How much do we know about suicide and self-harm that happen during incarceration?
By Rachel Crumpler | North Carolina Health News
Christopher Brandon Propst, a 44-year-old at Piedmont Correctional Institution, died of an apparent suicide on Saturday, Nov. 18. The N.C. Department of Adult Correction announced the death in a news release on its website the following Monday.
Propst is the latest to die by suicide in the state prison system. Five other suicides happened earlier this year.
But this public, real-time reporting of suicides in prisons isn’t happening across the country. Only North Carolina and 15 other states provide information on suicides that is frequently updated, detailed and freely given.
Recent research by the Third City Project found widespread data gaps on these in-custody deaths. The Third City Project is made up of North Carolina researchers working to publicize data on carceral systems and health in the wake of data inadequacies identified during the pandemic.
Twenty-one states provided no information on suicides, shared data that was outdated or required the information be obtained through a public records request, despite the Death in Custody Reporting Act, which federally mandates that states report data on in-custody suicides.
This substantial gap in reporting inhibits public understanding of the carceral system, said Kate LeMasters, who helped assess prison system suicide reporting policies as a doctoral student in the Department of Epidemiology at UNC Chapel Hill.
“We don’t have a starting point without data,” said LeMasters, who is now a researcher at the University of Colorado Anschutz School of Medicine, where she focuses on the intersection of incarceration and health equity. “There’s no way to ground the research or the policy or the programs without actually knowing who is dying, how many, when and under what conditions.
“There’s not really a way to move forward to try to improve outcomes.”
The widespread lack of transparent reporting is problematic, LeMasters said. In fact, she originally sought to examine changes in suicide rates in prisons during the pandemic, suspecting that factors like the spread of COVID behind bars, restricted visitation and more time spent in isolation to try to contain the disease may have worsened incarcerated peoples’ mental health. But she discovered she couldn’t measure this — the data didn’t exist.
And she knows there are many more research questions, policies and programs that can’t be properly analyzed — at a time when suicides during incarceration have been increasing nationwide — without improved data.
“Suicides are types of deaths that these institutions play an outsized role in preventing, and it's pretty egregious when these deaths are still happening,” LeMasters said.
Tracking suicides in prisons
Researchers at the Third City Project, led by Duke University’s Lauren Brinkley-Rubinstein, graded each state prison system by level of data availability on in-custody suicides.
States received an A if the prison system data was provided consistently, was complete, was frequently updated, was available at the facility or individual level, and was made freely available through statistical reports or news releases. That’s the ranking North Carolina got.
Susan Pollitt, an attorney at Disability Rights NC who specializes in defending the rights of people with disabilities who are incarcerated, has monitored prison suicide rates for years. In 2022, there were 13 suicides — a record high.
Pollitt said she’s glad that the prison system puts out timely news releases announcing confirmed suicides with basic information such as the name of the person, their age, the date of death and the correctional facility where they died.
The information provided in North Carolina is granular enough to pinpoint facilities where suicides may be more frequent. For example, last year Pollitt noticed that there were five suicides at Bertie Correctional Institution in Eastern North Carolina, indicating a need to explore the situation there further.
Although North Carolina publicly reports more information than other states, Pollitt said the information provided is still quite limited.
“I wouldn't have given North Carolina an A,” she said.
For Pollitt, the A rating is more indicative of the low bar of data access across the nation, rather than North Carolina particularly excelling in this area. Pollitt, for example, wants the North Carolina prison system to provide more details when announcing in-custody suicides, such as whether a person was held in solitary confinement. Only three states — California, Florida and Kansas — provide data on housing status at the time of death.
LeMasters agrees that greater context about the housing status and mental health conditions of suicide victims could help identify trends and underlying patterns into who is dying and why.
“If we see a lot of folks dying by suicide if they're coming out of solitary confinement, or if they have severe mental health issues,” LeMasters said, “I think that speaks to how we can and should be changing protocols around housing and around treatment.”
Pollitt said she can sometimes learn more of the circumstances around a suicide by making a public records request for the medical examiner's investigation and autopsy report.
Furthermore, Pollitt said she thinks it’s a "flaw” that the state prison system does not publicly report suicide attempts. She said this information could be a helpful indicator in understanding the mental health of the incarcerated. Researchers found that six states — Alabama, Arizona, Arkansas, Connecticut, Michigan and Tennessee — report this measure.
“The curtains have to be pulled back on what's going on in our prisons if we're going to understand the problems and work together to solve them,” Pollitt said.
Tracking suicides in jails
Greater transparency on suicides in the state’s over 100 county jails is also needed, said Luke Woollard, an attorney at Disability Rights NC, who has been tracking those deaths.
In March 2022, Disability Rights released a report on 2020 jail deaths that showed 21 suicides. Although a formal report has not yet been released by the organization, Woollard told NC Health News that Disability Rights counted 17 confirmed suicides in 2021 and 23 in 2022.
Woollard said Disability Rights tallied these statewide counts from public records obtained about in-custody deaths from the state health department and the Office of the Chief Medical Examiner. The state health department has an oversight role in jail health care, while the Office of the Chief Medical Examiner performs autopsies and toxicology analyses.
After someone dies in jail custody, an inspector from the state health department’s Division of Health Service Regulation team conducts a death investigation. The death investigations can provide useful information, Woollard explained, such as whether a facility met the minimum requirements of the state’s rules for jails regarding issues such as screenings and supervision level. In recent years, Woollard said many of these death investigations have found supervision failures and other deficiencies.
Public reporting protocols vary from county to county; some jails post news releases announcing suicides and some don’t. That means the primary and most reliable way to learn information about suicides in jails is through public records requests, Woollard said.
But Woollard said that method of information sharing comes with more lag time and isn’t as accessible, particularly for community members who likely don’t know what documents to ask for.
“It's important for the information to be easily accessible to people who are paying for these jails with their taxes — and whose friends, loved ones or themselves might end up in this jail,” Woollard said.
Woollard would also like to see more statewide mandatory reporting requirements, such as for suicide attempts. He said this measure could provide a more complete picture of the mental health state of those incarcerated and a jail’s effectiveness in responding.
House Bill 841, introduced by Rep. Carla Cunningham (D-Charlotte) in May 2021, would have required jails to report attempted suicides and required the state health department to conduct compliance reviews after each incident. But the bill did not go anywhere, leaving these incidents almost impossible to track.
Woollard said timely and accurate data is vital to understanding and improving jail conditions.
“Transparency is incredibly important,” Woollard said. “Sunshine really is, in most cases, the best disinfectant, and it's needed so that advocates, communities and the families of the folks in these jails know what's going on.”
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.