Rise in jail deaths is especially troubling as jail populations become more rural and more female

New data show record high deaths of people locked up in jail, as jail populations have shifted toward smaller, rural jails and growing numbers of women. A lack of accountability and acknowledgement of women’s unique disadvantages all but ensures more deaths to come.

by Leah Wang, June 23, 2021

In so many communities nationwide, jails act as reception centers for those experiencing poverty, mental health crises, or substance use disorders. Just a few days ago, Representative Alexandria Ocasio-Cortez referred to jails as “garbage bins for human beings.” This statement tracks with new data that show that even before the COVID-19 pandemic, deaths in jail had reached record high numbers, because they continue to be unregulated, under-resourced places where disadvantaged people are sent to languish.

The Bureau of Justice Statistics (BJS) recently came out with the 2018 mortality data for local jails. Nationwide, there were 1,120 deaths reported, or a rate of 154 deaths per 100,000 people in jail, the highest levels since BJS’ first report on this topic in 2000. The jail population has grown since 2000, of course, but jail deaths have grown more. These deaths spared no demographic, and almost no state; more jurisdictions than ever reported one or more deaths in 2018.

Dying in jail often happens within days or weeks

As in past years, suicide was the single leading cause of death for people in jails, accounting for almost 30% of deaths. Someone in jail is more than three times as likely to die from suicide as someone in the general U.S. population (and still twice as likely when the population is adjusted for age, sex and race/ethnicity to match jail populations).

Suicide in jail tends to happen quickly: half of all those who died by suicide between 2000 and 2018 had been in jail for 9 days or less – compared to a median stay of 17 days for all causes of death. A short stay in jail can be extremely harmful, a fact that even our nation’s top officials acknowledge, noting that “certain features of the jail environment enhance suicidal behavior.”¹ For suicide and deaths linked to drugs or alcohol, it’s those first few days in jail that are deadliest.

Millions of people are booked into jails each year with alcohol or drug use disorders, and the number who died of reported intoxication while locked up reached record highs in 2018. Since 2000, these deaths are up 381 percent, and over the entire 18 years of data collection, the median time served before a drug or alcohol intoxication death was just 1 day. One Texas woman, for example, was jailed for unpaid traffic tickets and died after 3 days from complications of withdrawal after begging for medical care, and instead, being asked to clean up her own vomit. With 18 years of data showing that jailing people with substance use disorders for low-level offenses so often leads to death, why are we still using jails as de facto detox facilities?

More women are entering – and dying in – jail

Women made up one-sixth of all jail deaths in 2018, slightly more than their share of the total jail population. Women also had a 7% higher mortality rate than men in jails; this isn’t the first year that was true, but because women are a key driver of jail population growth, the rise in their mortality rate should send correctional leaders and policymakers running toward solutions aimed at keeping women out of confinement.²

Previous research offers solid clues as to where to begin addressing the over-incarceration and preventable deaths of women. Between 2000 and 2018, women in jail died of drug and alcohol intoxication at twice the rate of men. (In state prisons, women died this way at half the rate of men.)³ Women are also more likely than men to enter jail with drugs in their system, with a medical problem or chronic condition, or with a serious mental illness.

As we’ve reported before, arrests of women, often for low-level drug offenses like possession, have increased (while men’s arrests have decreased) over the past 35 years. In general, those arrested and put in jail more frequently (a population that is disproportionately Black, too) face other major disadvantages: they’re much more likely to lack health insurance, education, and employment, and to have serious health needs. That’s not to mention the high probability of jail separating a mother from children or the estimated 55,000+ women who enter jail while pregnant and face abysmal nutrition and prenatal care. These statistics paint a bleak picture of what it’s like to be a woman in contact with the criminal justice system, but they also form a clear wishlist of social services that could exist to meet women’s needs outside of jail.

Rural jails, a growing force, had the highest death rates in 2018

Small jails – particularly those with an average daily population of 49 or fewer people – reported the highest mortality rates again in 2018. A long-standing reality, the mortality rate in these smallest jails has actually been more than double the overall jail mortality rate in some years. By absolute numbers, these deaths make up a small portion of all jail deaths each year, but rural areas have become major players in jail incarceration.⁴

And yes, women and rural jails are growing together. Between 2004 and 2014, the number of women in jail increased 43 percent in rural counties, while declining 6 percent in urban counties. For decades, jails in non-urban jurisdictions have quietly proliferated, fueled by increases in pretrial detention. Additionally, researchers have found that women entering rural jails are significantly more likely to have co-occurring serious mental illness and substance use disorder, despite being severely under-identified by their jails as having such needs.

Jail healthcare is sketchy at best, and deadly at worst

But what does the growth of women’s jail populations across America have to do with mortality? In 2020, Reuters published an unsparing 3-part investigation of jail healthcare systems, deaths, and the increasing presence of women entering and dying there. Reporters established a devastating pipeline of women being arrested, locked up, and left to detox, give birth, or go without necessary psychiatric care in jail cells.

According to the report, on average, deaths were higher in those jails with privately contracted healthcare services, and rural jails are likely to go the private healthcare route.⁵ These companies’ profit motives shine through in haunting examples of neglect. At a Georgia jail managed by Corizon – a major private correctional healthcare company – senior leadership routinely overrode the recommendations of medical staff; patient names or prescription orders were simply removed from lists to avoid the bad optics of providing untimely care. But when counties move to end their healthcare contracts, there are few real competitors.

The idea that jails are falling short in their care sometimes fuels short-sighted arguments for expanding or building new facilities. One county in Texas was considering a new women’s facility in order to provide “gender-specific” and “trauma-informed” services to this population; fortunately, county commissioners recently postponed the vote to approve its construction at the suggestion of local activists and the county judge. These myopic projects are expensive and do not help communities – in fact, research shows that jail incarceration drives deaths within those counties.

Jails are shameful replacements for key social and medical services, and too often low-level offenses are used to justify locking people up, out of sight, when they simply need help. For women, “gender-responsive” strategies for diversion and treatment do exist, but policymakers should exercise caution in implementing those that are simply new forms of supervision; these programs will only increase the footprint of the criminal justice system. Decriminalization and the provision of gold-standard medical care, followed by a halt to jail construction, should be top of mind when addressing record mortality in jails; our mass incarceration crisis is troubling enough when people survive.

Proposed slowdown of the mail would disproportionally hit incarcerated mailers

Proposal would make an already bad situation worse by removing nearly all First-Class mail from airplanes and putting it on trucks, no matter how far it has to travel.

by Stephen Raher, June 16, 2021

On the heels of a sharp price increase, the United States Postal Service is now proposing to slow down the speed at which letters are delivered, a change that would hit incarcerated people particularly hard. As we’ve noted before, incarcerated people are uniquely dependent on sending and receiving letters through the mail, and the USPS isn’t doing a good job of serving this population. The new proposal would make an already bad situation worse by removing nearly all First-Class mail¹ from airplanes and putting it on trucks, no matter how far it has to travel.

Despite the USPS’s disingenuous claim that most mail won’t be impacted by this proposal, the opposite appears to be true. Because states in the west and northeast currently rely more heavily on air transport for mail, postal customers in those states (including those in prison or jail) will be most penalized by the current proposal.

Incarcerated postal customers deserve better. In many situations (like filing a tax return or court document), incarcerated people have no alternative to the mail. In other situations (like maintaining family connections), alternative channels such as phone and electronic messaging might be available, but they are often expensive and/or plagued with problems. The price of a stamp represents a substantial expense for the average incarcerated person, and that stamp should purchase prompt and reliable delivery.
Our detailed argument is set forth in comments that we filed with the Postal Regulatory Commission opposing the USPS proposal. If you want to make your voice heard, contact your congressional representatives today and tell them to prevent the USPS’s proposed changes to First-Class Mail service standards.

What families can expect to be charged under the new FCC rules

A new order from the Federal Communications Commission lowers existing caps on rates and fees in the prison and jail telephone industry.

by Andrea Fenster, June 10, 2021

On May 24, the Federal Communications Commission released a historic order lowering existing caps on rates and fees in the prison and jail telephone industry. The same document also signals the FCC’s intent to further lower rates in the future, and create additional rules governing this industry. The public is invited to comment on a wide range of topics.

The FCC’s newest order applies only to out-of-state calls, where the caller and called person are physically in different states, but not to in-state calls, where the caller and called person are physically in the same state. Importantly, the FCC says that companies must charge the out-of-state rate unless they know where the parties are physically located. Previously, many companies calculated rates based on area codes, which will no longer be allowed. (This means some third-party services that offer different phone numbers with a different area code to obtain better calling rates will no longer be effective).

These newly lowered caps go into effect October 26, 2021. Here is what families with incarcerated loved ones can expect to be charged:

Rate caps:

• For prisons: With one exception, out-of-state calls will not cost more than 14¢ per minute. Previously, rates were capped at either 21¢ or 25¢ depending on whether the call was collect or debit. The exception is that the FCC is allowing companies to charge higher rates if a mandatory state statute or regulation requires a commission payment to the facility, however, “in no event…can the total rate cap exceed $0.21 per minute.” (FCC Order at fn309).¹
• For jails with an average daily population of 1,000 or more: With one exception, out-of-state calls will not cost more than $0.16 per minute. Previously, rates were capped at either 21¢ or 25¢ depending on whether the call was collect or debit. The exception is that the FCC is allowing companies to charge higher rates if a mandatory state statute or regulation requires a commission payment to the facility, however, “in no event…can the total rate cap exceed $0.21 per minute.” (FCC Order at fn309).²
• For all other jails: Out-of-state calls can cost no more than 21¢ per minute. Currently, collect calls can cost up to 25¢ per minute at these jails, but when the new regulations take effect, collect calls and debit calls will both be capped at 21¢.

International rate caps:

• International calls from both prisons and jails will now be capped at the out-of-state rate that applies (above), plus the amount that the provider pays to an underlying wholesale carrier for the cost of the call. Prior to these rules, international calls were not subject to price caps. The exact caps will be hard to predict because the “underlying wholesale” cost is not widely known. But for context, calls from the United States to Mexico via one wholesaler, Twilio, cost between $0.013 and $0.045 per minute depending on the location within Mexico and whether it is to a cell phone. The prices for other countries vary and other wholesalers may have different prices, but the FCC’s intent is clearly to restrict price gouging by the providers.

Single calls:

• From both prisons and jails, single call products, like Text2Connect™ and PayNow™, will now be capped at $6.95 per call, plus the applicable per-minute rate. We have previously found that companies were charging $9.99-14.99 for a single telephone call.

Third-party financial transaction fees:

• In both prisons and jails, third-party financial transaction fees, like fees associated with Western Union and MoneyGram payments, will be capped at $6.95 per transaction. Currently, these fees can be as high as $9.99.

New data: State prisons are increasingly deadly places

New data from the Bureau of Justice Statistics shows that state prisons are seeing alarming rises in suicide, homicide, and drug and alcohol-related deaths.

by Leah Wang and Wendy Sawyer, June 8, 2021

The latest data from the Bureau of Justice Statistics (BJS) on mortality in state and federal prisons is a reminder that prisons are in fact “death-making institutions,” in the words of activist Mariame Kaba. The new data is from 2018, not 2020, thanks to ongoing delays in publication, and while it would be nice to see how COVID-19 may have impacted deaths (beyond the obvious), the report indicates that prisons are becoming increasingly dangerous – a finding that should not be ignored. The new numbers show some of the same trends we’ve seen before – that thousands die in custody, largely from a major or unnamed illness – but also reveal that an increasing share of deaths are from discrete unnatural causes, like suicide, homicide, and drug and alcohol intoxication.

State prisons, intended for people sentenced to at least one year, are supposed to be set up for long-term custody, with ongoing programming, treatment and education. According to one formerly incarcerated person, “if you have the choice between jail and prison, prison is usually a much better place to be.”

Deaths in jail receive considerable attention in popular news, and here on our website – which they should, given the deplorable conditions that lead to tragedy among primarily unconvicted people. State prisons, on the other hand, are regarded as more stable places, where life is slightly more predictable for already-sentenced people. Why, then, are suicides up 22 percent from the previous mortality report, just two years prior? Why are deaths by drug and alcohol intoxication up a staggering 139 percent from the previous mortality report, just two years prior?

The answer isn’t just because there are more incarcerated people. The very slight net change in the state prison population since 2001 pales in comparison to the increase in overall deaths occurring in these facilities. (Prison populations have actually decreased since peaking in 2009, but they’re still larger in 2018 compared to 2001.) Prisons have been, and continue to be, dangerous places, exposing incarcerated people to unbearable physical and mental conditions. State prison systems must greatly improve medical and mental healthcare, address the relationship between correctional officers and the health of their populations, and work with parole boards to accelerate release processes. Then, maybe, a state prison sentence would not become a death sentence for so many.

Record-setting deaths in almost all categories

In 2018, state prisons reported 4,135 deaths (not including the 25 people executed in state prisons); this is the highest number on record since BJS began collecting mortality data in 2001. Between 2016 and 2018, the prison mortality rate jumped from 303 to a record 344 per 100,000 people, a shameful superlative. It may seem like a foregone conclusion that more people, serving decades or lifetimes, will die in prison. But for at least 935 people, a sentence for a nonviolent property, drug, or public order offense became a death sentence in 2018.¹

BJS slices mortality data in many ways, one of which is “natural” versus “unnatural” death; “natural” deaths are those attributed to illness, while “unnatural” deaths are those caused by suicide, homicide, accident, and drug or alcohol intoxication. Any death pending investigation or otherwise missing a distinct cause gets filed away as “other,” or “missing/unknown.” Other than accident deaths, every cause of death had its worst year yet in 2018.

Taking BJS’ definitions of “natural” and “unnatural” deaths at face value², the data shows that, like in past years, most (77%) of all prison deaths in 2018 were “natural.” However, “unnatural” or preventable deaths make up an increasing share of overall mortality: In 2018, more than 1 in 6 state prison deaths (17%) were “unnatural,” compared to less than 1 in 10 (9%) in 2001.³ Clearly, prisons are doing poorly at keeping people in their care safe. We must remember that being locked up is the punishment itself; inhumane conditions are not supposed to be part of a prison sentence.

Suicide rates in prison are higher than ever

Incarceration is not only difficult for someone who comes in with mental health needs, but it creates and exacerbates disconnection, despair, and overall psychological distress. Prison is basically a mental health crisis in and of itself, and too many incarcerated people contemplate and/or complete suicide.

In 2018, state prisons saw the highest number of suicides (340) since BJS began collecting this data 20 years ago. Compared to the 1% net growth of state prison populations since 2001, suicides have increased by a shocking 85 percent. Suicide is an affliction for the general U.S. population, but the mortality rate from suicide in state prisons has always been higher.

The BJS data does not allow us to compare death rates by sentence length, but it’s hard to ignore the possibility that longer sentences are contributing to a sense of hopelessness and forcing incarcerated people into harmful situations. Other data collected by BJS shows that between 2001 and 2015, the number of people admitted annually to state prison with a sentence of 5 years or longer grew by nearly 12,000 people, accounting for almost all of the growth in new prison admissions over that time period.⁴

At the end of 2015, 1 in 6 people in state prisons had already served over 10 years. To add insult to injury, between 2016 and 2018, the average state prison sentence grew by about four months.

Not only does a longer incarceration increase the sheer probability of having a mental health crisis inside, but it also creates the conditions for this to happen. With longer periods of separation from loved ones, and a rapidly changing outside world, people serving long sentences are isolated and deprived of purpose.

When someone in prison is clearly in crisis, correctional officers are supposed to act swiftly to prevent suicide and self-harm. Not only do officers routinely fail to recognize mental health warning signs, but they’ve been found allowing and even encouraging self-harm, a disturbing reality. And on an institutional level, prison systems avoid making the necessary changes to protect people in dangerous conditions: In response to a Department of Justice investigation finding that the Massachusetts Department of Correction “exposes [people experiencing a mental health crisis] to conditions that harm them,” the DOC is piloting Fitbit-like bracelets for its population to track changes in vital signs related to mental health distress. Instead of rolling back harsh solitary confinement practices and improving how correctional officers respond to crises, the DOC is increasing surveillance and allowing another private company to profit off of prisons.

Who is committing homicide in prison?

The number of homicides in state prisons reached a record high of 120 deaths in 2018, a reminder that while prisons are secure, they are largely unsafe. Violence in prison is commonplace, tied to trauma prior to incarceration as well as mental health stressors inside. The rate of homicide in state prison is 2.5 times greater than in the U.S. population when adjusted for age, sex, and race/ethnicity.

The age of those who died in prison seems most relevant when talking about illness, but older people were actually more at risk of homicide and all other causes of death, except for accidents. By absolute numbers, more homicide deaths affected people in their 20s, 30s and 40s, but the homicide rate was highest for incarcerated people aged 55 and older. They were twice as likely to die by homicide as anyone aged 25 to 44.

What about who is actually behind the deaths that are ruled homicides? The BJS data does not separate homicide committed by incarcerated people from death “incidental to the use of force by staff,” or even “resulting from injuries sustained prior to incarceration.” While correctional officials might go right to “prison gangs” or otherwise blame incarcerated people for these deaths, it’s a bit more complicated than that. In this terrible instance, a correctional officer heeded a request to close a cell door remotely, allowing someone to fatally wound a 72-year-old man in total privacy. The nuance of who is responsible for prison homicides points to huge gaps in security and staffing, but also a clear indifference to people’s lives and unaddressed anger and trauma.

How can drug and alcohol intoxication deaths be so high, when prison security is so strict?

As we look back to the beginning of mortality data collection in 2001, no manner of death has spiked more than drug overdoses and alcohol intoxications. (Unfortunately, the BJS data does not distinguish between the two.)

With such coarse data, it’s difficult to pinpoint an explanation for this trend with certainty. However, no conversation about illicit substances inside prisons would be complete without mention of contraband, particularly drugs brought in by correctional staff.

In the name of preventing contraband from entering prisons, many state prison systems have cracked down on incoming mail and visitation, two major lifelines for incarcerated people. However, there’s evidence to suggest that the majority of drugs, as well as sought-after items like cell phones and cigarettes, are brought in directly by prison staff. In 2018, we conducted a survey of local news coverage that revealed a dozen instances in that year alone where staff were fired, arrested, or sentenced with smuggling drugs and other items into correctional facilities.

A recent Twitter poll doubles down on the premise that prison security staff are the major players in contraband movement. Initiated by Worth Rises director Bianca Tylek, the poll and resulting thread brought formerly incarcerated voices into what could be the most revealing look to date at how correctional officers in particular are wound up in contraband dealings.

With so many people in state prisons lacking proper treatment for substance use disorders, it’s no wonder corrections staff will use their access to the outside and charge exorbitantly for drugs like Suboxone or potent synthetic cannabinoids. Instead of improving the quality of healthcare and treatment for drug addiction, prisons are imposing costly restrictions on mail and visitation and incentivizing their own staff to carry out illegal activity.

Mortality data for 2020 won’t be released for another two years or so, but we don’t have to wait to see whether drug contraband was drastically reduced when state prisons banned in-person visitation due to the pandemic: it wasn’t. In Virginia, for example, the Department of Corrections found that drugs did not become more scarce; positive drug tests actually increased after pandemic restrictions went into effect. Texas prisons also saw an uptick in drug contraband and related disciplinary reports in 2020, even as prison populations declined and visits were limited or cut off entirely.

Can we relate the thriving drug market in prisons to increasing drug-related deaths? Not directly. Clearly, though, the people working in prisons, who already turn a blind eye to violence and suffering, are responsible for introducing some of the dangerous substances that killed 249 people in 2018.

Illness is still the most common cause of death, but how natural is illness in prison?

Even though most prison deaths each year are attributed to illness, and are therefore “natural,” being sick or old in prison is not quite what it is on the outside. Incarceration can add 10 or 15 years to someone’s physiology, and take two years off of their life expectancy per year served, alarming statistics when considered alongside longer sentences and high costs of healthcare for older people.

The systemic neglect of illness and aging in prison populations isn’t natural at all. Every summer, we hear about prisons in hot climates that lack air conditioning, exposing incarcerated people to consistent temperatures of over 100 degrees. We’ve previously reported on these extreme heat conditions that exacerbate chronic diseases, counteract medications, and increase the risk of dehydration and heat stroke among even the healthiest people. In Texas, for example, when summer incarceration is described as unconstitutional, deadly, and a practice in reckless indifference, how natural are some deaths due to “illness”?

Again, consider the mortality data that will eventually come out for 2020, when prisons and jails played host to the COVID-19 pandemic and over 2,600 incarcerated people (and over 200 staff) died as a result. We know how badly every state handled this situation; it will be important not to brush these deaths aside as simply succumbing to illness – nor the deaths caused by other illnesses that went untreated in understaffed, overwhelmed prison health systems. These thousands of people were failed by state criminal justice systems, and deserved care and precaution while in custody.

State criminal justice systems can improve prison healthcare and loosen their grip on parole processes

We are supposed to trust prison systems to keep people alive and safe, so they can serve their sentences and be released back to their communities. The significant increase in overall “unnatural” deaths, like suicide, homicide, and drug intoxication tells us that state prisons are failing to provide humane conditions for incarcerated people, and it’s killing them. There are many ways that state prisons and related agencies can reduce the risk of death.

• A surefire way to reduce risk is to reduce prison populations, and parole boards are a natural bottleneck to this end. Parole hearings and approval rates must increase in order to move large numbers of incarcerated people back into their communities, despite many states failing to do this in 2020 when it was clearly a matter of life and death. Compassionate release should be ramped up, and no one should be ordered to return to prison after recovering from illness. Burdensome in-person check-ins should also be eliminated to reduce the incidence of low-level technical violations of parole and probation.
• States can also consider major sentencing policy changes to address the scourge of long prison sentences that only worsen physical health, mental health, and preparation for reentry. Dozens of state legislatures are considering “second-look” policies to review cases for those currently serving excessive, costly sentences.
• As one of the most basic services guaranteed to people in custody, healthcare must be improved. And if it feels like prison healthcare spending is already outrageous, releasing people – especially older, sicker people – would certainly mitigate those costs. Medical care aside, correctional officers must respond swiftly to sick calls and emergencies.
• Providing high-quality treatment for substance use disorders would prevent incarcerated people from turning to desperate and dangerous solutions. State correctional agencies must acknowledge the scale of drug smuggling facilitated by correctional staff. Instead of banning in-person visitation and meaningful resources like books, prison staff should be subject to stricter security measures and enduring consequences.
• Improving prison conditions can also prevent many “natural” deaths in prison; for example, there should be universal standards for indoor temperatures where extreme heat can be deadly. In a decently climate-controlled space, medications will work as intended, and people can remain focused on education, employment, and connection with loved ones, and deadly viruses might not spread so easily. And as we have learned through the pandemic, improving ventilation, access to healthcare, coordination with public health departments, and reducing population density by releasing more people from prison can prevent countless deaths when infectious diseases enter prisons.

Under pressure, change does happen, and we have been tracking state-level changes due to the COVID-19 pandemic. Some changes were only temporary or did not go far enough to slow the spread of the deadly virus. Had states taken these actions years ago to reduce other dangers in prisons, we might not have seen record mortality in 2018 – or for that matter, in 2020.