By Hannah Critchfield

In the first month of the new year, Melissa Middleton Rice, 49, was left alone in the booking room at the Jackson County Detention Center.

Nearly an hour later, an officer would check on her for the first time, even though on a closed circuit monitored by guards, she had not moved for 40 minutes.

It was too late — Rice, in view of the camera, monitored by staff, would become the third person in five years to die by suicide at the jail in Sylva.

Rice was one of twenty people who died by suicide while incarcerated inside a North Carolina jail last year —  up from 12 deaths in 2018 according to a report released earlier this week by Disability Rights NC. It’s the greatest number of people to have died in a single year since the organization first began compiling data on deaths by suicide in jails in 2013. This put 2019 on track to set a record for the number of jail suicides.

shows a woman in an orange jumpsuit, sitting on a bed, shackled. she's in a cell that has a sink and toilet.
A female prisoner living inside her tiny prison cell. Photo credit: Officer Bimblebury/ Wikimedia Creative Commons

The suicide victims were young — a little over half were between the ages of 26 and 35, according to the report. All but one had not had their day in court — meaning they had not yet been convicted of a crime.

Disability Rights legal advocates say their deaths highlight the critical need for reform of outdated state jail policies, which currently remain in limbo in the state legislature.

Setting the standard for care

On any given day, there are an estimated 18,000 people living within North Carolina’s jails. For many, this also becomes their de facto mental health provider — statewide, people with serious mental illness are 3.5 times more likely to end up in a jail or prison than in any form of treatment. Yet upon entering a jail, a person becomes 25 times more likely to die by suicide, according to a Disability Rights analysis of data from the Centers for Disease Control and  Prevention and the state Department of Health and Human Services.

Jails throughout North Carolina are governed by county sheriffs but are still required to uphold state-mandated jail rules. These rules, established by the Division of Health Service Regulation within the DHHS, set the minimum standard of care for inmates within jail systems in North Carolina. And though they must undergo review each decade, the current rules have not been updated in more than 25 years.

In nearly two-thirds of the jail suicides in 2019, a DHSR investigation found that jail staff involved had not violated any of the current rules.

“To me, that [two-thirds figure] really speaks to the inadequacy of the rules — they don’t do enough to protect them,” said Luke Woollard, an attorney at Disability Rights and primary author of the report.  “All these suicides are still occurring, even in an environment where they have the ability to monitor these folks 24/7.”

shows a very basic prison cell with a sink, toilet, bed, plastic chair adn a pile of books
A typical cell at Central Prison in Raleigh. Cells in the solitary unit are more sparse, and smaller. Photo credit: Rose Hoban

Mental health rules in limbo 

In mid-April 2019, after a three-year-long review process, updated jail rules were approved by DHHS, Attorney General Josh Stein and Governor Cooper.

The amended rules include new requirements to address mental health needs, including mandating all jails establish a suicide prevention program. It would also require detention facilities to provide routine medical care for “mental health, developmental and intellectual disabilities, and substance use disorder,” and increase health screening and observation of at-risk inmates.

Woollard said these prevention measures could have a lasting impact on reducing jail deaths by suicide in the state. A little over half of jail suicide victims in 2019 died within their first 12 days in jail, according to the report, meaning identifying at-risk individuals early is key.

“I think we need statewide regulations because with the system we have in place now, the level of care you can expect simply by getting arrested on one side of a county line versus the other is pretty stark,” said Woollard. “We need minimum requirements to work from. And that’s what these rule updates give us.”

The rules could have been implemented as early as May 1, 2019.

But objections from the North Carolina Sheriffs’ Association and individual sheriffs delayed them from going into effect. They must now undergo review by the 2020 legislative session before they can be adopted, but this process has been stalled further due to COVID-19 shutdowns.

Eddie Caldwell, executive vice president and general counsel of the Sheriffs’ Association, argued the updated rules are “vague and unclear,” particularly around how jail administrators should screen and establish adequate suicide prevention programs.

“The sheriffs aren’t resistant to change,” said Caldwell. “But the sheriffs don’t want to be saddled with a burden that people are gonna be writing articles about in the future — and writing reports on in the future — about a rule that nobody understands and DHHS can’t explain.”

A bill opposing the proposed jail rule amendments, House Bill 1173, was introduced on May 22, 2020 at the behest of the Sheriffs’ Association, according to Caldwell.

Unless the bill passes, the news jail rules will go into effect at the close of the General Assembly.

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Critchfield is NC Health News' Report for America corps member. Report for America is a national service program that places talented emerging journalists in local newsrooms to report on under-covered...