As the opioid epidemic continues to grip the nation, the Pima County jail is working to stem the tide of suicides and suicide attempts among detoxing inmates.
A new report assessing suicide risk at the jail, issued in response to two highly publicized inmate suicides this year, found that the detention center has a relatively higher rate of suicides than other jails, and that completed and attempted suicides for this year are on track to exceed 2017.
The report, ordered by Pima County Administrator Chuck Huckelberry, showed a high correlation between inmates withdrawing from opiates or alcohol and increased risk for suicide.
Most inmates who attempted suicide at the jail did so within three to four days of their booking β a critical window that might warrant more intense medical monitoring, the report said.
The first 72 hours of detoxification from alcohol and opiates is reportedly the most difficult, with people experiencing the worst symptoms, including nausea, vomiting, diarrhea, depression, hallucinations, seizures and anxiety. People withdrawing from alcohol could experience life-threatening crises, including seizure, high blood pressure and issues with the central nervous system.
As opioid abuse grows in Pima County, the jail population with a history of substance abuse will continue to increase, according to the report.
βThe opiate addiction crisis is a public health emergency,β Sheriff Mark Napier said. βItβs reasonable that we would see some of that trickle into our environment, and perhaps even result in, unfortunately, suicide and suicide attempts, as these people are detoxing or have addiction problems.β
RECORD NUMBERS
On May 18, Norman Schrank III was found unresponsive in his cell around 4 a.m. Schrank was in custody in connection with the slaying of his mother-in-law and the beating of his estranged wife.
A month later, convicted murderer Brian Ferry was found dead in his cell while awaiting sentencing. Ferry had just been convicted in a second trial, after the first resulted in a hung jury.
Both deaths were ruled suicide, but the methods used have not yet been made public.
The Arizona Daily Star requested the investigative reports into both deaths in June, but the Pima County Sheriffβs Department has yet to release the results.
Schrank and Ferry accounted for two of 30 inmate suicides at the Pima County Jail over a period from Jan. 1, 2000, through June 30, 2018, according to the study conducted by Assistant County Administrator Francisco Garcia and the Behavioral Health Department.
With two such deaths so far in 2018, suicides are on track to match or exceed the record year of 2015, in which four inmates committed suicide, the report says.
Between 2013 and June 2018, there were 122 suicide attempts by jail inmates.
In 2015, the jail began tracking suicide attempts that required inmates be taken to outside hospitals for injuries that couldnβt be managed inside the jail.
Since Jan. 1, 2016, 29 inmates have attempted suicide and required transportation off-site for medical treatment. The study found that 21 of those people were being observed for withdrawal from alcohol or opiates, the report says.
COORDINATED EFFORT
Earlier this year, Centurion, a health-care provider with experience in behavioral health, signed on to serve the jail.
βCenturion appears to recognize the importance of addressing the needs of co-occuring mental-and physical-health needs among the detainee population,β the report said.
Centurionβs proposal to the county included a comprehensive plan to address behavioral health, including an augmented risk assessment to gauge suicide risk based not only on self-reported information, but also on behavioral observations and identification of risk factors.
Centurion also has established practices for monitoring inmates at risk of withdrawal and clinical guidelines for the management of alcohol, drug and opiate withdrawal, according to the report.
The report identified other risk factors, which included behavioral-health diagnoses, a history of prior bookings and being within the first week of detention.
Since the suicides earlier this year, the Sheriffβs Department has taken steps to improve inmate safety and prevent self-harm.
Inmates with a history of suicide attempts are no longer housed alone, and in the mental-health and detoxification units, bed sheets have been replaced with blankets and standard bath towels have been replaced with smaller ones. Bunks have been modified to lower the risk of hanging, according to the report.
The report also says that redesigned staff space in the jail has allowed for the medical team to be located in the mental-health and detoxification units, βproviding improved access and visibility.β But during a Friday visit to the jail, a Star photographer noted that there were no medical team employees in the mental-health unit. A jail official told the Star they had been there earlier that day.
The jail also has plans in place for increased monitoring for all inmates, with special attention to the mental-health and detox units.
The report recommends that Centurion and the jail staff develop processes to identify detainees with risk factors and closely monitor those who are detoxing, especially during the first 72 to 120 hours after booking.
The Maricopa County jail in Phoenix provides medication assisted treatment, also called MAT, to detoxing inmates. MAT programs involve the use of medications such as Vivitrol, methadone or Suboxone that ease the symptoms of opioid dependence and withdrawal.
While the Pima County jail last year implemented the program for pregnant women who are at risk for spontaneous abortion if they go through withdrawal, it is not available to the rest of the jail population despite the increase in suicide attempts and completions among detoxing inmates.
When the Star spoke to Napier Friday, he said he didnβt know if the program was available to the rest of the population or if plans were even in the works, saying, βThatβs not been part of the discussions that have bubbled up to me.β
A department spokesman later confirmed that the program was still only available to pregnant women.
But when it comes to opiate withdrawal, MAT is the standard of care, since 75 to 90 percent of addicts need medication to successfully kick the habit, said Kathleen Maurer, chief medical officer for the Connecticut Department of Corrections.
Prisoners who are treated with medication have fewer disciplinary violations, and itβs ultimately less expensive to medicate inmates than to let them go through withdrawal and deal with the consequences, Maurer said.
βWe have to ensure that jails and prisons provide the community standard of care for mental-health and substance-abuse treatment,β Maurer said. βWe should not be incarcerating people because theyβre sick.β
