While serving as Coroner of Richland County, South Carolina, I responded to a death scene at the old Central Correctional Institution, known as CCI, on the banks of the Congaree River in downtown Columbia. An inmate had apparently killed himself. I was escorted to a solitary confinement cell. When I entered the cell, I saw the body of a man in his thirties totally nude, lying on the floor. The room was bare of any movable articles. There was a video camera mounted near the ceiling in a corner of the room. Anyone with access to a monitor for that camera would be able to see every inch of that room as well as the naked inmate.
I asked the prison warden for both recent and historical details concerning the deceased inmate. He told me that the inmate was serving two consecutive life sentences for murders and was on suicide watch. There were no clothes, mattress, sheets or blankets in the room. The inmate convinced a guard to give a towel to him. He then used the towel as a ligature around his neck and tied it to the door handle which was made of a piece of steel bent at a 90-degree angle. He twisted around and around until he strangled and asphyxiated. For the first time, I was able to empathize with a suicide victim. He had no hope, nothing to live for, only misery and boredom. He had no privacy at all, being watched like an animal at a zoo. Stripped of clothing, nothing to read, no one to talk with, no radio or television, no blanket to cover himself, no pillow to put under his head. Was this cruel and unusual punishment, inflicted under the pretense of “suicide prevention?”
Upon realizing such undignified, humiliating and demeaning methods were being used, I was shocked and appalled. Many years later, as a college student, at The Citadel, studying the corrections system, I set out to research just how such an inhumane method of suicide prevention ever became acceptable by our corrections department. How can suicide prevention be implemented in a humane manner?
Over the past 25 years, as the rate of incarceration has steadily increased, there has been a drastic deinstitutionalization of people with both mental illness and substance abuse problems. “As a result, the rates of suicide are on the rise in local jails and remain steady in state prisons. Death by suicide as a percentage of total deaths, however, is generally on the rise in both prisons and jails, since the death rate has otherwise been in decline. Suicide is the second leading cause of death in jail and the third leading cause of death in prison.” (DeGroote’, 2014, p. 260)
Rights that we have under some of the constitutional amendments no longer apply to a person who has been convicted of a crime and sentenced to serve in a jail or prison. This also applies to those who are under arrest and being held as suspects of committing crimes. Other rights protected by the constitutional amendments have been determined by the United States Supreme Court to apply to persons in judicial custody. All persons have the right to due process of law, “whenever they are threatened with the loss of life, liberty, or property at the hands of the state.” (Stohr and Walsh, 2019, p.308) Prisoners have the rights granted by the Habeas Corpus Act which became English Common Law in 1679. Prisoners have no rights to privacy in their cells because their rights are “secondary to maintenance of institutional order and security and the safety of other inmates and staff.” (p.318)
The Supreme Court does not consider a cell to be the rightful home of an incarcerated person and therefore the cell does not afford them a place deserving privacy. For the same reasons just stated, there are limitations on many of the other rights granted in the constitutional amendments. To whatever extent these rights can be granted to inmates without jeopardizing security and safety they are allowed. Some of these rights are to “practice their religion and have visitation with their family and friends.” (p.313)
“The one area in which Fourth Amendment rights have not been completely extinguished for inmates is that involving opposite-sex body searches. The courts have needed to wrestle with conflicting claims on this issue. One is the equal employment claim of female corrections officers who want to work in male institutions where, because of their size and scope, promotion prospects are greater than they are in female prisons. Working in all-male prisons necessarily means that women officers occasionally view inmates undressed or using toilet facilities, and sometimes they may be required to perform pat downs and visual body cavity searches (physical searches of body cavities may be performed only by medical personnel). A frequent inmate claim is that cross-gender searches are ‘unreasonable’ within the means of the Fourth Amendment.” (p.314)
Even though courts have denied inmates rights to privacy in their cells, I believe they should not be denied all privacy. The possessions that they have certainly have to be available to be searched and identified as harmless. I argue that inmates should have the opportunity to protect their modesty such as when dressing, undressing, using the toilet, or urinal and while showering. This is especially true now that females are guards in men’s prisons. As an advocate for gender equality, I do not condone justifying less privacy for one gender than is granted to the other. Strip searches should only be conducted in the presence of two same gender (as the inmate) guards. Otherwise privacy and body cavity examinations should only be conducted by medical personnel under normal guidelines for physical examinations. I am adamantly opposed to forced nudity under surveillance like the suicide victim I described earlier.
“According to the balancing test, then, the viewing of opposite sex inmates is constitutionally valid ‘if it is reasonably related to legitimate penal interests.’ Bennett (1995) told us how lower courts have interpreted “reasonableness” and concluded that while female officers conducting or observing strip searches of male inmates is tolerated in emergency situations, similar observations and searches by male officers of female inmates are considered unreasonable.” (p. 316)
This is discriminatory and a double standard.
“From an ethical perspective, the invasion of privacy should be minimized to the greatest extent possible without compromising other important values and rights to safety and security. In defending this position, I argue that respect for inmates’ privacy should be part of the objective of creating and upholding a secure environment to better effect in the long run.” (Bulow, 2014)
During the summer of 2018, I had the opportunity to shadow the warden at Kirkland Correctional Institute that houses around 1,750 prisoners, including prisoners on Death Row and those in maximum security (solitary confinement) which includes those on suicide watch. I observed that instead of taking their clothes to prevent use of clothing to make a ligature, the suicidal prisoners were wearing a “Safety Smock,” which is virtually indestructible.
All penal institutions fear lawsuits from the relatives of inmates who commit suicide. They are compelled to use any means, no matter how extreme, to prevent the prisoner from extinguishing their own life. “The risk of suit from inmate suicide and the cost of defending against such suits, needless to mention the potential cost of an unfavorable judgment, have led officials to take extraordinary measures in physically restraining inmates.” (DeGroote’, 2014, p.262) There have been prisons known for shackling inmates by their wrists and ankles for many hours, unable to move. This is “cruel and unusual” treatment. “These measures are too often aimed not at providing mental health services, but rather at preventing the attempt from succeeding.” (DeGroote’, p.261)
“Notably missing from the literature on effective and productive suicide prevention measures is the use of restraints. Juries have held prison officials liable even when they took all reasonable precautions, thus encouraging officials to take extreme measures such as full restraints. Mr. Wells a prisoner in an Illinois correctional center, thought to be suicidal, exemplifies the concerns inherent in the restraint practices. Mr. Wells was placed in a four-point shackle wherein each limb was shackled to one corner of the bed. Mr. Wells remained shackled to the bed for nine days. The shackles were not gentle; there were abrasions and bruises resulting from restricted blood flow. Mr. Wells had limited access to water, limited access to a urinal pitcher that required help of the guards and was rarely emptied, was itchy, ill, covered in a rash, and was not permitted to shower for the entire nine-day period. The District Court dismissed Mr. Wells’ claims on a motion for summary judgment, deciding that there was no genuine dispute as to any material fact and that the officials were entitled to a judgment as a matter of law without ever reaching a jury. The disturbing aspects of Mr. Wells’ confinement demonstrates how the use of restraints may disturb common notions of decency. The Seventh Circuit recognized the potentially ‘unconscionable conditions of restraints’ before reversing and remanding to the lower court.” (DeGroote’, p. 275-276)
The last thing that a suicidal prisoner needs is for their life to be made more unpleasant. By far the largest percentage of suicides in penal institutions nationwide occur in local and county jails. Many of those suicides happen within hours of admission or within the first few days after the accused has been imprisoned and even before they have been tried and convicted of a crime. Suicides in jails often happen without the facility management realizing the prisoner is in a state of mind that is self-destructive.
Lindsey M. Hayes, a well-known sociologist and an expert on suicide in jails and prisons says that the two primary causes for jail suicide are “1) jail environments are conducive to suicidal behavior, and 2) the inmate is facing a crisis situation.” (Hayes, 2014) Hayes says, “fear of the unknown, distrust of authoritarian environment, lack of apparent control over one’s future, isolation from family and significant others, shame of incarceration, and the dehumanizing aspects of incarceration as well as drug or alcohol addiction and mental illness,” (Hayes, 2010) often contribute to the ideations leading to suicidal thoughts and behaviors. Richard E. Werner, sociologist, criminologist and author of The Environmental Psychology of Prisons and Jails: Creating Humane Spaces in Secure Settings, finds that there are many contributing factors leading to suicide in jails and prisons. Some of those contributing factors are isolation, noise, crowding, lack of privacy, lack of natural lighting and color and the separation from nature and its natural beauty as well as the factors mentioned above. (Wener, 2014)
When it is suspected that a person in custody of a jail or prison is suicidal, it seems reasonable to promptly have that prisoner evaluated by a psychiatrist or a psychologist. Medication and / or counseling may be beneficial in reducing anxiety or depression. When there are reasons to believe that a prisoner has suicidal ideations, “the scientifically supported policies to ensure proper care and prevention include, 1) suicide assessment, observation, and intervention, 2) psychotropic medication use, 3) involuntary/forced medication and involuntary medical treatment, and 4) inpatient hospitalization for mental illness.” (DeGroote’, p. 273) Treating suicidal prisoners for their mental illness should certainly outweigh the fear that prison officials have of being sued by the inmate’s family when they are unable to prevent suicide by humane methods.
“The cost of defending against suits asserting a failure to take adequate precautions to prevent inmate suicide and the likelihood and magnitude of liability have led prison officials to ignore the science and instead employ archaic precautions. Although liability for the inhumane conditions of confinement and a failure to provide medical care for serious mental conditions theoretically should be able to provide a backstop to such measures, they are not doing so successfully, at this point in time. In order to see the proper balance being achieved, we need an even playing field. The state of our current law suggest that inmate suicides should be prevented at any cost. In addition to the perverse incentives this creates in the treatment of suicidal prisoners it also has implications on one’s right to the control of one’s own body. While the Supreme Court has been reluctant to establish a broad sweeping “right to die,” there is no legal prohibition on suicide. In fact, we as a society, sentence convicted felons in our prisons to death and force their lives to be taken. In light of this, it seems contradictory to so rigorously prohibit determined prisoners from taking the identical action themselves. I make no suggestion that suicide ought to be permitted in our prison system. I raise the aforementioned arguments in an attempt to suggest that even though tort balancing will likely see instances of suicide that would otherwise be prevented through extreme isolation and restraint, it is still preferable to the inhumane suicide prevention measures currently in effect.” (DeGroote’, p.281)
Although most people who find themselves incarcerated are there as a result of their own deviant behavior, they are still human beings who, in most cases, have the potential of being rehabilitated. Losing one’s freedom and control of one’s life is itself a depressing situation. The surroundings in which they are placed, in most jails and prisons, contributes feelings of dire circumstances. It requires significant expenditures to improve the environmental conditions for inmates, thereby suppressing the adverse conditions that inspire feelings of hopelessness, which often lead to suicidal ideations. Reducing overcrowding, noise, boredom, and isolation from the beauty of natural surroundings, as well as providing opportunities for entertainment, improved visitation conditions, and the creation of a sense of security are admirable goals for penal institutions.
Winston Churchill supposedly said, “A civilization can be judged by the way it treats its prisoners.” Because of the crimes that criminals have committed, “Many members of the public see prisoners getting better treatment than they deserve.” (Stohr and Walsh, p.,308) Prisoners have access to medical care and treatment (at no cost to them) that is not available to many law-abiding citizens. “The medical needs of inmates in today’s prisons are as well addressed as those of the average free person of roughly similar class background presenting with similar health problems. Indeed, inmates are the only group of people in the United States with a constitutional right to medical care.” (p.317) Sending a criminal to prison serves the public by removing the threat and danger of having that person free to prey on society.
Prison can also serve as a means of retribution and/or rehabilitation. Retribution may be best accomplished by making prison unpleasant, a place that no one would prefer to freedom in society. Rehabilitation for criminals who have the potential to leave prison as a better person than when they entered prison should be the goal of our corrections system. If rehabilitation of prisoners is the ultimate objective of the institution, the inmates who are possibly candidates for character development and improved self-image must begin to view themselves in a positive way. This would be difficult to accomplish if the inmate is treated in a disrespectful manner. At Kirkland Correctional Institution, I observed Warden Davis, who obviously has the respect of both staff and inmates, reciprocate respect for each inmate who got his attention.
“The courts have moved through three general periods with respect to inmates’ rights: the hands-off period, a short period of extending many rights to prisoners, and the current retreat to a limited hands-off policy.” (p.322) During the period when the courts were the most lenient, the federal courts established prisoners’ rights as pertains to the First, Fourth, Eighth, and Fourteenth Amendments to our Constitution. As a result of these court decisions that favored prisoners, the courts were flooded with prisoners’ lawsuits against the correctional institutions. This period followed by the US Congress passing the Prison Litigation Reform Act (PLRA) in 1996. The PLRA limited prisoners’ access to the courts. Also, in 1996 Congress passed the Anti-Terrorism and Effective Death Penalty Act (AEDPA).
“The pervasiveness of mental illness and the rates of suicide in our prison system are staggering. But, the treatment of these mentally ill and suicidal prisoners is even more alarming. Physically restraining prisoners in painful positions for extended periods of time is effective in physically preventing suicide and therefore Eighth Amendment suicide liability. The Eighth Amendment, however, also prohibits cruel and unusual punishment. As a result, there must be a balance between the duty prison officials have to protect inmates from committing suicide and the extent to which officials can employ any method possible to prevent potential suicides.” (DeGroote’, p.284)
Centers for Disease Control and Prevention (CDC) provide the following suicide risk factors that should be determined upon admission to a jail or prison.
“A combination of individual, relationship, community, and societal factors contribute to the risk of suicide. Risk factors are those characteristics associated with suicide—they might not be direct causes.” (CDC, 2018)
• Family history of suicide
• Family history of child maltreatment
• Previous suicide attempt(s)
• History of mental disorders, particularly clinical depression
• History of alcohol and substance abuse
• Feelings of hopelessness
• Impulsive or aggressive tendencies
• Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
• Local epidemics of suicide
• Isolation, a feeling of being cut off from other people
• Barriers to accessing mental health treatment
• Loss (relational, social, work, or financial)
• Physical illness
• Easy access to lethal methods
• Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts (CDC, 2018)
Centers for Disease Control and Prevention (CDC) provide the following suicide protective factors. “Protective factors buffer individuals from suicidal thoughts and behavior. To date, protective factors have not been studied as extensively or rigorously as risk factors. Identifying and understanding protective factors are, however, equally as important as researching risk factors.” (CDC, 2018)
• Effective clinical care for mental, physical, and substance abuse disorders
• Easy access to a variety of clinical interventions and support for help seeking
• Family and community support (connectedness)
• Support from ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
• Cultural and religious beliefs that discourage suicide and support instincts for self-preservation (CDC, (2018)
Upon admission to a jail or a prison physical and mental health evaluation should be made by a staff member who is properly trained for this purpose. If there is any reason to suspect suicidal ideations proper precautions should be taken. The above protective factors should be applied when appropriate
Solitary confinement also known as administrative segregation is a method of punishment and is also used for isolation for various reasons. The adverse effects of isolation are both physiological and psychological. Professor Michael Jackson, of the University of British Columbia, Peter A. Allard School of Law in Vancouver, British Columbia has devoted 40 years to studying the effects of incarceration and has interviewed thousands of prisoners. “It has been convincingly documented on numerous occasions that solitary confinement may cause serious psychological and sometimes physiological ill effects. Research suggests that between one third and as many as 90 per cent of prisoners experience adverse symptoms in solitary confinement. A long list of symptoms ranging from insomnia and confusion to hallucinations and psychosis have been documented. Negative health effects can occur after only a few days in solitary confinement, and the health risks rise with each additional day spent in such conditions.” (Jackson, 2015)
Professor Jackson said, “Earlier in my report I described the questionnaire that the Task Force on Segregation sent to every segregated prisoner regarding the conditions of their confinement. The questionnaire had space for comments. At the time Glen Rosenthal responded to the questionnaire, he had served a year in segregation at Edmonton Maximum Security institution after being attacked by another prisoner. In addition to checking off the list of questions, he offered these reflections: ‘In the course of completing this survey I have found it extremely difficult to convey the reality of living in this segregation unit for nearly a year. I have spent fifteen years in many different prisons and have found myself in the segregation units of most of them at one time or another. Never have I experienced anything remotely comparable to what I am experiencing now. It is one thing to be locked in a cell for a year, and that of itself is bad enough. Add to that the fact that you have no idea how long it will continue... And add to that the fact that your health has deteriorated to the point where you doubt you will ever be healthy again ... You can’t sleep more than three or at best four hours at a time. You are constantly getting awoken by music blasting, barriers clanging open and shut. You are always tired. You have gone from a hundred and fifty pounds to a hundred and ninety pounds and every muscle in your body is either knotted or atrophied. The warden told you he would transfer you to B.C., so your wife moved there six months ago, and you have watched your marriage fall apart one piece at a time since then. You have been wearing stinking rags for so long you don’t notice it anymore. You look older, fatter, disgusting to yourself when you look in the mirror. Your self-esteem is sub-zero... You want to complain about the rags you get for clothes, but you know the cleaners will spit in your food or urinate in your coffee if you do. You want to complain about the guard who miscounted your phone calls for the month, only giving you one or two, but you know next month you won’t get any if you do. You want to complain about not being transferred but you know that this will piss somebody off and you will never get out. You can’t bear the thought of people you love seeing you in this condition, so you don’t take any visits. Your life is so static there is nothing, absolutely nothing left to write to anyone about. Your once passionate and hopeful phone conversations with your wife turn into a string of uncomfortable silences and misdirected frustrations. But she is the only one who will listen, and then one day there is no one. You spend twenty hours a day on your back, somewhere between waking and sleeping, trying to keep your mind out of the dark places but you can’t. Your mind seems full of thoughts that don’t belong there. You can’t carry a conversation anymore because you are afraid one of them will slip out. You don’t tell anyone because you are even more afraid of the medication, they might think you need. I don’t use words like “afraid” easily. I have always identified myself with being up to whatever challenge came my way, and so far, I have. I have never faced a challenge that threatens who and what I am more than this last year in this segregation unit.’ It is no exaggeration to call this cruel and unusual punishment. Though the circumstances here are likely more the product of indifference than malice, it is no less insidious and destructive. My health is gone, my life has fallen apart, parts of me that words can’t describe will not recover from this. And I did nothing wrong. All this is happening to me because the machine isn’t working, and no one seems obliged to fix it.” (Jackson 2015)
The physical and psychological effects that solitary confinement have had on Mr. Rosenthal could certainly lead anyone to have suicidal ideations. In some cases, described by Professor Jackson inmates have become psychotic as a result of solitary confinement. In his writings, Professor Jackson talks about human rights: right to due process, the right to counsel, the guarantee against unreasonable search, and that punishment does not approach cruel and unusual because it is excessive or inhumanely harsh. He talks about prisoners’ rights to practice their religion, unnecessary censorship, the right to vote, and the right to adequate healthcare. (Jackson, 2015) Every person in judicial custody has the right to humane treatment, regardless of the crimes they have committed or their behavior while incarcerated. Any circumstance an inmate is forced to endure that resembles torture is a violation of that inmates’ civil rights.
“Recent research suggests that suicidal inmates are often reluctant to discuss their suicidal thoughts because of the likelihood of being exposed to the harsh conditions of suicide precautions, with the vast majority (75%) of inmates reporting that they did not want to be transferred to an observation cell.” (Hayes, 2018) Lindsay M Hayes is with the National Center on Institutions and Alternatives and a nationally recognized expert in suicide prevention in correctional facilities.
Stories about inmates being stripped naked under observation in solitary confinement cells and being shackled by their wrists and ankles is justly regarded as torture. Because of the widespread knowledge of such atrocious treatment of suicidal inmates, many inmates avoid alerting the jail or prison staff to their suicidal ideations. Because of their fear many potential suicide victims remain undetected until it is too late.
Historically prison officials have resorted to the only methods of preventing suicide known to them. Since the primary and usually only means of suicide available to prisoners is strangulation by ligature, it seems prudent to corrections officials to remove all articles such as towels, sheets, and clothes that can be used to make a ligature. Some mental patients have resorted to pounding ballpoint pens into their heads, through their skulls and into their brains. Some suicidal inmates have battered their heads against concrete walls until they were unconscious. The only preventative means that corrections officials have found to prevent such behavior has been the use of shackles. Mental hospitals have used padded cells to prevent this type of behavior. Most suicidal inmates will not resort to such extremes; therefore, elimination of anything that can be used to create a ligature is usually adequate to prevent suicide in jails and prisons. With the invention of anti-suicide smocks and their successful use to prevent suicides in prisons and jails, it should be uniform policy with all corrections facilities to avoid the inhumane policy of stripping an inmate of all clothing or shackling an inmate by their hands and feet. Universal use of anti-suicide smocks should be adopted by all corrections facilities as standard procedure in prevention of suicide by inmates.
Frank E. Barron III (guest columnist) served as Coroner of Richland County for 22 years. He is a graduate of The Citadel with a degree in Criminal Justice.