said.

From the point of view of figuring out who needs to be put on suicide watch, imminent thoughts of suicide are what matter the most (for what it’s worth, suicide hotlines work the same way, quickly sorting those who say they are feeling suicidal at the time of their call into a different, more urgent set of questions and procedures as compared to those who are generally suicidal but doing okay at the moment). But to Harkavy-Friedman, the fact that there can be such a terrifyingly short gap between a given instance of suicidal ideation and someone following through with the act “highlights the importance of understanding the host of contributors to suicidal behavior and not relying solely on whether a person is thinking of suicide at a particular moment in time.”

Only a full investigation will reveal whether there were points during Bland’s jailhouse stay at which the tragedy of her death could have been averted (not imprisoning her in the first place would have obviously been a good start). White, like all suicide researchers, highlighted the fog that surrounds a situation in which “the best source of information is dead and you can’t ask them.” “When you really talk about this, everything is a theory,” he said.

More broadly, White said that attempts at preventing suicides tend to run up against simple financial issues. “There are obviously many issues about prevention, but resources are always an issue,” he said. “Given that jails now house three times as many mentally ill offenders as do state mental hospitals, the need for a mental-health infrastructure to manage so many people with severe mental illness or serious psychological problems is always a critical factor in cases like this. Unfortunately, this is rarely raised until a tragedy like this arises.”