The Alabama prison system’s “dramatic increase” in inmate suicides is a result of state corrections officials’ failure to take adequate steps to improve the conditions of its solitary confinement units and its treatment of mentally ill inmates, says the Southern Poverty Law Center (SPLC).
Four inmates have already committed suicide this year in Alabama state prisons—one on death row and three in solitary confinement units. In all of 2014, the state Department of Corrections (DOC) reported just one inmate suicide, and last year there were four suicides in Alabama prisons over 12 months.
Four suicides may sound like a small number for a prison system that houses about 21,000 inmates. But if the trend continues for the remainder of 2018, the inmate suicide rate in Alabama’s prisons will be about 40 suicides per 100,000 inmates this year, ten times higher than the rate the DOC reported four years ago.
In 2014, the latest year for which such data is available from the US Bureau of Justice Statistics, there were 249 inmate suicides in state prisons across the nation. That’s a rate of about 18.4 suicides per 100,000 inmates, or less than half the rate Alabama’s prisons are experiencing so far this year.
“As far as we can tell, the state has done very little beyond promising to improve conditions in Alabama prisons,” Maria Morris, senior supervising attorney for the SPLC, said in the organization’s statement released this week.
“We continue to see the mentally ill kept in extreme isolation, and this is driving a steep rise in suicides.”
While reducing prison suicide rates is a difficult and complex task, multiple attorneys told AL.com that there are a number of concrete steps the DOC should take to begin that process in Alabama’s overcrowded state correctional facilities.
Those steps include boosting staffing levels, decreasing the number of mentally ill people held in isolation, fixing faulty solitary confinement cells, and improving the living conditions in solitary confinement units.
Dr. Edward Kern, who was appointed in April 2018 as the DOC’s first director of psychiatry, said in a statement issued by the department that the DOC is already working to address the issue of inmate suicides.
“ADOC is developing a comprehensive strategy for suicide prevention to go along with the changes already implemented in response to the court” following a June 2017 court ruling that “ordered the state to enter mediation and develop a remedial plan” to address a number of mental health care issues, the DOC statement said.
A key step toward bringing down the suicide rate would be to reduce the number of inmates—particularly inmates with diagnosed mental illnesses—in the state’s solitary confinement units, according to lawyers and experts who study such remedies.
And yet, the DOC has instead seen a marked uptick in the number and percentage of mentally ill people incarcerated in its solitary confinement—also known segregation or “seg”—units since 2014.
In January 2014, 196 prisoners on the DOC’s mental health caseload were being held in segregation units statewide, a number that represented 17.7 percent of the 1,096 people in such units at the time, according to data collected by the SPLC. As of January 2018, there were 274 prisoners on the mental health caseload incarcerated in seg units, or 25.5 percent of the 1,076 people who were in such units.
The increase in the use of solitary confinement to house mentally ill inmates creates a situation in which suicide is more likely, according to experts including Lisa Borden, an attorney with the Memphis-based firm Baker Donelson and co-counsel in a lawsuit against the DOC over prison conditions.
Jamie Wallace, a client of Borden’s, committed suicide in his cell at Bullock Correctional Facility prison in December 2016, less than two weeks after he testified in the trial in that case, which challenges the adequacy of the Alabama prison system’s mental health care.
“Less use of segregation would absolutely make an enormous difference, in my opinion,” Borden told AL.com. “When you have hundreds and hundreds of people in units that need that level of supervision, that’s a big problem and you need lots of staff to make that feasible.”
Kern said in the DOC’s statement earlier this month that though mental illness is often linked to suicide, a study released earlier this month by the US Centers for Disease Control and Prevention stated “that ‘many factors contribute to suicide,’ and that despite the strong association between mental illness and suicide, research ‘has found that more than half of people who died by suicide did not have a known diagnosed mental-health condition at the time of death.'”
The study looked at all suicides, not just those that took place within correctional settings.
The DOC added that “increasing the number of mental health professionals available to provide treatment within ADOC has been and remains a top priority … The department has increased the number of clinical positions, including psychiatrists, nurse practitioners, psychologists and licensed counselors, and is working with Wexford Health Sources to fill these positions.”
Meanwhile, the Alabama DOC faces both a severe staffing shortage and overcrowding crisis, which means that solitary units often go without proper levels of supervision, which increases the likelihood of inmates committing suicide, according to Maria Morris.
“They have a system that is putting people at an unconscionable and unconstitutionally high risk of harm,” Morris said Thursday. “Unfortunately, in the Department of Corrections they are not staffing [segregation] units anywhere near as well as they should be because of staffing shortages throughout the whole correctional system.”
Even if the DOC significantly reduced the number of inmates in segregation, flaws in the design of many Alabama prisons’ solitary confinement cells that make it easier for inmates to kill themselves would remain a concern, according to multiple attorneys who are involved in lawsuits against the department.
Some segregation unit cells have ceiling light fixtures or cell doors with exposed bars from which inmates can hang themselves, they say.
And many are each served by a single water pipe that feeds into both a metal combined toilet-sink unit and a fire sprinkler directly overhead. That setup creates an opportunity for inmates to kill themselves, according to Morris.
“If you want to kill yourself, you can climb up on the sink and hang yourself from the sprinkler head,” she said.
Some prison systems in other states have made fixes the design of solitary cells in order to reduce the ability of inmates to commit suicide.
But performing such work in all of Alabama’s state prisons—where sprinklers installed directly over toilet-sink units is “a pretty universal setup,” according to Morris—would likely cost millions of dollars, and the DOC has repeatedly stated in recent years that budgetary constraints limit its ability to make all manner of upgrades to its prisons.
On Jan. 14, 2017, Anil Mujumdar, an attorney with the Birmingham firm Zarzaur Mujumdar & Debrosse, asked DOC Commissioner Jeff Dunn during the trial challenging the adequacy of the prison system’s mental health care if he would “prioritize cost savings on sprinkler heads over the value of life,” according to a trial transcript.
Dunn responded that “[t]he value of a life is much greater than the cost of a sprinkler head. But to the specific detail as to the hundreds of items in a particular contract, I think that would have to be dealt with in concrete, in the sense of at the time, to determine.”
James Tucker, the executive director of the Alabama Disabilities Advocacy Program—one of the outfits representing plaintiffs in the lawsuit against the DOC challenging the adequacy of the prison system’s mental health care—argues that inmate safety should trump budgetary concerns.
“In any environment in which health care is being provided to persons who have serious mental health needs, there should be breakaway construction and a broad review of all aspects of physical setting so that any physical structure that can be used in completing a suicide can be removed,” he said.
“Yes, the objection of cost is made, but we’re talking about human lives here.”
Isolated for Years
The fact that some inmates are left in solitary confinement for months or even years at a time likely also contributes to the high rate of suicide in Alabama’s state prisons, according to lawyers and inmates.
“Back in December 2016, we were aware of numerous people who had been in solitary confinement for years on end, sometimes with a couple of short breaks,” Morris said. “The time I was last in Holman’s seg unit, which was 2016, there was a person who was in solitary since 2003, but he’s an outlier.”
Psychological studies have repeatedly shown that solitary confinement can wreak havoc on the mental health of inmates, according to a 2015 review of the literature by Mary Murphy Corcoran of New York University’s Department of Applied Psychology.
“Confined inmates experience a multitude of psychological effects, including emotional, cognitive, and psychosis-related symptoms … Longer stays in solitary confinement are associated with greater mental health symptoms that have serious emotional and behavioral consequences,” Corcoran wrote.
As such, many experts advocate a total ban on solitary confinement of mentally ill individuals and argue that even people without mental health diagnoses should never be isolated for long periods of time.
In April 2016, the National Commission on Correctional Health Care, a non-profit advocacy group, issued a position statement with a list of 17 “guiding principles” for the use of solitary confinement in correctional facilities. The first two principles were: “Prolonged (greater than 15 consecutive days) solitary confinement is cruel, inhuman and degrading treatment, and harmful to an individual’s health,” and “Juveniles, mentally ill individual (sic) and pregnant women should be excluded from solitary confinement of any duration.”
Yet the DOC continues to house inmates in solitary confinement for periods greatly exceeding 15 days. And as of January, 274 prisoners with mental health diagnoses were incarcerated in seg units across the state.
Mentally ill people subjected to such conditions, in addition to dealing with other issues like the overwhelming stench and the fact that they are locked in their cells more than 22 hours per day, often see their mental health degrade further, which increases the risk of suicide attempts, the lawyers said.
“They are horrific, atrocious environments, that are dark and dank and filthy, where people are in these cells that have just a tiny window into the hallway and then a tray slot for their meals and that’s their view outside of their disgusting cell,” Borden said. “Inside the cells there’s plenty of ways for someone to kill themselves should they become so inclined.”
The DOC did not respond to specific questions about the conditions in its segregation units.
“Our department is committed to safely and humanely incarcerating every individual in its custody and providing proper and appropriate care for those with mental illness,” Dunn said in the DOC statement.
“We will continue to follow the court’s order, which includes working with the plaintiffs to remedy challenges that is (sic) in the best interest of those receiving mental-health care in the state prison system.”
Connor Sheets, an investigative reporter for AL.com, is a 2018 John Jay/Langeloth Justice Reporting Fellow. This is a condensed and slightly edited version of an article published this month as part of his reporting project. The full version can be read here.