TOWARDS ACCOUNTABILITY

Prevention

• Sheriffs must conduct multiple screenings for substance use and mental illness. 

  • One of the most effective ways to prevent overdoses and suicides in jails is screening people at intake to identify who may be at risk. Early identification allows jails to provide necessary treatment and alter conditions to address risk. But sometimes people fail to report honestly about their conditions because they fear the repercussions, both the potential of further prosecution and the more severe incarceration (segregation, for example). Sheriffs must use the least restrictive conditions to address these risks and must act in a way that encourages honest reporting so that they can ensure people receive the help they need during the first several days of incarceration.

  • Current screening practices almost all focus on individuals at intake; further interviews and screenings are rare. But, circumstances change and the longer people are incarcerated, the more depressed or overwhelmed they may become. Jails should conduct ongoing screenings to ensure they are providing support and taking necessary precautions for those who later experience suicidal ideations. 

• People suffering from a mental illness or disorder while incarcerated should be referred for further evaluation and treatment.

  • A mental health evaluation should be performed by a qualified mental health professional whenever someone screens positive during a mental health screening.

Treatment

• Sheriffs must establish medication-assisted treatment in their jails.

  • Medication-assisted treatment (MAT) is one of the most effective ways to address substance use disorder. Jails can help curtail overdoses and help people address substance use disorder by providing them with FDA-approved medications like buprenorphine and methadone while they are incarcerated.

• Sheriffs must ensure that people continue to receive their medication while incarcerated.

  • The National Alliance on Mental Illness reports that”more than 50% of individuals who were taking medication for mental health conditions at admission did not continue to receive their medication once in prison.” Incarcerative settings disrupt treatment and care, but they shouldn’t, and sheriffs should act to ensure care is continued.

• Sheriffs must ensure prompt and satisfactory physical and mental healthcare is available to each person in the jail. 

  • People who are incarcerated are more likely to suffer from both physical and mental illness. But the care in jails is often substandard and delayed. Jails should aim for a “community-level standard of care,” providing the kind of treatment that someone would expect outside a carceral setting. 

  • Sheriffs should research and identify a health provider who can ensure prompt treatment and adequate care.  

  • Jails should seek “accreditation” from the National Commission on Correctional Health Care. Studies show jails that “undergo accreditation, like most hospitals, saw a marked improvement in healthcare delivery and standards, a substantial decrease in deaths, and millions in cost savings.”

Conditions

• Sheriffs must mandate robust training and strict adherence to policy for any use of force, including restraint chairs, stun guns, and beanbag rounds.

  • Some jail deaths occur as a direct result of abuse by correctional officers. Those officers are usually acting outside of policy and with impunity. If sheriffs fail to properly supervise officers or discipline them when they act outside of policy, deaths as a result of these violations are more likely to occur. The decision to allow correctional officers to use force against those in the care of the sheriff’s department requires that sheriffs ensure those officers exercise restraint and are properly trained on any method of force.

Response

• Sheriffs must mandate training to correctional officers on emergency response. 

  • Correctional officers should all carry naloxone and be prepared to use it if they encounter a person who is overdosing. 

  • Correctional officers should also know CPR and be able to render emergency aid.

Oversight

• Sheriffs should promptly and publicly report any deaths inside the jail and provide continuing information and updates to the public on the investigation.

  • Transparency is critical to preventing jail deaths. “[S]ecrecy around jail deaths makes it difficult to hold jail systems accountable and to intervene in ongoing crises.” Public reporting can help address issues and prevet future harm to those incarcerated. 

• Sheriffs should collect data on and analyze incidents that nearly resulted in death. 

  • Reporting on “near misses,” as the National Institute of Justice refers to them, is severely lacking. Sheriffs should identify, track, and analyze these incidents to prevent future harm.