Suicide haunts jails across our country. Unfortunately, the Central Detention Facility, DC’s city jail, is no exception to this trend.

More than half of all prison and jail inmates in the United States have mental health problems, according to a 2006 report by the Bureau of Justice Statistics (BJS). Another BJS report that year found that suicide caused 32.3 percent of deaths in local jails.

According to the DC Department of Corrections, two suicides were committed from 2009 to 2012 at the Central Detention Facility. In 2013, there were three suicides between January and September. 

The increase in suicides prompted DC Department of Corrections Director Tom Faust to ask for “the assistance of an outside consultant” to evaluate and impartially judge the facility’s suicide prevention practices. Lindsay M. Hayes, an official from the National Center on Institutions and Alternatives, conducted the investigation. In November, just after the report’s publication in September 2013, another suicide occurred.

Hayes made 19 recommendations to the Central Detention Facility’s suicide prevention practices. However, most were concerned with preventing suicide, rather than preventing suicidal ideation, or suicidal thoughts. He proposed that mental health clinicians at Central Detention Facility “develop treatment plans for inmates on suicide precaution,” which was an idea “consistent with national correctional standards.”

According to the National Commission on Correctional Health, such precautions include describing signs, symptoms and circumstances where the risk for suicide is likely. They also try to reduce suicidal thoughts, propose actions for correctional staff and patients if suicidal ideation does occur, and suggest follow-up assesments by mental health clinicians.

However, only two recommendations address mental health. If investigations like Hayes’ simply emphasize inmate suicide attempts rather than the mental health problems behind suicide ideation, an effective, permanent outcome will remain elusive.  

To prevent inmate suicide, we have to start with the root of the problem. Like garden weeds, we must pull out the roots, or it will grow right back. People still suffer.    

Hayes condemned the relocation of suicidal inmates to solitary confinement. Unfortunately, this situation is happens. 

“In determining the most appropriate location to house a suicidal inmate, there is often the tendency for correctional officials in general to physically isolate the individual,” Hayes said in the report. “This response may be more convenient for staff, but it is detrimental to the inmate. The use of isolation not only escalates the inmate’s sense of alienation, but also further serves to remove the individual from proper staff supervision.”

Hayes’ claim that isolation negatively affects inmates is not new. American University Professor Robert Johnson wrote in 1978 isolation could “undermine preferred coping strategies” among self-destructive adolescent inmates.

Solitary confinement, according to Johnson, “exposes men to special environmental challenges and calls for special psychological resources. Those unable to martial appropriate responses are abandoned to defeat and left to ponder, alone and unaided, the nature and import of their failure.”

The Department of Corrections is not the only organization hoping to improve inmate suicide prevention. The American Foundation for Suicide Prevention and other non-profit organizations support research in under-informed areas to better understand mental health issues, such as preventing suicide.

Lisa Barry holds a doctorate in epidemiology, the study of health and disease in defined populations. Currently, ASFP funds her research which evalutes risk factors for suicidal ideation among inmates in Connecticut state prisons who are 50 years and older. She’s an assistant professor of psychiatry at the Center on Aging at the University of Connecticut Health Center.

“It has been well-established that inmates [of all ages] have higher suicide rates than the general population. Inmates share risk factors for suicide with the general population,” Barry said in an email. “These include, but are not limited to, a prior suicide attempt and depression.  However, inmates also disproportionately experience other risk factors for suicide which may make them particularly vulnerable to dying by suicide.”

According to Barry, other risk factors include a history of substance abuse, trauma and poor social support before incarceration.

“Efforts to ‘deinstitutionalize’ individuals with serious mental illness in the US over the past two decades have led to the closure of a large number of psychiatric hospitals,” Barry said. “Development of community-based health services to offset these hospital closures, however, has been inadequate. Consequently, jails and prisons have become the de facto mental health institutions in the US”

If this is true, and more than half of jail and prison inmates have mental health issues, measures must be taken in the correctional community to treat mental illnesses and eventually reduce the number suicides. But where do we start? 

At the roots. According to Barry, there is not enough information. The correctional community needs to know more to successfully prevent suicide.

“In my opinion, as inmates are a particularly high-risk population, more research is needed regarding inmate suicide so as to inform the development of suicide prevention programs,” Barry said. 

If prison is the new American psych ward, then perhaps suicide is just a symptom of a larger issue of inadequate mental health care. If prisons placed a larger emphasis on the reform of inmates, and then perhaps more of mental health problems would be recognized, and treated, before it is too late.