Hard of Hearing 

The city was slow in adopting a jail-suicide expert's advice

When it comes to preventing jailhouse suicides, Lindsay M. Hayes is widely regarded as the nation's leading expert. He is editor of the respected quarterly Jail Suicide/Mental Health Update and has served as an expert witness in dozens of lawsuits. On behalf of the National Institute of Corrections, an arm of the U.S. Department of Justice, Hayes has also developed a model curriculum designed to teach guards how to prevent suicides.

So last year, after five prisoners killed themselves during a six-month span, St. Louis officials turned to Hayes for help in identifying ways to improve their response to suicidal inmates. His report, paid for by the National Institute of Corrections, took a hard look at what the city was doing and offered recommendations.

The 32-page report, issued in May of 2000, minced no words. Hayes chronicled a wide range of problems with the city's policies and practices -- problems also identified in police and internal investigative reports [Rushton, "Unlucky Seven," Nov. 7]. And his report frequently described the city's response as "grossly inadequate."

But when it came to adopting Hayes' recommendations, the city moved slowly. After his report was delivered last year, two more inmates killed themselves within two months. Another inmate committed suicide in the workhouse on Oct. 21.

Hayes' report, released by the city three weeks after the Riverfront Times requested a copy under the Missouri Sunshine Law, offers a checklist of problems at facilities operated by the city's Department of Public Safety. Hayes found:

· A lack of suicide-prevention training. Nationally recognized standards call for eight hours of suicide-prevention training for newly hired employees, followed up by two hours of annual training. In St. Louis, guards receive four hours of training on being hired and two hours of annual training. Exactly what is taught is unclear. "There does not appear to be a standard curriculum utilized during the in-service training," Hayes wrote. "In addition, it would appear that both social service and health care staff are not regularly involved in suicide prevention training." After the fifth suicide, workhouse supervisors spent 10 minutes briefing the staff on suicide prevention and also required them to watch a 20-minute video on suicide prevention. However, the city did not make annual suicide-prevention training mandatory when it revised its suicide policy two months after receiving Hayes' report. Rather, the new policy states that workhouse employees will receive such training "when deemed necessary."

· Inadequate mental-health services. At the time of Hayes' report, the workhouse psychologist worked just four hours a day. "Although assessing mental health staffing was outside the scope of this short-term technical assistance, it would appear that part-time (four hours per day) services of a psychologist for over 1,100 inmates is very inadequate," Hayes wrote. The backlog of requests for psychological services supports this opinion. The workhouse has a goal of responding to requests for a psychologist within 48 hours, but a psychologist hired in October 1999 had a backlog of 600-700 referrals waiting for him on his first day. The backlog had been whittled to 250 referrals when Hayes issued his report. Lee Daniel Lloyd was one of the inmates who fell through the cracks. Lloyd, who had bipolar disorder, twice asked to see a psychologist in the weeks before he killed himself in February 2000. Both requests went unanswered, Hayes reported.

· Poor communication. Contrary to the department's written policy, mental-health professionals at the workhouse did not share information about suicidal inmates with guards or social-services staff, increasing the likelihood that at-risk inmates wouldn't get adequate attention, Hayes found. Mental-health files were kept separate from medical files. The workhouse psychologist assessed inmates without access to medical or social-services files. "Simply stated, correctional, medical and mental health staff within DOC do not communicate effectively regarding the identification and management of suicidal inmates," Hayes wrote. "Correctional staff often do not even have basic information regarding the management of suicidal inmates in their housing unit." As evidence, Hayes recalled asking a guard why a particular inmate was on suicide watch: "The officer stated that he was not given any information about the inmate and only knew that the individual was on suicide precautions because he was in a smock." It turned out that the inmate had tried to kill himself the previous day in a police holdover cell.

· Inadequate screening. At the time of Hayes' report, inmates arriving at the workhouse were asked just two questions pertaining to suicide: Have you ever tried to kill yourself, and are you thinking about killing yourself now? Furthermore, medical and mental-health staff did not routinely see every inmate, nor did they conduct mental-health or medical assessments for all incoming inmates. The staff also did not review available medical and mental-health records for inmates who had previously been incarcerated. Hayes recommended that all available records on inmates be reviewed and that the screening questionnaire be revised to include such queries as whether an inmate has a history of mental-health problems, has recently experienced a loss such as a death in the family or has feelings of hopelessness. The Department of Public Safety has since revised the screening process to include medical personnel and now asks such questions when inmates arrive at the workhouse.

· Dangerous housing conditions. Although they weren't identified as suicide risks, four of the five inmates who killed themselves in the months before Hayes' report were in housing units designed for suicidal prisoners. Those cells in the workhouse pre-max unit included vents, bars and hooks that made convenient anchors for makeshift nooses. Inmates deemed suicidal were routinely stripped of their clothing and placed in the cells, contrary to widely accepted standards that say suicidal inmates should not be placed in isolation unless absolutely necessary, Hayes wrote. After the fourth suicide, male inmates at risk of suicide were placed in less dangerous, but hardly ideal, housing areas -- the cells included black curtains over door windows, making it difficult to monitor inmates. Female prisoners identified as suicidal were still placed in the pre-max unit, which Hayes called "grossly inadequate for housing suicidal inmates."

In addition, Hayes found that first-aid kits were missing latex gloves, protective shields for mouth-to-mouth resuscitation and other basic lifesaving equipment. There were no tools in the housing units that could be used to cut down hanging inmates. Noting that guards had trouble freeing three hanging inmates, Hayes wrote that specially designed cutting tools that could not be used as weapons cost as little as $7.30 and should be placed in all units along with first-aid kits. The kits should be regularly inspected, and the workhouse should conduct suicide drills to ensure the staff knows how to respond to suicides, he wrote. Contrary to national standards, at least one guard assigned to each housing unit is not certified in first aid or CPR, Hayes found. "This writer found that the DOC had grossly inadequate practices regarding intervention measures following discovery of a suicide attempt," he wrote.

Hayes also recommended that the city remove supposedly suicide-proof clothing or towel hooks that two inmates had used to hang themselves -- the city had already removed, inspected and then reinstalled the hooks. But problems lingered after Hayes put the city on notice. Six weeks after Hayes submitted his findings, guards couldn't quickly free Michael Reeves when he hanged himself because no cutting tool was available. In Reeves' case, guards also hadn't been trained to perform CPR and had to wait for paramedics. Corrections officials in October assured RFT that all hooks have been removed, cutting tools are readily available and every guard in the workhouse has received CPR training.

· Poor monitoring. Although all inmates are supposed to be checked every 15 minutes, that wasn't the case, Hayes found. Log sheets showed that checks were routinely made every 20 or 30 minutes, and 15-minute checks are "grossly inadequate for acutely suicidal inmates," he wrote. Hayes found no written documentation that required checks had actually been performed. "In fact, one correctional officer told this writer that he 'tries to see an inmate on suicide watch every 15 minutes or so,'" Hayes wrote. "This practice is also grossly inadequate and increases the agency's liability by not being able to demonstrate in writing that an inmate is being properly observed. Suicidal inmates should be observed commensurate with their behavior, not the availability of staff."

Dora Schriro, hired as the city's corrections commissioner in October, says Hayes' report was balanced and "quite thorough." The city is now rewriting its suicide prevention and response policy, she adds.

"This is beyond regular," she says of the pending policy revision. "I felt that I had a good enough working knowledge that there were some changes that needed to be made and I felt they were important enough that I didn't want to wait for an annual review."

Already Schriro has ordered workhouse staff to screen inmates when they return from court to identify any who may be at risk for suicide. All first-aid kits were inspected shortly after she arrived, and she has issued orders that all kits be inspected on a daily basis to make sure they're properly equipped. She's planning a drill to make sure guards know how to respond to suicides. She also made sure all housing units had functioning televisions for the Thanksgiving holiday -- TVs help reduce isolation, she explains. And she plans to allow contact visits in time for Christmas. As it stands, glass windows separate inmates from visitors.

"That would give people something to look forward to, indeed, to live for," she says. "While I can't do much immediately about overcrowding, there were things I could do to reduce the idleness."

Former public-safety director Martie Aboussie says he thinks the city is making progress. Aboussie, who was replaced when Francis Slay became mayor earlier this year, says he repeatedly told former Mayor Clarence Harmon that the city needed a new corrections commissioner before work was completed on the new jail, which is scheduled to open next year.

"I said numerous times to the administration, 'We are not prepared to run that new jail with the people who have operated it," Aboussie says.

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