As authorities investigate a recent flurry of inmate suicides, the North Carolina prison system has rolled out a plan to prevent more inmates from taking their own lives.
The new policy was signed on Wednesday – four years after a national expert first recommended that the state adopt a plan and two weeks after the Observer reported on the rising number of inmate suicides.
Whether the plan will actually save lives is unclear. Fully carrying it out may be impossible without more staff. And some of the requirements fall short of what one national expert says is needed.
Everyone says resources are tight. But people’s lives are at stake here.
Jack Register, executive director of the North Carolina chapter of the National Alliance on Mental Illness
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But advocates say it’s a start.
Among other things, the plan would require that:
▪ All prison staff be trained to recognize whether an inmate is at risk of committing suicide.
▪ Every prison conduct three mock drills each year to prepare staff on how to handle an attempted suicide in progress.
▪ Prison mental health professionals do more frequent monitoring of inmates after they come off suicide watch to ensure they’re out of danger.
The policy, which becomes effective on Sept. 1, also discourages prisons from placing mentally ill inmates in solitary confinement – an environment which research has shown can worsen mental illness. If prison officials find they must place such inmates in segregation, they should do so for no more than 30 days a year, the plan states.
“It’s a step in the right direction,” said Susan Pollitt, an attorney for Disability Rights NC, a nonprofit advocacy group. “But there are places where the policy could go further. It doesn’t represent in every case what’s considered best practice.”
One can argue that you don’t write policy based on what you’re able to do. You write policy based on the right thing to do.
Dr. Gary Junker, the N.C. prison system’s director of behavioral health
On Wednesday, state prison officials also approved a revised policy aimed at handling inmates who are at risk of hurting themselves.
Lindsay Hayes, a nationally recognized expert on preventing suicides among inmates, examined both policies at the Observer’s request. He said the plans include most of what’s needed but lack some key requirements.
One example: The plan says that inmates deemed at risk of hurting themselves should be constantly monitored until they can be seen by mental health professionals. Hayes said that requirement makes sense. The problem, he said, is that the policy allows the monitoring to be done by camera. In other prison systems, busy officers have failed to monitor video screens as inmates killed themselves, he said.
“(Relying on video monitoring) is not acceptable,” Hayes said. “It’s particularly dangerous.”
‘Too many suicides’
In a 2012 assessment, a prison mental health expert recommended that North Carolina develop a suicide prevention policy based on national best practices. Jeffrey Metzner, a clinical professor of psychiatry at the University of Colorado School of Medicine, repeated his recommendation in a second report in 2014.
The issue gained further attention earlier this year, when a spate of inmate suicides hit the state prisons. During the 17-day period that ended on May 5, four state prison inmates reportedly committed suicide. A fifth killed himself in January, according to the state Department of Public Safety.
The five suicides so far this year exceed the number for all of 2015, when three suicides were reported.
Had stronger precautions been in place before now, advocates say, prison staff might have been able to save the lives of some of those inmates.
“It has taken so long to develop these policies that have obviously been needed since at least 2012,” said Pollitt, the attorney with Disability Rights NC. “Now we’re seeing too many suicides … Maybe we have a trail of deaths now because of it.”
‘Real human pain’
Historically, prison leaders say, the suicide rate among North Carolina inmates has been lower than that for state prison populations nationally – and lower than the rate for the U.S. population as a whole.
But critics say the prison system faces a dire shortage of mental health professionals – a problem that will continue to make it difficult to monitor and treat inmates who are at risk of committing suicide.
About 25 percent of the prison system’s staff psychologist positions – and about 40 percent of the psychiatrist positions – are vacant, state figures show.
Some North Carolina prisons have no psychologists or psychiatrists on-site, but instead rely on the services of professionals stationed at other prisons. And some staff psychologists are responsible for visiting inmates in three or four prisons.
Elizabeth Forbes, director of the criminal justice reform group NC Cure, says she has gotten many complaints from inmates who say that when they request visits with mental health professionals, they often are forced to wait four to six months.
“Their staffing pattern is not adequate,” Pollitt said. “That translates into real human pain and suffering.”
In the budget approved last year, the legislature did not grant Gov. Pat McCrory’s request for funding to bolster mental health staffing in the prisons. Meanwhile, the budgets proposed by the House and by McCrory this year don’t call for additional money to enhance prison mental health services.
But state officials say financial challenges won’t stop them from making prisons safer.
“One can argue that you don’t write policy based on what you’re able to do,” said Dr. Gary Junker, the prison system’s director of behavioral health. “You write policy based on the right thing to do.”
While there’s little public sympathy for inmates, the law requires prison officials to protect them, advocates say.
“Everyone says resources are tight. But people’s lives are at stake here,” said Jack Register, executive director of the North Carolina chapter of the National Alliance on Mental Illness. “These are people’s children, their husbands, their wives. They’re people for heaven’s sake.”
Key pieces of plan
The prison system’s new suicide prevention policy would:
▪ Train staff members at orientation to recognize whether an inmate is at risk of killing himself – and to refer such inmates for mental health services.
▪ Designate specific rooms or cells for suicide watch. Inmates placed on observation will be given a vinyl-covered mattress, and a tear-resistant blanket and smock so that they’re less likely to try hanging themselves.
▪ Require mental health professionals to do more frequent visits with inmates after they come off suicide watch.
▪ Require that every prison be assigned a coordinator who will be responsible for managing the treatment of suicidal inmates.
▪ Attempt to keep inmates with mental illness out of solitary confinement, which can worsen problems. But if any inmates with mental illness have to be placed in restrictive housing, it will be for no more than 30 days.