The death of Jeffrey Epstein—apparently but not definitively a suicide—received wall-to-wall coverage in the media for understandable reasons. Epstein—a wealthy financier and convicted sex offender who had been charged with sex trafficking of minors—was clearly a high-profile lightening rod, whose lurid history provoked intense reactions. Furthermore, the unanswered questions surrounding his death kindled wild speculation and baseless conspiracy theories. In short, Epstein’s story was media catnip. Unfortunately, lost in all the sensational coverage of this one man was the systematic mistreatment of people with serious mental illness in the criminal justice system.
According to the Bureau of Justice Statistics, suicide has been the leading cause of death in US jails every year since 2000. In 2013, a third (34%) of jail inmate deaths were attributable to suicide. The suicide rate increased 14%, from 40 suicides per 100,000 jail inmates in 2012 to 46 per 100,000 in 2013.1 Rates hit a high of 50 deaths for every 100,000 inmates in 2014, the latest year for which the government has released data. Not unexpectedly, men are more likely to die by suicide than women in jail settings, as in the general population.
Suicide rates in jails are generally higher than those in prisons, an effect often attributed to “the shock of confinement” experienced by those in jail—many of whom have never been in serious legal trouble before. According to corrections expert Steve J. Martin,2 being jailed for the first time “. . . over-takes your being, in the sense that normalcy is gone.” Also, as the Marshall Project has noted, by the time someone arrives in prison, a prisoner’s suicidal tendencies have had a longer time to emerge, and—at least in some cases—to be recognized.3
This last point sheds light on the real scandal within the US penal system. As Jane Wiseman and Stephen Goldsmith have put it, “Today, after decades of deinstitutionalization of all but the most critically ill patients from state mental hospitals, America”s jails are the central address for the mentally ill.”4 Indeed, as Wiseman and Goldsmith note, there are 10 times more people with mental illness in the criminal justice system than are being treated in psychiatric hospitals.
The story gets worse. A joint investigation by The Associated Press (AP) and the University of Maryland’s Capital News Service (CNS) found that “. . . scores of jails have been sued or investigated in recent years for allegedly refusing inmates medication, ignoring their cries for help, failing to monitor them despite warnings they might harm themselves, or imposing such harsh conditions that the sick got sicker.”5
The AP/CNS investigation also found that in about a third of cases where jail inmates attempted suicide or took their lives, they did so after staff allegedly failed to provide prescription medicines used to manage mental illness. We do not yet know the outcome of these lawsuits, but there is good reason to believe that better assessment and treatment of incarcerated people with mental illness would reduce suicide rates in this population.
In fairness to jail officials, it should be noted that they are dealing with a situation not of their making. As Jonathan Thompson, head of the National Sheriffs’ Association, put it, “We’re not the nation’s psychologists . . . We have decided that, as a society, let’s just warehouse the mentally ill in a jail . . . which is neither equipped for, trained to handle, or able to be most efficient and effective at solving the problem.”5
Those of us in psychiatry who have lost patients to suicide—and sadly, I include myself—-know well that suicide risk determinations are complex and harrowing, and sometimes reach the wrong conclusion, despite a thorough assessment. Meanwhile, the much larger issue of why so many people with serious mental illness wind up in jail or prison—and often receive inadequate assessment and treatment there—will loom before us, long after the media have lost interest in Jeffrey Epstein.
Dr Pies is Professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY and Tufts University School of Medicine, Boston. He is Editor in Chief Emeritus of Psychiatric Times (2007 to 2010). He reports no conflicts of interest concerning the subject matter of this article.
1. Noonan M, Rohloff H, Ginder S. Mortality in Local Jails and State Prisons, 2000-2013: Statistical Tables. US Department of Justice. August 2015.
2. Kaste M. The “Shock of Confinement”: The Grim Reality of Suicide in Jail. National Public Radio. July 27, 2015.
3. Chapman M, Meagher T. Why Jails Have More Suicides Phan Prisons. The Marshall Project. August 4, 2015.
4. Wiseman J. Why We Need to Move Away From Jailing the Mentally Ill. Governing. September 2, 2016.
5. Cohen S, Eckert N. AP Investigation: Many US Jails Fail to Stop Inmate Suicides. AP News. June 18, 2019.