Means restriction to prevent suicide in the LA County Jail: the safety smock

Last Sunday night, CNN re-ran an episode of This is Life with Lisa Ling, Inside the Largest Jail System in the Country. My interest was that the LA County Jail is also by far the largest mental health facility in the United States. I think most of my readers will be shocked by what I discuss in this blog post.

Here is 1:27 minute video that is a tantalizing teaser that makes some important points.

Here is a link to the just-under-2-hour full value of the episode. You can fast-forward through some of it to come to more unsettling material about the life of the mentally disordered persons who make up more than 20% of the LA County jail prison population.

I noticed that some of the suicidal patients had on prison clothes that resembled something out of Star Wars.

Here is what Wikipedia says about these anti-suicide smocks

An anti-suicide smock, Ferguson, turtle suit,[1] or suicide gown is a tear-resistant single-piece outer garment that is generally used to prevent a hospitalized, incarcerated, or otherwise detained individual from forming a noose with the garment to commit suicide. The smock is typically a simple, sturdily quilted, collarless, sleeveless gown with adjustable openings at the shoulders and down the front that are closed with nylon hook-and-loop or similar fasteners. In an The thickness of the garment makes it impossible to roll or fold the garment so it can be used as a noose. It is not a restraint and provides modesty and warmth while not impeding the mobility of the wearer.

These items are formally known as Safety Smocks and were designed and developed by Lonna Speer in 1989 while she was a nurse working in the Santa Cruz, California, county jail.[2] Safety Smocks are now standard issue throughout jails and prisons in the United States. [3] The same material is used for the anti-suicide blanket. Prior to use of the Safety Smock many jails and prisons stripped inmates naked and held them in a stripped down padded cell with no furniture or protusions of any kind. Some facilities opted to use paper gowns to provide modesty. However, inmates are able to fashion a noose from a paper gown in less than 15 seconds, so most institutions no longer use them. The American Correctional Association (ACA) has established use of appropriate Safety Smocks and Safety Blankets as one of the Standards used to judge jails and prisons for accreditation.

To learn more, I went to the website of what is probably the leading manufacturer of anti-suicide smocks, Ferguson with an aptly named link,  Preventsuicide.com.

claim-of-stronger-for-longer-smock

Along with ads asking, “Have a smelly situation?” and offering a product Reverse-It as a solution, you can find links to a full line of anti-suicide products.

him-1anti-suicide-smock

antisuicide-bed

Ferguson also makes a sanitary belt for suicidal females that “Cannot be twisted into a cord. Produces a gagging reflex if an inmate attempts to choke herself.”

anti-suicide-sanitary-belt

Anti-suicide smocks come in colors, but not yellow or gold in Gitmo

I learned from another site about use of anti-suicide smocks for detainees at Gitmo.

Any Guantanamo detainee thought to be a suicide risk is also clothed in green. What’s up with that? Green and navy blue are both popular colors because they’re considered “soothing.” Manufacturers try to avoid colors like yellow or gold because the brightness could agitate the inmates and perhaps keep them up at night.

Suicide prevention in the “Hole” Segregation Units

The CNN video revealed the horrible mistreatment of mentally ill patients under horrible conditions in the LA County Jail. The patients are placed in a special Observation Unit, but in numerous other American prisons, mentally ill patients are put in the Hole, which

is formally called “Segregation” or “Seg”—is off-limits to visitors. It’s where prisoners are separated from the general population and held in a small, barren cell with a cot and a toilet, 23 out of 24 hours, with one hour of recreation a day.

Seg units have become controversial as solitary confinement is starting to get a hard look. Solitary confinement was recently called “cruel and unusual punishment” by Sen. James Eldridge (D-Acton), who along with Rep. Elizabeth Malia (D-Boston), filed a bill this month to put more restrictions on the use of solitary confinement in Massachusetts prisons.

Here’s a little-known fact about prison Segregation Units: Besides housing those in protective custody (such as sex offenders who need protection from the general population) or those locked for disciplinary problems, some prisoners are isolated because they are suicidal.

A recent article in the New York Review of Books  gave a chilling description of such solitary confinement at New York’s Sing Sing Prison :

If you look inside a solitary confinement cell such as the ones I have visited in New York’s Sing Sing prison, you’ll see a gray-walled, eight-by-eight-foot room with a concrete slab bed; it’s underground, more like a tomb than a cell. The light is always on. Usually there aren’t any windows, but there is a toilet (no toilet seat or paper) and a shower.

The solitary cell is home to a single prisoner, twenty-three or twenty-four hours a day; the extreme isolation and sensory deprivation imposed by the cell can last for days, months, years, or decades on end. Someone who visits a solitary cell might not notice the feces or the urine that leaks from the cells above, down the walls into a puddle on the floor. He or she would not be shown prisoners mutilating themselves or fighting guards or one another to the death, or men in their underwear, or naked, shackled by their hands to the bottom of bunks, deprived of books, paper, radio, pens, or pencils. I have represented a range of defendants in constitutional and criminal cases during the last fifty years, and my clients who have spent time in solitary consistently testify to having witnessed, or been subjected to, these abuses.

Anti-suicide smocks are effective, sort of…

An article that I found in Boston Magazine discussed how a rash of suicides in the Massachusetts prisons had led to adoption of anti-suicide smocks.

Billerica House of Correction bought smocks after a rash of eight prison suicides in Massachusetts in 2010. According to the Middlesex Sheriff’s Office, Billerica had 11 suicide attempts that year, and after The Boston Globe reported that, in 2010, Massachusetts prison suicides were four times the national average, re-evaluation and re-training occurred in facilities throughout the state. Also adding fuel to the fire was a study in 2007 by the Justice Department finding that “64 percent of inmates across the country reported mental health problems within the past year.” That meant more and more facilities were housing troubled—and not just dangerous—people. In 2013, two years since Billerica instituted the smocks, the suicide rate dropped to zero.

Suicide prevention without anti-suicide smocks

The Boston Magazine article also discussed how suicides and been reduced without anti-suicide smocks:

If there is another way, maybe it’s along the lines of what’s being done at the Hampden County Correctional Center (HCCC), a House of Correction that serves Springfield, Chicopee, and Holyoke. HCCC has had zero suicides in the past 20 years. Spokesperson Rich McCarthy says HCCC has gone in another direction in their Seg Unit. Their website discusses how the facility aims to “counter the mental deterioration that can take place in lockdown” by a number of behavioral “carrots” including offering “in-cell programming for one hour, twice a week, through the use of an MP3 Headset System.” Similar to electronic books, the Seg Unit offers a variety of meditation, classical and contemporary music, “how to” and instructional-type material on their headphones. All prisoners stay in their regular orange or green jumpsuits.

A better solution to preventing suicide than anti-suicide smocks or MP3 headset systems

Serious structural dysfunction in the American approach to suicidality and the severely mentally ill leads to many vulnerable persons being placed in jails, rather than having access to beds in units specifically designed for their needs – or having services organized so that inpatient stays are not needed for many patients or more readily available for those who do. The real solution to suicidality in American prisons is to allow ready access to appropriate mental health care in the community, especially the now scarce inpatient beds.