Suicide prevention is a focus of Douglas County Corrections as the jail houses many inmates with serious mental health illness.

The Daily Record recently ran a series detailing how jail suicide cases nationally are leading to substantial financial settlements over faulty policies and neglect.

That recent investigative series, a collaboration between The Associated Press and the University of Maryland’s Capital News Service, found that many U.S. jails have allegedly refused inmate medication to help manage mental illness, failed to properly monitor them and ignored cries for help.

Suicide has long been the leading cause of death in U.S. jails and hit a high of 50 deaths for every 100,000 inmates in 2014, the AP-CNS investigation found. The problem is often blamed on how many mentally ill people face incarceration following the closure of state psychiatric hospitals in the 1970s. But advocates say many suicides are preventable.

Michael Myers, director of Douglas County Corrections, said the local jail hasn’t had a death by suicide recently, despite several attempts. The last inmate suicide was in 2017, he said in an emailed statement to The Daily Record.

“We take many steps in order to prevent suicides,” Myers said. “We have intervened in several active suicide attempts, saving the lives of individuals who may have died within minutes if the officers didn’t respond.”

Douglas County conducts a mental health screening during the booking process as well as during other points of an inmate’s incarceration. Myers said officers are trained to recognize and report signs of mental illness and suicide risk, and the department employs several mental health professionals to provide services to inmates. Myers also holds a licensed mental health practitioner credential.

“Any individual who has a suicidal risk is placed on a suicide watch, meaning they are visually checked several times each hour,” he said. “They are also seen by a mental health professional daily.”

In extreme cases, corrections staff will place an inmate on 24/7 monitoring, with constant, one-on-one supervision to ensure the inmate is kept safe in custody.

Douglas County Corrections, as a matter of policy, consistently provides access to psychiatric medication consistent with prescriptions, whether that’s from a community provider or its staff.

“Medication would only be withheld if we were attempting to verify information from a community provider or for a medical reason,” Myers said. “At times, individuals booked into jail are under the influence or are withdrawing from illegal street drugs, and it may be necessary to withhold prescribed medication which may have a dangerous interaction with street drugs which are in the individual’s system.”

The bottom line, Myers said, is medication is never withheld as a matter of routine.

Myers said the jail sees thousands of people each year who have a serious mental illness. In any given day, the jail is caring for about 215 people with serious mental illness, which is about 17% of its average population.

Examples of severe mental illness include schizophrenia and other psychotic disorders, bipolar disorder, major depression and obsessive-compulsive disorder.

Myers said it feels like they are “swimming upstream” in trying to address mental health issues.

“Our staff confront dangerous situations on a daily basis,” Myers said. “We work very hard to mitigate the impact that incarceration has on mental health, but, at the end of the day, we are still a correctional facility and any treatment we deliver is still within the context of incarceration. We actively work to divert individuals who are in our custody for law violations that are primarily driven by mental illness from the criminal justice system to the behavioral health system.”

Douglas County was recently recognized as an Innovator County by the Stepping Up Initiative, a joint program of the National Association of Counties, American Psychiatric Association Foundation and the Council of State Governments Justice Center that aims to reduce the number of people with mental illness in jails.

Sarpy County was also recognized by the initiative. In addition, Sarpy County is actively pursuing a partnership with Nebraska Medicine to open a crisis stabilization center for use by law enforcement as an alternative destination instead of jail for people experience a mental health crisis. The county hopes to locate it at the Bellevue Medical Center.

“Every expert we spoke with said putting the facility near a medical center was going to be crucial to our success, both in terms of care and staffing,” Sarpy County Commissioner Jim Warren said in a June statement.

A Sarpy County spokeswoman declined to answer emailed questions about inmate suicide prevention from The Daily Record.

Finding ways to avoid booking mentally ill people into jail is also the aim of Douglas County efforts. Douglas County Commissioner Mary Ann Borgeson said during a May news conference that the county jail is now the de facto largest mental health treatment facility in Nebraska.

“Jail is the absolute worse place to be treated for mental health,” Borgeson said at the time.

Myers said he hopes diversion, more options for placement and better identification of mental health crises could help reduce how many inmates with serious mental illness are booked in to jail in the first place, reducing stress for the jail while also helping those people receive assistance.

“We have acknowledged that our jail has become a collection point for the problems that our community has not successfully addressed in more appropriate settings,” Myers said. “We will continue to develop the best responses we can to address that reality while advocating for the changes necessary to decriminalize mental illness.”