Is San Diego County doing enough to prevent suicides in its jails?

Blog note: this article references a recently released grand jury report on the subject.

One of the sad realities of the criminal justice system is that people who suffer from mental illness — and commit crime — often end up in jail, a less-than-ideal environment for psychiatric healing.

In an article I wrote that appeared two weeks ago in The San Diego Union-Tribune, county authorities acknowledged that reality. Jail is where many people accused of crimes end up even when a psychiatric hospital might be the better option.

Sheriff Bill Gore acknowledged it, too. “There’s something wrong with that,” he said, noting that the men’s Central Jail in downtown San Diego has long been the largest mental health facility in the county.

“That shouldn’t be the case,” he said.

Gore and his staff would likely also agree that inmates who suffer from mental illness shouldn’t die in county jail. But that’s another sad reality.

Over the past 12 years, 46 people have committed suicide in San Diego County jails, according to a report released this month by the county grand jury. The report cites data from the Sheriff’s Department, which runs the county’s seven detention facilities.

The May 4 report also says the suicide rate in San Diego County’s jails is the highest in all of California’s large county jail systems.

Something’s wrong with that as well.

Over the past few years, the Sheriff’s Department has been working to reduce inmate suicides by creating “enhanced observation modules” inside the jails for inmates at high-risk of harming themselves, hiring more medical and mental health staff, and revising the screening process to better identify high-risk inmates at intake.

In March 2016, the department’s Detention Services Bureau updated its policy manual to include procedures for the enhanced observation modules and other specialized units.

There were five inmate suicides last year, none of which occurred in the enhanced units. So far, no inmate suicides have been reported in 2017.

Still, the county grand jury sees room for more improvement.

According to its report, the panel said the department’s policy manual lacked detailed training procedures for the deputies who work inside the jails to reduce inmate suicides effectively and a clear policy statement for suicide prevention.

The report states that “effective communication” is key to curbing suicides and must exist in several areas, including:

• Communication between the officers and deputies who contact a person before booking, and the nurses at the jail who receive the inmate during intake.

• Communication between intake personnel and internal correctional staff, including medical and mental health personnel.

• Communication between all staff and the potentially suicidal inmate.

Gore told the Union-Tribune in a previous interview that his staff was working to improve communication among sworn staff and medical personnel throughout the time that an inmate is in county custody, but particularly at intake.

He explained that people are most vulnerable to suicide during the first 48 to 72 hours they’re in jail.

“They go through the seven stages of grief (because of) the situation they find themselves in,” he said. “That’s our challenge, right there, (at) intake.”

Because the county uses private contract personnel for its mental health workers, the grand jury recommended hiring a full-time mental health director to coordinate services for all jail inmates with mental health problems.

County authorities signed a contract in February with Liberty Healthcare Corp., which is responsible for hiring psychiatrists and other clinicians to oversee quality control of the mental health programs.

Sheriff’s spokesman Ryan Keim said in an email that the department is committed to ensuring the safety of the inmates.

“The Sheriff's Department, along with the Grand Jury, believes that one suicide in a detention facility is too many,” Keim said. “The Department has worked tirelessly to improve our ability to identify individuals susceptible to suicide and provide them the necessary mental health services.”

The department is expected to respond to the grand jury’s report within the next few months.

May 14, 2017

The San Diego Union-Tribune

By Dana Littlefield