At jail, a rising tide of suicide
Facing a flood of mentally unstable inmates, county takes action to make facility safer
Sunday, October 28, 2012
Attempted suicides and deaths in the Clark County Jail
2012 (through Oct. 26): 19 attempts, 4 suicides, 1 homicide
2011: 11 attempts, 3 suicides
2010: 13 attempts, 1 suicide
2009: 14 attempts, 2 suicides
2008: 13 attempts, 1 suicide
2007: 8 attempts, 2 suicides
Clark County Jail
• Inmates: 717, average daily population at jail and the work center on Lower River Road.
• Inmates on suicide watch: 64 a day, on average.
• Custody officers: 143 budgeted officers, sergeants at jail and work center.
• Opened: 1984 in downtown Vancouver, adjacent to the Clark County Courthouse.
• 2011-12 budget: $38.6 million
• Marius C. Asanachescu, 28: Died Feb. 10 while being restrained by custody officers; the homicide is under review by the prosecutor's office.
• Zachary A. Morrow, 26: Attempted to hang himself while in his cell on Feb. 18; died Feb. 24 in a hospital.
• Shawn D. Rahier, 42: Hanged himself in a shower stall on July 1.
• Lee E. Dow, 24: Hanged himself in his cell on July 7.
• Sean P. Watson, 55: Hanged himself in his cell Oct. 3.
Where to get help
National Suicide Prevention Hotlines
1-800 273-TALK (273-8255) press 1 for Veteran support
1-800-Suicide (784-2433) press 1 for Veteran support
1-866-4UTrevor (488-7386) – Gay, lesbian, transgender and bisexual support
Clark County Crisis Line
http://www.suicidepreventionlifeline.com (online chat available)
Zachary A. Morrow was arrested on drug and theft charges Feb. 8 and taken to the Clark County Jail, where he'd been booked at least 20 times since 2003, the year he graduated from Washougal High School.
A little more than a week into his stay, the 5-foot-8, 160-pound Morrow reported he'd been assaulted by an inmate. He was moved to protective custody in the medical unit.
The next day he returned to the general population but was kept in protective custody, placed alone in a two-person cell in G Pod.
At 6:34 p.m. on Feb. 18, two custody officers finished a walk-through and had accounted for all the inmates, according to police reports.
Twelve minutes later, Officer Cindy Sardo heard two inmates yelling into Morrow's cell. One of the inmates was banging on Morrow's door. The inmates told Sardo what happened.
Morrow, using a bedsheet, had hanged himself from a fire sprinkler located above a sink.
Sardo called a Code 14, which signals a suicide attempt.
At least seven custody officers and four nurses responded, according to a county report.
One officer lifted Morrow up while another officer used "the suicide knife" to cut through the sheet. Morrow was not breathing. Chest compressions were started, and an automated external defibrillator was used. Morrow eventually started intermittently trying to breathe and was transported by American Medical Response to PeaceHealth Southwest Medical Center.
He was removed from life support on Feb. 24 and died shortly thereafter.
He was 26.
In addition to Morrow, three other inmates have hanged themselves at the Clark County Jail this year and a fifth inmate's death was ruled a homicide. Clark County Prosecutor Tony Golik said last week he's reviewing investigative reports on the homicide, which involved an inmate with bipolar disorder who died from asphyxia while being restrained by custody officers. Golik will determine whether criminal charges should be filed.
Between 2007 and 2011, there were nine suicides in the Clark County Jail. In 2007 there were eight suicide attempts; so far this year there have been 19 attempts, said Clark County Sheriff's Commander Ric Bishop.
In response to increasing pressure from mental health advocates, families of inmates, custody officers and county commissioners, Sheriff Garry Lucas tasked Bishop with taking specific steps to make the jail safer.
Among the steps:
• On Nov. 6, county commissioners are expected to approve a supplemental budget that includes $545,000 for modifications to the jail. That work includes replacing all 42 shower heads with shorter-nozzled models, and replacing at least 356 protruding fire sprinklers. Installing new sprinklers will require cutting into walls and moving pipes.
• The jail will work with the Southwest Washington Behavioral Health Regional Support Network, which arranges mental health services for people on Medicaid, to share as much information about mutual clients as can be shared without violating patient privacy laws.
• Mental health services in the jail will be increased by 40 hours, to 120 hours a week, and services will be available during the night. A psychiatrist will be at the jail three hours a week to see the most troubled inmates. Bishop said Conmed Healthcare Management, which contracts with the county to provide medical services in the jail, can increase services without increasing its budget because other medical costs have been kept down.
Bishop said input from the community, national practices and advice of mental health professionals has convinced administrators that the jail needs to take a more therapeutic approach to housing mentally ill or otherwise vulnerable inmates, rather than an approach based strictly on security. Lucas has directed staff to create a treatment facility in the jail for mentally ill inmates who are unable to post bail or deemed too dangerous to be in the community.
"We will house, treat and help discharge the mentally ill back into the community in a better condition than we find them," Bishop said. "This is the direction we must pursue to meet the community expectations of jail, inmate and public safety. We are the Inn of the Last Resort, and are accepting the challenges and responsibility."
Screening for risk
The jail already has a secure area for inmates considered at risk for harming themselves.
When screened Feb. 9 for pre-trial release, Morrow said he didn't have a job and was living with a girlfriend. Morrow, who had missed prior court dates and was not considered a good candidate for release, said he'd previously been treated for an alcohol or drug addiction but did not report any current alcohol, drug or mental health issues, according to court documents.
After his death, inmates said Morrow had been distraught over the jail assault, the nature of which was redacted in reports provided to The Columbian in response to a public records request. A detective who listened to recordings of phone calls between Morrow and family members wrote Morrow was told his girlfriend had ended their relationship.
Had Morrow been identified as a suicide risk, he would have been placed in the A Pod, where inmates stay alone in two-person cells.
Every 15 minutes, a custody officer gets up from his desk and checks each A Pod cell, peering through thin vertical windows in cell doors. From his desk, he can view monitors aimed at common areas, but there are no video monitors in cells.
Inmates take five-minute showers, one at a time, but under a new policy have to repeatedly stick an arm out from behind a shower curtain to let the officer know he's still alive.
The A pod system has been successful.
It's been the other six pods in the jail, where inmates who haven't been identified as at-risk are assigned, that have been scenes of an increasing number of suicides, attempted suicides and a homicide.
The number of inmates on suicide watch has been increasing, from 493 in 2008 to 671 in 2011, even though the average daily inmate population dropped during those years, from 740 to 706.
An average of 64 inmates are on suicide watch every day.
One problem with making the facility a safer place has been the design of the facility itself. Designed in the 1970s and constructed in the early 1980s, the jail was built in an "indirect supervision" model.
Lucas, who took office in 1991, told commissioners in August that national jail construction standards weren't followed in order to keep costs down.
The jail opened in 1984 with 306 beds; it has been retrofitted and modified to add beds.
Modern jails -- including the jail's work center, which has not been the scene of any of the suicides this year -- are built for direct supervision, with an officer in the midst of a group of inmates. And in modern pods with an upper tier, there wouldn't be bars for railings as there are in the Clark County Jail. Inmates have used those to hang themselves. Instead there would be a clear plastic barrier, Bishop said.
Modifications to the jail have been made over the years, but the old building still creates challenges, Bishop said.
Another challenge has been getting inmates to admit they are contemplating suicide, and Bishop said he's working on better psychiatric assessment tools including making sure inmates see one of the mental health professionals in the jail because an inmate will be more likely to confide in someone who isn't an officer.
When inmates are booked into the jail, an intake officer asks a series of questions, Bishop said. Inquiring about mental health is a mandatory field in the online form, so the question must be asked and answered.
Mary Jadwisiak, Youth Suicide Prevention Program coordinator for Clark and Cowlitz counties, describes suicide as a complex subject best asked about in a direct, clear manner.
"I think everybody should be trained on what to look for, what to listen for and how to ask that question, 'Are you thinking of killing yourself?'" said Jadwisiak, who will be meeting with Bishop to discuss what can be done at the jail.
"We know that suicide is preventable," she said. Inmates need to know what resources are available while they are in custody and what will be available when they are released. And suicide isn't just committed by people with a diagnosed mental illness, she said.
"It's a public health issue, not a mental health issue," she said.
"Often for people who are thinking about suicide, one of the over-arching themes is loss," she said. Overwhelmed by the trauma of incarceration, inmates need to be reassured that life will get better.
Terri Dow, whose 24-year-old son Lee committed suicide in July, said she wished someone could have reassured her son that in prison he would be able to participate in programs, including job training. Her son, whom she first took to see a psychiatrist at age 3 because he was so aggressive, had bipolar disorder. She wished Lee could have had more than four people on his visitation list and that he would have been allowed out of his cell for more than one hour a day.
"He was so lonely," she said. "He was just in his cell, with not enough stimulation. He was pacing and driving his roommate crazy."
After his roommate was either moved or discharged, Lee hanged himself from a fire sprinkler.
"They shouldn't have sprinklers that hold that much weight," Dow said. She said a suicide note had been found in his cell a day earlier by a janitor, but she doesn't know why that wasn't reported.
Dow, the past president of the Clark County chapter of the National Alliance on Mental Illness who now lives in King County, also said there shouldn't be a delay with inmates getting their medications after they are booked.
She said inmates should always be released with a supply of medication, too.
Steve Maynard, provider manager with the Southwest Washington Behavioral Health Regional Support Network, said there are transition services for inmates getting out of jail, but the county and the network will work to improve those services.
"We are just trying to look at better coordination," Maynard said.
As for the number of visitors an inmate can have, Bishop said four is a manageable number. He said he's considering following through on one of Dow's suggestions, which would be letting mentally ill inmates make free local calls to family members. Currently, inmates only make collect calls.
The increase in suicides was essentially foreshadowed in a 2007 study funded by custody officers, in which jail administrators were warned that "inmates appear to be sicker, more mentally ill, drug addicted and violent than in the past." Those observations are consistent with reports from local jails across the United States, noted the consultants, Crout & Sida of Templeton, Calif.
Custody officers also reported in 2007 that overcrowding and insufficient staffing was making it difficult to properly follow all of the safety and security rules. Consultants observed an overreliance on video monitoring to replace actual supervision, which, they noted, can result in a false sense of security.
Bishop said past practices have been consistent with legal standards and were fitting for a time when jail administrators considered the jail to be a place of incarceration, not a treatment facility. But that attitude has been evolving, he said.
Nationwide, there are three times more seriously mentally ill people in jails and prisons than in hospitals, according to a 2010 study by the National Sheriff's Association and the Treatment Advocacy Center. The study also found that in 1955 there was one psychiatric bed for every 300 Americans, and by 2005 there was one psychiatric bed for every 3,000 Americans.
Of the 15,639 people booked into the Clark County Jail last year, 33 percent were considered "special needs" inmates, based either on information they provided when they were booked or, for repeat visitors, on information on file at the jail. "Special needs" includes mentally or chronically ill and elderly inmates.
Inmates are routinely double-bunked in the jail's six-room medical unit, and other special-needs inmates have to be isolated.
Since that 2007 study, two sergeant and 12 custody officer positions have been cut and approximately 56 jail beds closed, said Officer Jeff Young, president of the custody officer's guild.
"We work in an inherently dangerous environment. We understand that," Young said.
The easiest and most expensive solution would be adding custody officers, but that hasn't been discussed.
He said the guild has a good working relationship with all levels of the sheriff's administration.
"We strive to maintain strong communications and work in partnership to resolve issues that find balance between labor concerns and department needs and direction," Young said.
For family members of inmates who've died, that balance will come too late.
Lillian Kadrie of Missouri doesn't believe her son, Sean Watson, committed suicide on his own. She believes he was despondent, but thinks someone talked him into it.
Clark County Medical Examiner Dennis Wickham ruled that the cause of Watson's death was asphyxia by hanging.
Kadrie said her son's wife died in December of pancreatic cancer. In addition to grieving the loss of his wife, the father of three was on a pain management program for an aching ankle he broke years ago. Worried about the side effects of his medication, he started using marijuana, Kadrie said.
Watson, 55, was booked into the jail at 11:07 p.m. Oct. 2 on suspicion of possession of more than 40 grams of marijuana, a felony.
Within three hours, he was discovered hanging in his cell during a bed check.
"The whole family is in shock over this," Kadrie said.
Don Greenwood, a retired Episcopalian priest and former president of NAMI Clark County, leads a support group for family members of the mentally ill. His oldest son, who has never been in jail, has schizo-affective disorder. Greenwood has persistently asked Lucas and county commissioners to improve jail conditions. Greenwood wishes there was more training for custody officers. Young, president of the custody officer's guild, agrees.
"We certainly need the specialized/additional training to help us better manage people while they are in our care," Young said.
As part of a pilot project, Bishop and other leaders in the Sheriff's office participated in just such a training. For 45 minutes, they had to wear headphones and listen to a CD recorded by mental patients who hear voices. While listening to the voices, Bishop and others were asked to perform tasks such as putting together a puzzle.
For Bishop, it was an eye-opening experience, listening to the voices make constant obscene, degrading statements.
"It attacks your self-esteem, and you can't get away from it." During the training, he was given something to read and he found that focusing on the written word helped him tune out the voices in his head. Then his reading material was taken away from him, and he had no distraction from the voices.
The jail doesn't allow inmates on suicide watch to have reading material. That's a policy that should change, Bishop said, although material would have to be screened and staples would have to be removed from bindings.
In 2013, Bishop said a goal will be to get that training for all of the custody officers.
The number of mentally ill inmates in the jail will only go up, as the state Legislature has cut funding for Western State Hospital and decided only the most seriously ill and dangerous offenders will be transferred to the Tacoma-area hospital for evaluations. Other inmates will be evaluated in the jail.
There's a lot of work yet to do, Bishop said.
"I'll take any help I can get right now, because we're talking about people's lives."
Stephanie Rice: 360-735-4508 or firstname.lastname@example.org.