The nation's jails face increasing pressures as they house large numbers of mentally ill and addicted inmates. But the policies that contributed to this problem are decades in the making.
Here's a look at why the population of troubled inmates has increased in jails and what's being done to address the problem:
HOW MANY JAIL INMATES ARE MENTALLY ILL?
About 2 million times each year, the seriously mentally ill are admitted to jails nationwide; nearly three-fourths of these inmates also have drug or alcohol problems, according to the Stepping Up Initiative . That program, launched in 2015, aims to divert such inmates to alternative programs. It's working with nearly 500 counties in 43 states.
About 4 to 5% of Americans are seriously mentally ill, compared with as many as 18% of those in jails, according to Risë Haneberg, who leads the initiative on behalf of The Council of State Governments Justice Center. That number is dramatically lower than what many jails report, but Haneberg says that's because jails often use a broader definition of mental illness and may include substance abuse disorders.
A U.S. Department of Justice report, based on a survey conducted between 2011 and 2012, found 44 percent of jail inmates had a history of mental health problems, including depression and bipolar disorder.
Many jails report significant populations of emotionally troubled inmates. In Spokane County, Washington, for example, a 2015 survey found 86% of incoming inmates reported they had a mental health need.
WHY DO JAILS HAVE SO MANY MENTALLY ILL INMATES?
Some experts say the problem began with deinstitutionalization. In the 1970s, state psychiatric hospitals, many with appalling living conditions, began closing. Mental health care was supposed to shift to community-based centers.
But the promise to invest in local services didn't materialize, leaving many former psychiatric patients without treatment, says Michele Deitch of the LBJ School of Public Affairs at the University of Texas at Austin. "We still aren't putting money in community mental health care the way we should," she says.
Law enforcement policies can exacerbate the problem. When the homeless, for example, are arrested for offenses such as disorderly conduct, they often cycle in and out of jail without their mental health needs addressed.
Mentally ill inmates may also remain locked up longer because they often can't afford relatively low bonds in misdemeanor cases.
WHY IS THE SUICIDE RATE SO HIGH IN JAILS?
Lindsay Hayes, a consultant who has advised hundreds of jails and prisons over nearly 40 years, attributes it to growing numbers of jail inmates with serious mental illness or addiction problems, both of which come with an elevated risk of suicide.
Most small jails, especially in rural areas, don't hire enough staff to deal with the needs of the mentally ill and those with addictions because of the costs, he says. In addition, he says, workers in these jails aren't always adequately trained in suicide prevention and caring for the emotionally disturbed.
In the last five years or so, jails have seen a tremendous increase in inmates who use opioids and meth, straining medical workers who may be so focused on treating the inmates' physical ailments that they overlook their deteriorating mental health, Hayes says.
WHY IS SUICIDE MORE COMMON IN JAIL THAN PRISON?
In 2014, the latest federal data available, the state prison suicide rate was less than half of that in jails.
Jails often house first-time or lower-level offenders who are anxious because they don't know when they'll be released, how their families will react and whether they'll still have jobs — the "shock of confinement," Deitch says. "They're hit with a dose of reality that their lives as they knew it have forever changed."
Jails often don't know much about those entering the system, in contrast with prisons, where officials have time to assess inmates. Jails also have less money and staff members aren't as well-trained to spot potentially suicidal inmates.
WHAT'S THE SOLUTION?
Some jails are adding mental health staff, improving surveillance and tightening monitoring.
Others are trying innovative programs. In Pima County, Arizona, inmates are given computer tablets that have access to the law library and other reading material "to occupy their minds," Capt. Sean Stewart says. In the year before the tablets, there were 28 suicide attempts. In the following year, there were five.
In Bexar County, Texas, Sheriff Javier Salazar created a specially trained mental health team in 2017 that identifies inmates who seem likely to harm themselves. Salazar also is working with judges and prosecutors to try to secure the release of inmates charged with low-level misdemeanors — many of them mentally ill — who languish in jail because they can't post a small bond.
"It just stands to reason that this is not the place for them," the sheriff says. "There's got to be something else we could be doing."