To be or not to be, that is the question:
Suicide Non-Prevention in American Jails
When I was a mental health therapist for the Commonwealth of Virginia, I joined the Emergency Services weekend team. For 24 hours, we were the psychological equivalent of Lone Rangers – with an administrative back-up – for five counties in central Virginia, balancing family crisis calls with medication questions and refill requests, people seeking therapy appointments, and suicidal and homicidal ideation evaluations. Fighting sleep deprivation but fueled by the adrenalin of being needed and the importance of the tasks at hand, our team earned extra income when we were called out and honed our clinical skills. For those afterhours’ assessments, we were asked by emergency room physicians, sheriffs’ departments and jail personnel to come ASAP to their facilities. My personal approach was to interview whatever relatives were available first in order to gain a family perspective before meeting with the individual in need. By doing this, I could gently confront the individual if he or she was not being honest about what was going on. The on-call therapist had the ultimate decision about whether to release the troubled person back to their family, with the information needed to set up a follow-up counseling appointment. Or, to obtain a Temporary Detention Order (TDO) to have the individual psychiatrically hospitalized to prevent them from harming themselves or others.
If the person being assessed was already the inmate of a city, county or regional jail, he or she could, if needed, be sent to a state mental hospital forensic unit for further evaluation and treatment. The member of the emergency mental health team had positive working relationships with hospital staff, sheriff’s department and jail staff members. They did not hesitate to call if there was a mental health crisis emergency to respond to that was beyond their training and expertise. A mutual respect and trust between local authorities and the mental health team was formed. We clearly needed each other. We served the public in our complementary roles to the best of our abilities. Unfortunately, this type of mutuality and reliance upon each other’s training and skills does not often occur in fact, there have been many cases when jail and prison personnel did not take advantage of the need for an availability of mental health therapists – with disastrous consequences, and lawsuits that followed.
It can safely be said that there are many employees in the American penal system – in both jails and prisons – who should not have anything to do with the mentally ill. Their insensitivity and callousness toward the increasing population of incarcerated mentally ill jail, state and federal prisoners are dangerous qualities that lead to completely preventable suicides. Two tragic, unnecessary deaths of prisoners in jail were highlighted in the December 2017 edition of Prison Legal News (PLN). In the article entitled, “Missouri Town Pays $1.2 Million to Settle Lawsuit Over Jail Suicide,” Lonnie Burton described the circumstances that led to the City of Pagedale, Missouri being ordered to pay the family of a young woman over $1 million. Even though there was a confidentiality agreement, PLN was able to obtain the court documents. They told the story of 21 year-old Kimberlee Randall-King, a mother of two who was jailed on September 19, 2014 for “outstanding traffic warrants.” Jail personnel informed Ms. Randall-King that she was unable to be released on bond because she had outstanding tickets from other jurisdictions. This unexpected order caused Randall-King to go into an immediate mental health downward spiral.
Kimberlee Randall-King became highly agitated and hysterical, yelling that she was afraid of losing her job, home and children if she was not released. She openly revealed that she would “die” if the jail would not let her leave. The jail staff completely dismissed her desperate cries for help. Instead of reaching out to the on-call mental health therapist, two jail guards used force to lock her in a cell with an empty top bunk bed. Within 90 minutes, Kimberlee Randall-King was dead. She used her shirt to make a noose and tied it around a hole in the upper bunk, which had been utilized for that lethal purpose in the past. Gladys King, Kimberlee’s mother, filed a successful wrongful death lawsuit on behalf of herself and her daughter’s two young children. This happened despite jail staff having been notified about the dangers of pretrial detention. Because obvious warning signs in big letters were totally ignored two children had to grow up without their mother.
The second case involved a U.S. Army veteran, Elliot Earl Williams, age 37, in Owasso, Oklahoma. Williams was arrested by Owasso police in October 2011 for disturbing the peace at a local hotel. The arresting officer reported that it was “readily apparent that [the subject] was having a mental breakdown.” Williams openly admitted to being suicidal and asked officers “What do I have to do to get you to shoot me?” It is a shame that officers did not call for an immediate emergency mental health assessment. Instead, Elliot Williams was placed in a holding cell with no suicide watch. Within a brief time, the jail video showed that Williams was behaving strangely. The video revealed that he suffered a seizure after ramming his head several times against the cell walls and into the cell door. The seizure caused him to bang his head hard against the concrete floor. Elliot Williams was in critical need of medical attention. Although Williams told the nurse at the Tulsa County jail that he was suicidal and had already rammed his head several times in an attempt to kill himself, she did not arrange for either a medical or mental health evaluation. The mental and physical condition of Elliot Williams deteriorated rapidly. He lost bowel control. Jail staff wheeled him into “the tank” – a cell for agitated, difficult to control prisoners. Then they dumped him off a gurney into a shower and left him alone for two hours. During his horrendous treatment, the jail guards mocked and taunted Williams, even telling him he was “faking” his symptoms. Their callousness and uncaring treatment was extraordinary.
After being transferred to a “suicide cell” with video monitoring, Elliot Earl Williams begged for help, telling staff he could not move. He collapsed two days later, dying from a broken neck while attempting to crawl toward food and water. As in the case involving Kimberlee Randall-King, Elliot Williams clearly informed the jail staff that he was a danger to himself. The degree of unwillingness to assist a fellow human being in clear distress led to yet another preventable death in an American jail. Worst of all, the attending nurse would not even kneel on the floor to correctly provide CPR to the dying victim. She ineffectively chose to apply CPR while standing next to Williams. As a result, three attorneys filed a federal civil rights lawsuit on behalf of Williams’ estate. They claimed that “inadequate mental health policies, understaffing in the medical department, inadequate and untimely medical treatment, inadequate screening, limitations on off-site treatment and inadequate training had violated Williams’ Eighth Amendment rights” and led to his unnecessary death. The jury found in the plaintiff’s favor awarding $10 million from Tulsa County and Correctional Healthcare Management, and $250,000 from Tulsa County Sheriff Stanley Glantz for punitive damages.
In each of these cases, highly trained, experienced and state licensed therapists could have taken over and assessed the young woman for active suicidality and the middle-aged veteran for suicidality and severe mental illness that caused him to be “substantially unable to care for himself.” Psychiatric hospitalization could have been arranged. The jails demonstrated that they believed the urgent need of these suffering people were unimportant, ignored their desperate cries for assistance, and ultimately caused their tragic deaths. Even though sad cases like these should serve as warnings to be learned from, the ongoing, deadly combination of insufficient training and callous, uncaring attitudes will continue to lead to these kinds of preventable personal and family disasters in the lamentable American penal system.