"The biggest concern is that prisoners will not report that they’re feeling suicidal if they’re held in these kind of settings," Kahn adds. "We think it’s one of the many factors that explains this high rate of suicide within our system."
And despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up. Over the past 14 years an average of 31 prisoners a year have killed themselves -– a rate higher than the national averages for federal and state prisons as a whole.
Ask any psychiatrist who works in a California prison about suicide prevention, and he’ll tell you he follows a strict protocol: assess the inmate’s risk, move him to a cell where he can’t harm himself, send him for treatment, and closely monitor him throughout. But records show things don’t always work out that way. Dr. Alan Abrams recently retired from his job as chief psychiatrist at the California Medical Facility in Vacaville.
He described one case in particular.
"We had a patient who had every reason for suicide, severely depressed," he said.
Abrams said staff sent the inmate to the acute care facility at the prison.
They said he was malingering, kicked him out without telling us, and he hung himself within 3 hours," Abrams said.
That suicide seemed to be tied at least in part to bureaucratic bungling. But Kahn says that the high rate of suicide overall is a marker of how "bad the care is."
In a court filing, the state's corrections department said its system saves thousands of lives every year. Focusing on the handful of suicides distorts the overall picture, the state says.
But the court’s expert, Raymond Patterson, found the treatment of suicidal prisoners to be routinely deficient. Patterson said that in nearly half of the suicides last year, prison staff failed to assess the inmates for suicide risk or assessed them incorrectly.
The state accused Patterson of “second guessing and conjecture.”
Corrections Secretary Jeff Beard says it’s time for the federal court to end its oversight of the prisons’ mental health system.
"I’ve been around this system and visited over 20 institutions, and I can assure you there is not a deliberate indifference to the needs," Beard said. "People are being identified; people are being properly placed, and people are given the level of care that they need."
But the question remains: why has the rate of suicide in state prisons not fallen?
Terry Kupers, a forensic psychiatrist and prisons consultant, says California has gutted rehabilitation and education programs for inmates in recent years. He says prisons resorted to more lockdowns and isolation of inmates to deal with overcrowding and violence. Taken together, Kupers says, it can all lead to despair.
"In fact, a lot of the suicides that I’m asked to investigate will be of someone housed in solitary confinement," Kupers says. "There will be on the record that they’ve been to the observation area three or four times, and they return to their cell -- and that’s where they kill themselves."
But former chief prison psychiatrist Alan Abrams says even if the state restored its education and rehabilitation programs, and had the best psychiatric care available, some prisoners would still kill themselves. Because, he says, not all suicidal inmates are mentally ill.
"People finally understanding that they’re going to spend the rest of their lives in prison and not wanting to. Who’s to say that it isn’t an acceptable solution to a failed life?” Abrams said.
After the state makes its case tomorrow, the federal judge is expected to rule within two weeks whether California is ready to once again assume sole control over mental health care in its prisons.
California's Prisons (The Lowdown)