New BJS report reveals staggering number of preventable deaths in local jails

In 2016, over 1,000 people died in local jails - many the tragic result of healthcare and jail systems that fail to address serious health problems among the jail population, and of the trauma of incarceration itself.

by Alexi Jones, February 13, 2020

A newer article about jail deaths with data from 2018 is now available. We suggest using that article instead of this one.

A new Bureau of Justice Statistics report reveals that over 1,000 people died in local jails in 2016, underscoring the dangers of jail incarceration. Most troublingly, the report finds at least half of these deaths are preventable, with suicide remaining the leading cause of death. These preventable deaths are the tragic result of healthcare and jail systems that fail to address serious health problems among the jail population – both inside and out of the jail setting – and of the trauma of incarceration itself.

The new report reveals that half of all deaths in jails are due to suicide, accident, homicide, and drug or alcohol intoxication, all of which are largely preventable. Once again, suicide was the leading cause of death in jails. The jail suicide rate is far higher than that of state prisons or among the American population in general.

The other half of deaths in jails are due to illness, such as heart disease or liver disease, many of which likely could have be prevented if not for the abysmal healthcare in jails.

People in jail often have serious physical and mental health needs. They are five times more likely than the general population to have a serious mental illness, and two-thirds have a substance use disorder. They also are more likely to have had chronic health conditions and infectious diseases. Moreover, many people experience serious medical and mental health crises after they are booked into jail, including withdrawal, psychological distress, and the “shock of confinement.”

Yet despite their serious needs, people in jail rarely have access to adequate healthcare. History has shown that jails are unable to provide effective mental health and medical care to incarcerated people.

For example, CNN recently published a scathing investigation into WellPath (formerly Correct Care Solutions), one of the country’s largest jail healthcare providers. The investigation found that WellPath provides substandard healthcare that has led to more than 70 preventable deaths in local jails between 2014 and 2018. WellPath, like other correctional healthcare companies, has been accused of prioritizing cost-cutting over patient health, with little governmental oversight. CNN found that WellPath doctors and nurses often denied specialized testing, medication, and treatments. They have also failed to diagnose and treat psychiatric disorders, denied emergency room transfers for urgent cases, and allowed common infections and conditions to progress to the point of fatality.

Previous research also shows that the jail environment itself can lead to serious health crises. As a report from the Department of Justice explains, “certain features of the jail environment enhance suicidal behavior: fear of the unknown, distrust of an authoritarian environment, perceived lack of control over the future, isolation from family and significant others, shame of incarceration, and perceived dehumanizing aspects of incarceration.” People in jails are regularly denied contact with family and friends through the elimination of in-person visits and the high cost of phone calls, denied access to adequate medical care and nutritious food, exposed to unbearable heat and cold, and often subjected to the torturous conditions of solitary confinement.

Moreover, jails are often understaffed and/or have inadequately trained staff, and the vast majority of people working in jails are trained as correctional officers, not health providers or social workers. Despite years of evidence that suicide is the leading cause of jail deaths, many jail staff are not even trained in suicide prevention. Worse, some jail staff display indifference toward incarcerated people’s lives, often refusing to take their health concerns seriously and cutting off access to healthcare – with fatal consequences. For example, Clackamas County Jail workers were caught on camera laughing and joking about a military veteran overdosing in his cell. Even a nurse on duty reportedly spent less than five minutes with the man, who died after authorities finally took him to a hospital.

The Bureau of Justice Statistics data released yesterday emphasizes, yet again, the dangers of even short jail stays: 40% of jail deaths occur within the first week of a person’s incarceration. Given how just a few hours or days in jail can turn deadly, the report underscores the need to divert people away from jail – especially those with mental health and substance use disorders who are at increased risk – as well as the urgency of reducing the use of pretrial detention.

Our new “best practices” guides show counties how to strike fairer contracts for jail services

Most "consumers" of telecom services in jails are families in poverty. Counties can and should negotiate contracts that treat them more fairly.

by Prison Policy Initiative, February 7, 2020

The average cost of a phone call from a Texas county jail is 44 cents per minute¹ — which can add up to hundreds of dollars a month for families trying to stay in touch — but Dallas County may soon lower its rates to 1 cent per minute. How? The county is aggressively renegotiating its contract with jail phone provider Securus, prioritizing getting the lowest rate possible for the families making the calls.

For other counties wondering how to negotiate contracts that treat consumers more fairly, we’ve just published three “best practices” guides. Our three guides cover the three most common types of telecommunications contracts in jails: contracts for phone services, contracts for video calling technology, and contracts for electronic tablets.

The simplest and best policy for a county is to pay for these services out of its general fund, thus making communication free. (Otherwise, personal wealth determines which families can stay in touch and which families can’t.)

For counties that won’t go that far, though, it’s still possible to write a jail contract that holds the vendor accountable, and allows families to stay in touch without paying dearly. Our best practices guides show how smart agencies can:

• Get the lowest rates possible for families by refusing commissions
• Protect customers from predatory fees, such as unnecessary “account maintenance” fees or high deposit fees.
• Make sure that vendors return customers’ unspent funds
• Ensure that expensive technology is never used to “replace” vital (and free) existing services
• Avoid excluding good providers from the bidding process by accident

During the contract award process, county procurement officials are often outmatched by their counterparts in the jail telecom industry — highly experienced businesspeople intent on maximizing their returns. Because of this imbalance, far too many poor families end up paying hundreds or thousands of dollars a month to stay in touch. But county governments that do their homework can get families a fairer deal.

To learn more, see our new best practices guides about:

• Phone services
• Video calling technology
• Electronic tablets

And if you are new to these issues, see our research and advocacy about phone services in prisons and jails, protecting in-person visits from the video calling industry, and exploitation on prison tablets.

Footnotes

“What percent of the U.S. is incarcerated?” (And other ways to measure mass incarceration)

Nearly one out of every 100 people in the United States is in a prison or jail.

by Peter Wagner and Wanda Bertram, January 16, 2020

We’re often asked what percent of the U.S. population is behind bars. The answer: About 0.7% of the United States is currently in a federal or state prison or local jail. If this number seems unworthy of the term “mass incarceration,” consider that 0.7% is just shy of 1%, or one out of a hundred. And a little more context shows that this fraction is actually incredibly high.

Because talking about portions of a percentage can be confusing, this concept is more often expressed as a rate: The United States currently incarcerates 698 per 100,000 people. (The rate is out of 100,000, rather than 1,000 or 10,000, because back when incarceration was much rarer you needed a larger denominator to express the rate in whole numbers. But either way, these are all different ways of expressing the same percentage.)

In some ways, though, looking at the portion of a country that is incarcerated understates the sheer size of mass incarceration, because the denominator includes many groups that are infrequently incarcerated. For example, no toddlers, few adolescents, and not very many teenagers are incarcerated.

Rather than calculating how many people in the U.S. are incarcerated, you could calculate how many adults are incarcerated (0.88%), or how many working-age adults are incarcerated (1.07%). These statistics are rhetorically useful, but are often difficult to pair with compatible data from other countries, states or topics, so they’re not used very often.

There is another way to look at the scale and uniqueness of the U.S mass incarceration experiment: Less than 5% of the world’s population is in the United States, but 20% of the world’s incarcerated people are right here:

For more perspectives on the scale of mass incarceration, see:

• Our report Mass Incarceration: The Whole Pie, which breaks down how many people are locked up in the United States, where, and why
• Our related reports looking specifically at how women and youth are locked up and why: Women’s Mass Incarceration: The Whole Pie and Youth Confinement: The Whole Pie
• States of Incarceration: The Global Context, our report showing that all U.S. states have incarceration rates higher than most independent countries
• Our state profiles pages with data about mass incarceration in your state

As of August 2021, the newest available data on incarceration in both the U.S. and globally does not change any of the statistics or percentages referenced in this article.