The weekend death, apparently by suicide, of billionaire financier and sex offender Jeffrey Epstein in a Manhattan jail has drawn the nation's attention to the challenges of preventing inmates who want to kill themselves from doing so while in custody. The issue is hardly academic for detention centers in Colorado, including the Boulder County Jail, where a handful of prisoners have recently taken their own lives.
Indeed, the suicide of 44-year-old Michael Courtney at the Boulder jail on August 4 marked the third fatality from such an act at the institution in just over a year, and a fourth person who tried to take his own life during that period barely survived after being found shortly after he hanged himself.
These incidents concern Boulder County Sheriff's Office Division Chief Jeff Goetz, who oversees the jail; he emphasizes that the facility has put in place a slew of policies and procedures intended to prevent such tragedies, including an innovative new mental-health facility that recently opened inside a unit at the complex. But he also believes the difficulties inherent in keeping potentially suicidal inmates alive has steadily ratcheted up over time due to a significant increase in in those suffering from assorted mental conditions.
Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, divides psychiatric diagnoses into five divisions, or axes, with Axis I designating "all psychological diagnostic categories except mental retardation and personality disorder." According to Goetz, as of August 6, of the 449 men housed in the Boulder County Jail, 204 of them, or 45.4 percent, had documentation identifying them as Axis I. On the same day, 25 of 62 female inmates, or 40.3 percent, were Axis I.
"I've worked at this jail thirty years come February," Goetz says, "and our inmate population is very different from what it was five years ago, ten years ago, twenty years ago."
Since 1998, when Boulder County Jail opened, 26 people have died there. Eleven of the casualties were identified as being from either natural causes or medical issues such as heart attacks, while the remaining fifteen were suicides. That means 20 percent of the suicides at the facility over more than two decades took place in the last year.
The other recent suicides include 29-year-old Benjamin Fueston, who died on July 28, 2018, six days after he was discovered hanging by the neck in his cell; he'd been busted on a municipal trespassing charge and a warrant out of Glenwood Springs. Early on May 27 of this year, 47-year-old Erie resident Jerome Bornn, who'd been accused of attempted murder following his arrest in a barricade situation, died after being found unconscious in his cell with a bag over his head in a suicide-by-suffocation bid.
And on December 6, 2018, Joshua Male, 40, was resuscitated after a nearby inmate saw him dangling from a noose; Shannon Carbone of the Boulder County District Attorney's Office says Male has a competency review hearing scheduled for August 22 in regard to charges of attempted first-degree murder, second- and third-degree assault and domestic violence.
In-custody suicides are hardly unique to Boulder County. In March 2016, we documented thirteen jail deaths in Colorado facilities during the previous year or so, with three suicides in Jefferson County jail, two in Denver County jail, and one apiece in Arapahoe and Rio Blanco county jails. Earlier this year, we reported on a lawsuit over the January 2016 suicide by inmate Dillon Blodgett at the Montrose County Detention Center. The Montrose jail was the setting for two additional suicides in each of the next two years: Robert Petersen in August 2017 and Clinton Mitchell in March 2018.
Dan Shaffer, the attorney representing Blodgett's family, said that his research suggests "a disproportionate number of in-custody deaths by suicide happen in rural jails because there's not enough mental health care to go around."
Not that every person who commits suicide in jail has been diagnosed with a mental problem, however. Indeed, Courtney, who was taken into custody on July 10 when he was one of twenty people rounded up in a massive northern Colorado drug bust said to involve large quantities of meth, fentanyl and prescription drugs, was not Axis I.
Here's how Commander Mike Wagner, a public information officer for the BCSO, describes what happened with Courtney: "Just before three o'clock in the maximum security module on Sunday [August 4], an inmate notified jail staff: 'Hey, it looks like this guy needs help.' He said it to attract attention, because he noticed that a neighboring cellmate [Courtney] appeared to be hanging in his cell. He ran in and tried to lift him up or cut him down or aid this guy until medical staff was able to get in there, and get him down."
At that point, Wagner continues, "our staff immediately started CPR on him, and they continued to work on him in the jail with help from paramedics with the Boulder County Fire Department and AMR ambulance. It's my understanding that they worked more than thirty minutes trying to revive him before a doctor pronounced him deceased."
Events like this one have ripple effects, Goetz says. "When somebody commits suicide and is successful inside the jail, the inmate is often referred to as the victim — but he isn't the only victim. There's also the staff members who had to go through the traumatic process of giving CPR or cutting them down if they were hanging, or dealing with an inmate who cut their body up to try and bleed out. They're not sitting back and watching, like it's a TV episode. And it's also impactful on the staff who've gotten to know the inmate."
As an example, he cites "an inmate who was in here for almost two years before he committed suicide. He moved around through the jail and he touched so many of our staff's lives in good and bad ways. Not everybody gets along, and for what his situation was, he was not a good person. But while he was in here, he was able to control that and not be the ugly person he was on the outside doing the things that got him in here. When he found out how long he was going to be in prison, though, he hanged himself — and there was nothing on the radar to indicate that was even an option for him, nothing to let us know, 'This is a big red flag,' or, 'Here are five big red flags.' That's the thing with suicides. The ones who are screaming, 'I'm going to kill myself, I'm going to kill myself' are easier to pay attention to. It's a lot harder to figure out what's going on with the ones who don't call a lot of attention to themselves — who just decide one day, 'Okay, that's it. I'm done.'"
Checking for possible suicidal ideation begins with the booking process. "There are a lot of statistics out there to indicate that when people go to jail, they're most apt to commit suicide within 72 hours," Goetz says. "They could have alcohol and drugs on board, and they might be thinking, 'This is the end of the world. I'm losing my family, I'm losing my job, I'm losing my house.' So the first 72 hours are critical, which is why we closely scrutinize everyone as we go through the process of delineating who goes on suicide watch."
This decision is a snap for those inmates "who are telling the officers, 'Just kill me now. Just shoot me,'" he continues. "That happens a lot. You'd be surprised how often it happens. But our nursing staff meets with everybody within the first 24 hours — and the reason we say 24 hours is because some people who are on alcohol or drugs are in no way, shape or form able to have a conversation. Once they get to a point where they can be coherent and converse with the nurses, they'll talk to them. But if you're coherent when you come in, our nurses will see you before you go to the back of the jail, meaning when you know you're not going to be bonding out and you'll be staying a while. They have a series of questions they ask, and some of them are trigger questions, where if you answer yes to them, or if you're hesitant, we're going to err on the side of caution."
Through August 6, the Boulder County jail had put 268 inmates on suicide precautions in 2019 — a substantial amount considering that 682 people total were booked at the jail from January 1 to July 31.
Once inmates are placed in the jail's general population, they're monitored using a technique Goetz dubs "direct supervision, where the officer is in the module with the inmates, not in a work station with a window — and that has a lot of advantages. Say you're in an office with cubicles and you see a couple of coworkers who are angry with each other. You're going to figure it out in nanoseconds, whereas if you're looking through a glass, it might take you a while to realize something's wrong. And it also gives our inmates who might be getting bullied by stronger inmates a sense of relief — like, 'Okay, there's a cop in here, so hopefully nothing bad is going to happen to me right now.'"
This approach also allows staff "to talk to the inmates, and converse with them about family and court cases," he continues. "Many of them develop relationships with these guys, because they're with them twelve hours a day, three or four days a week. They spend more time with them than they do with their spouses or significant others on those days. So when the inmate has to go to court and may get bad news, they're pretty quick to pick up on that body language. They'll tell staff, 'Joe Blow has a court date tomorrow, and he's not sure if it's going to go well. We need to keep an eye on him.' We do that all the time, and we share it with our mental health team. It's passed from shift to shift."
Inmates are in Boulder jail modules working, attending classes and so forth for ten hours or more per day, which leaves around twelve to fourteen hours that they're in a cell. During those periods, staff checks on inmates at designated intervals — within every fifteen minutes for those under the strictest scrutiny, or at roughly half-hour or hour intervals for those who aren't considered to be at as great a risk for self-harm or other issues.
In Boulder, the checks take place day or night (in the latter circumstance, staff will shine a flashlight through cell windows to make sure the inmate is breathing and may enter the space and even jostle the person to make sure everything is okay), and they tend to be irregular within the prescribed time periods to make them less predictable. The idea is that if a staffer is as likely to stop by the cell of an inmate on a half-hour schedule after twenty minutes as thirty, a suicidal person will be less certain that he or she won't be interrupted.
For those with the most significant mental-health challenges, however, options are limited as a result of long-running capacity complications at the Colorado Mental Health Institute in Pueblo and Fort Logan. The facilities serve inmates who require competency evaluations, as well as those in need of restorative treatment if they've been found incompetent to go on trial, plus individuals found to be not guilty of a crime by reason of insanity. But space is extremely limited: CMHI Pueblo has 455 beds, and CMHI Fort Logan boasts just 94. But the need is much greater, as has been underscored by the advocacy organization Disability Law Colorado in a decade's worth of lawsuits and court actions against the state over delays in care.
Attorney Iris Eytan, of Eytan Nielsen LLC, has been part of the fight since the beginning. In 2008, she said for a Westword post published last September, "I received information from a public defender that two people were accused of stealing a bike worth more than $500 — a felony offense. One of them approached by law enforcement was hallucinating, in a completely different world, in need of mental health treatment and not really aware of his circumstances. He was unable to communicate with his attorney, didn't understand the court system and was unable to comprehend simple information because of his mental health impairment."
The public defender "asked for a competency evaluation to determine if he was competent to proceed in the criminal case," she noted. "But six months went by and he was never evaluated."
After being taken to task over such holdups in court, the Colorado Department of Human Services signed a contract agreeing to evaluate inmates believed to be suffering from mental illness within 28 days, with another 28 days granted to either restore them to competency or declare them incompetent — but the agency has chronically failed to meet these deadlines. At one hearing last year, Eytan shared the story of a mentally ill Colorado man who'd spent more than eight months in jail after spitting on a police officer because he was still waiting to receive restorative treatment in Pueblo.
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Such scenarios are all too familiar to Goetz. "We've had people waiting up to a year to get into the state hospital," he says. "Our sheriff even sued the state with another county over this and won. But there are only around 550 beds at the state hospitals for all of Colorado, and that's shared between criminal and civilian beds. The jails in the state alone have more than twice as many people who need to go there. And even if we were able to wave a magic wand and build five new hospitals, there wouldn't be enough people with the expertise to staff them."
Faced with this dilemma, Boulder has taken unilateral action by opening up its own mental health facility at the jail, based on a program out of San Bernardino, California, called Restoring Individuals Safely and Effectively, or RISE, which had already achieved success in Arapahoe County. In recent months, one of the jail's units was converted to a RISE module, and as of its June 1 launch, Boulder County inmates can now get treatment for mental disorders in-house. If they're restored to competency, they'll be able to move forward with their criminal case; if they're not, they will be designated for relocation to either Pueblo or Fort Logan.
Trouble is, Boulder's RISE module has room for only eighteen patients, which should help improve the situation but hardly fixes a broken system. That leaves Goetz and his crew to figure out other ways to address inmate suicides and other issues. "We're doing everything we can to stop these kinds of things from happening," he insists.
But everything isn't always enough, and jail officials from Colorado to New York understand.