No One in Jail “Gets Better” on Suicide Watch

As the whole world now knows, on Saturday, August 10, Jeffrey Epstein was found dead in his cell in New York’s Metropolitan Correctional Center. The internet quickly exploded with opinions: some positing negligence on the part of correctional staff; some assuring the public that suicide was impossible for someone who was being watched like he was. President Trump weighed in on Twitter, suggesting that President Clinton had conspired to have Epstein murdered.

Apart from what we hear from the media, we the people have no way of knowing what happened in Epstein’s cell. The published reports make it pretty clear that he committed suicide, and was able to do so because the guards watching him, on the tail-end of a double shift, fell asleep. The New York Times reported that Epstein saw a mental health worker earlier that day — for five minutes in the midst of an attorney visit, supposedly as a follow-up to his suicide attempt a few weeks earlier.

While I know nothing about Epstein’s death in particular, I know a lot about suicide in jails and prisons. Prisons are toxic to mental health. They are places of violence.

For over a decade, I have been one of the lead counsels in a federal civil rights case known as Rasho v. Jeffreys, which established that the state of Illinois is not providing people in prison who are diagnosed with mental illness with the minimum treatment required by the Constitution. During the course of this work, I have met with dozens of people who have attempted to commit, or later succeeded in committing, suicide. I have reviewed medical records, and listened to testimony of outside experts and the prison’s own mental health workers.

What I have learned is that suicides are far more common in prisons (20 per 100,000) and jails (46 per 100,000) than they are among the general public (14 per 100,000). This is hardly surprising. The very purpose of imprisonment is to isolate people from their social networks; remove as much of their individuality as possible; and remove all sense of control over their lives and destiny. All of these are key danger signs for suicide: social isolation, loss of a sense of agency, feelings of helplessness. These are not flaws in the system, but inherent to the concept of incarceration.

All of this is exacerbated by the complete failure of most prisons and jails to provide meaningful, harm-reducing mental health treatment. California has a 30 percent vacancy rate for psychiatrists in its state prisons; my state of Illinois is worse. We are supposed to have 85 psychiatrists; we actually have fewer than 50. When someone attempts suicide, they are, like Epstein was, placed on suicide watch. This is generally a euphemism for solitary confinement. The person is typically stripped naked except for a “suicide smock,” left in a cell entirely alone, with no property, no books, no TV or radio, nothing to keep your mind occupied. “Treatment” consists of exactly what Epstein seems to have received: a five-minute visit by a mental health worker who makes an assessment to determine if you remain suicidal. No attempt is made to help a person develop coping skills, let alone to investigate and change the factors that led them to attempt suicide in the first place. No one gets better on suicide watch.

These statistics suggest there is a serious problem in our prisons and jails. But until you become proximate to the people impacted, until you understand the human tragedies behind these statistics, it is hard to truly understand the issue.

I feel morally obligated at this point to provide a content warning — I am going to share the stories of some affected individuals, including stories of suicide and self-harm. This will not be an easy read.

In all cases, the people’s names have been changed to protect what little privacy prison has left them. But what happened to them is all too real.

• Pat was diagnosed with schizophrenia as a child. In and out of mental health hospitals, he was often left on his own, without treatment, without medication. At the age of 19, a few days after release from another inpatient hospitalization, alone on Chicago’s streets without medication, he committed a murder and was sentenced to life in prison. His mental health only deteriorated further in prison: he found that the only way to silence the voices in his head was to cut himself. His arms now have no skin on them — they are 100 percent scar tissue. Rather than being offered treatment, Pat was prosecuted — given an additional seven-year sentence for possession of a sharp object (the one he used to cut himself). In another episode, as he was uncontrollably pounding his head against the wall, some blood splattered on a guard. Pat was prosecuted and given an additional six-year sentence for aggravated battery of a correctional officer. Thankfully, as a result of our case, now Pat is being given treatment, and is acting as a peer mentor for other prisoners.
• When she was 2 years old, Mary was taken from her mother by child protective services. She spent the rest of her childhood cycling through foster homes, group homes, inpatient treatment programs, and homeless shelters, as well as living on the streets. Rousted from sleeping under a bridge by the police, high on the drugs she used to self-medicate, she resisted, and was sentenced to prison for aggravated battery of a police officer. In prison, she further deteriorated, turning to self-mutilation. At one point, she climbed up the outside fence and used the barbed wire to slice open her abdomen. When she was placed in a “crisis room,” she kicked the wall until a piece of plaster came loose, and used it to cut herself. When placed in a cell naked, she broke the lightbulb, ate some of the glass and rolled around in the rest. When strapped down to a bed in restraints, she used the Velcro to rub her wrists raw until they bled.
• David was sentenced to life for murder as a teen. He escaped from the county jail while awaiting trial, and attempted escape from prison. He spent the next 20 years in solitary confinement. While in Illinois’s now-closed supermax prison, he tied a bag over his head, putting himself into a coma. Prison officials revived him, and when I met with him, he denied having any mental illness. He told me he just could not imagine living out the rest of his life in solitary confinement.
• Mark spent several years in the same supermax prison. He was engaged in treatment, and was told that if he went an entire year without a disciplinary report and continued to participate in treatment, he would be transferred out of the supermax. When the year was up, he was told that he needed to stay in solitary confinement longer. He hanged himself.
• Tammy had no history of mental illness, until she was placed in solitary. Then she began to cut herself. Eventually, she was placed in an allegedly suicide-proof cell, stripped naked except for a heavy smock. After her shower one day, she managed to cut off a small piece of her towel. She then wrapped it around her neck and asphyxiated herself.
• No matter how “suicide-proof” the cell, one thing officials can’t remove is gravity. While confined in solitary, deprived of all property, John dove off his bed headfirst onto the concrete floor, fracturing his skull. He too denied any mental illness, and was sure that death was preferable to solitary confinement.

I described these men and women not because they are unusual, but because they are not. Prisons are terrible places. Some people who find themselves in prison will try to kill themselves. No tinkering with the system will prevent them from doing so.

The only way to stop people in prisons and jails from killing themselves is to not put them in prisons and jails.