Thesis Formatted

DEATHS IN CUSTODY IN CALIFORNIA

A Thesis

Presented to the faculty of the Division of Criminal Justice

California State University, Sacramento

Submitted in partial satisfaction of the requirements for the degree of

MASTER OF SCIENCE

Criminal Justice

Andrea Gutierrez

SPRING 2018

Andrea Gutierrez

DEATHS IN CUSTODY IN CALIFORNIA

A Thesis

Andrea Gutierrez

Approved by:

______, Committee Chair Tim Croisdale, Ph.D.

______, Second Reader Kim Schnurbush, Ph.D.

______Date

iii

Student: Andrea Gutierrez

I certify that this student has met the requirements for format contained in the University format manual, and that this thesis is suitable for shelving in the Library and credit is to be awarded for the thesis.

______, Graduate Coordinator ______Sue C. Escobar, J.D., Ph.D. Date

Division of Criminal Justice

Abstract

DEATHS IN CUSTODY IN CALIFORNIA

Andrea Gutierrez

Deaths in custody are increasing every year in the United States. Few studies have thoroughly researched the effects national and state laws have on deaths in custody. This study evaluated the different categories of the deaths in custody reports submitted to the

United States General Attorney in California. The following study compared 16,101 female and male deaths in custody between 1980 through 2015 in California to understand the causes of deaths in custody. Using a series of tables and figures to illustrate the different categories, the study found whites are more likely to die from a natural cause in California.

______, Committee Chair Tim Croisdale, Ph.D.

______Date

ACKNOWLEDGEMENTS

These past three years in Sacramento have helped me become a stronger woman.

Saying “thank you” is not enough for my loved ones who have been by my side as I go through this journey. I want to first thank my family for the endless support and encouragement through my journey. I always joke that I have the strictest parents, but their strictness has helped me achieve all my goals. Thank you to my mom and dad who have always pushed me to never give up and to pursue what I want. My parents never limited my goals and dreams, and I will be forever grateful for their continuous support.

To my four brothers who always tested my patience, but somehow kept me motivated to become a sister they will be proud of. Thank you, I love you all.

Thank you to all my friends who supported me to finish this thesis, because they know my passion for education. I have made lasting friendships while being in

Sacramento. Moreover, thank you to the Criminal Justice faculty who have helped me achieve my full potential through this Master’s program. I am so honored to have met all the wonderful faculty and staff that have supported my goals. Thank you to Dr. Croisdale for helping me perfect this thesis. Thank you to Dr. Schnurbush for encouraging me to never give up on my goals, and always having a cheerful smile. Thank you both for helping me finish this thesis before my career started!

It truly is a blessing to have the support and love from family and friends throughout this journey, and future journeys that life has in store. Thank you all, from the bottom of my heart for the unconditional support I have received.

TABLE OF CONTENTS Page

Acknowledgments ...... vi

List of Tables ...... viii

List of Figures ...... ix

Chapter

1. INTRODUCTION ...... 1

Statement of Problem ...... 5

Purpose of the Study ...... 5

Hypothesis ...... 7

Terms and Definitions ...... 8

Organization of the Study ...... 9

2. LITERATURE REVIEW ...... 10

Deaths in Custody ...... 11

Health Care in Prisons and Jails ...... 18

Mental Health of Inmates ...... 24

Suicides in Prisons and Jails ...... 32

Law Enforcement Training and Use of Force ...... 38

3. METHODOLOGY ...... 42

Scopes and Limitations ...... 45

4. DATA ANALYSIS ...... 47

Deaths Occurring between 1980-2015 ...... 47 vii

Race of Deaths in Custody ...... 49

Deaths in Custody by California County ...... 51

Reporting Agency ...... 54

Manner of Death in Custody ...... 55

Means of Death in Custody ...... 56

5. CONCLUSION ...... 59

Implications for Future Research ...... 61

References ...... 64

viii

LIST OF TABLES

Tables Page

1. Race and Ethnicity of Deaths in Custody.……….………………………………. 50

2. Deaths in Custody by California County ...... 52

3. Deaths in Custody by California Agency.…….…………………………………. 55

4. Manner of Death in Custody………………….……… . …………………………. 56

5. Means of Deaths in Custody ...... 57

LIST OF FIGURES Figures Page

1. Deaths in Custody in California between 1980-2015……………………………. 49

Chapter 1

Introduction

Typically, civilians do not think about inmates, especially the inmates that die while in custody. Deaths in custody are a reality, but many do not bat an eye when a death takes place in a jail cell. In 1961, California State Senator Grunsky referred an Act to add section 12525 to the Government Code (Reuter, 2018). California’s Government

Code Section 12525 mandates that any deaths occurring while in the custody of law enforcement be reported to the Attorney General within 10 days, and these reports must include the determined cause of death. The reports are submitted annually and are available to the general public. The importance of the annual reports is that they aid in informing the public as well as researchers about the causes of deaths in custody.

In 2013, United States Congress passed the Death in Custody Reporting Act that requires all states to report any death in custody to the United States Attorney General.

The reports help increase the safety of both law enforcement officers and inmates. Deaths caused by excessive use of force can be reduced by educating officers on the main causes of death among individuals while in custody. Additionally, the reports bring awareness to the number of inmate deaths that occur every year while in custody.

In April 2015, California Government Code Section 12525 was amended by

Assembly Bill 619. That bill changed the title of the government code to Reports: Uses of force and deaths in law enforcement custody by Weber (2015), which defines custody to include when a person’s freedom is curtailed or limited by any law enforcement official.

The amendment defines the use of force as force that results in the contribution to medical treatment or hospitalization. Suspects detained by law enforcement officials should not need medical attention due to use of force by arresting officers.

It is important to note how the use of force was added to California Government

Code 12525. This change could have possibly come from researchers realizing the excessive use of force law enforcement officers are using when arresting suspects. Since

2003, data collected as deaths in custody show increases due to the police use of force

(Flosi, 2011). From 2003 to 2005, the National Institute of Justice reported 1,095 deaths in custody due to law enforcement use of force across the United States (Flosi, 2011).

Law enforcement officers only use excessive use of force when suspects are non- compliant.

Although AB 619 addresses the use of force by law enforcement personnel, it does not address reporting mentally ill suspects. Those identified as mentally ill should be seen by mental health professionals to prevent further injury to themselves or others around them. Addressing the needs of mentally ill inmates can bring awareness to law enforcement personnel to reduce the risk of injuries while in custody.

Beginning January 2018, AB 619 will require each state and its local law enforcement agencies that employ peace officers to submit a report to the Attorney

General on the use of force by that agency’s sworn personnel (Weber, 2015). The last addition to AB 619 is important as it holds all types of law enforcement officials accountable for any additional injuries they cause during an arrest. The goal is not to

punish the law enforcement officials for using force, but rather have them learn from these encounters and be trained to reduce the use of force.

On the night of March 22, 2017, in Cathedral City, California, Susan Wentworth woke up to Phillip Garcia breaking into her home and threatening to kill her. When

Riverside County Sheriff’s Department arrived, they violently threw Garcia on the floor before arresting him. Garcia was arrested on suspicion of assault with a deadly weapon, battery, vandalism and resisting arrest. On March 24th, he was pronounced dead inside a secured detention unit at the Riverside University Health System in Moreno Valley.

Garcia’s family is now suing the Riverside County Sheriff’s Department for excessive use of force on Garcia the night of his arrest that left him bloodied after the assault

(Marx, 2017). Phillip Garcia’s family told investigators that Garcia was in the middle of a mental crisis and possibly suffering from a seizure during the break-in. Riverside

Sheriff’s Sergeant Wallace Clear commented to news reporters that Garcia experienced a medical emergency while being housed at the hospital, but it is unclear as to why Garcia was housed in the hospital rather than a jail cell while awaiting his court date

(Montgomery, 2017).

Garcia’s story is not uncommon. As for the Riverside Sheriff’s Department,

Garcia is the third person this year to die while in custody (Marx, 2017). Deaths in custody can be due to different reasons, including natural causes, self-injury, substance abuse, injury from others, or lack of medical attention, which can lead an inmate to die while in custody. However, inmates are most likely to have mental health problems, which can negatively affect their treatment while in custody (Walters & Crawford, 2013).

Many suffer from mental illnesses that are not easily recognizable. For example, mental illnesses like bipolar disorder, depression, psychotic crises, or schizophrenia are not easily identified by law enforcement officers while responding to emergency calls. Even before inmates are booked into jail, law enforcement officers are typically not able to identify an individual having a mental breakdown. Law enforcement officers sometimes use excessive force to detain people with mental health problems depending on how the officers assess the threat.

According to Lurigio and Kerle (2015), mentally ill inmates make up about 18 percent to 20 percent of the jail population, which means for roughly one in five total inmates suffer from a mental illness. Walters and Crawford (2013) explain how inmates with major mental illnesses (MMI) are more likely violent due to a third variable. The third variable that is common in Walters and Crawford’s (2013) study is substance abuse of drugs. However, before inmates are booked, it is difficult for many law enforcement officers to know a suspect’s state of mind when responding to a call. Many suspects will get violent with law enforcement officers, which causes the suspects more harm. When suspects are booked, many do not receive medical attention while in custody that can often lead them to act erratically and at times suicidal (Wilper et al., 2009).

As more research is published on deaths in custody, there are many categories that are intertwined within this subject. Understanding the different factors, like medical attention, mental health status, and the use of force, will help researchers and politicians decrease the deaths of inmates across the United States. Ultimately, deaths in custody rasie several questions within current literature and academia. How have these deaths in

custody changed over time; how can the number of deaths be reduced; and what are the leading causes of death?

Statement of Problem

Between 2001 and 2013, California’s jails and prisons reported 4,790 deaths occurring while in custody (Noonan, 2015). That is an average of 400 deaths per year in a

12-year span across California’s jails and prisons. That number is alarming. Researching the number of deaths reported while in custody is essential. However, the hardship of investigating a death in custody is identifying the main cause of death, which has been a problem since deaths in custody have been reported (Flosi, 2011). The fluctuation of deaths across a time span can be a result of laws passed to reduce these numbers, better health programs for inmates, reducing use of force, or educating law enforcement officials of mental health illness among the suspects. Understanding what programs or laws help to reduce deaths in custody is crucial in decreasing the number of deaths throughout California’s jails and prisons.

Purpose of the Study

Research in this field is limited. Deaths in custody are not always reported accurately or in a timely manner, which causes a hardship for researchers in this area.

Inmates continue to die every year while in custody at an alarming rate. Each state reports deaths in custody differently, but there has to be uniformity across all states when handling deaths in custody. As Flosi (2011) states, the difficulty in investigating these deaths can cause more ambiguity of deaths in custody.

This study seeks to understand how legal changes across time in California have impacted the deaths in custody. It is important to examine how deaths in custody can be prevented. While not all deaths are a direct effect of legal change, studying programs and mental health problems can help reduce the number of suicides that occur while in custody. Additionally, understanding the main causes of deaths in custody can help law enforcement personnel, correctional staff, inmates and their families reduce deaths in custody.

An example of a program that can reduce deaths while in custody is the Crisis

Intervention Team (CIT) explained by Lurigio and Kerle (2015). This program was introduced in the state of Ohio to educate court and jail personnel on how to better approach inmates while in custody and to recognize signs of mental illness. Programs like

CIT can help reduce the number of deaths in custody with proper training. Similar to

CIT, Adams and Ferrandino (2008) argue for better mental health assessments of inmates when entering jail or prison to improve the identification of mentally ill inmates. The changes that are proposed by Lurigio and Kerle (2015) and Adams and Ferrandino (2008) are crucial in helping the mentally ill inmates that are incarcerated in a world that worsens their mental conditions.

As this study examines deaths in custody across California, it will contribute to the literature by identifying the changes of deaths in custody occurring as a result of national and state legal changes. In doing so, this study can help other states review the number and reasons for deaths in custody to better understand and reduce these deaths.

Moreover, this study can help identify the main causes of deaths in custody.

Open Justice is a transparency initiative that is led by the Department of Justice to publish criminal justice data. The California Department of Justice informs the public about criminological data acquired throughout the state in order to create better policies, hold the department responsible, and improve public policy. Open Justice publically posts data sets regarding crime, arrests, deaths in custody, hate crime, homicide, juvenile probation, and complaints of use of force. This research will analyze the 2016 data set of all recorded deaths in custody from every jail in California between 1980 to 2015. In

Chapter 3, this data will be reviewed in order to see the changes that have occurred between 1980 to 2015.

Hypothesis

Studying the deaths in custody in California between 1980 to 2015 will show the changes across time of reports submitted to the United States Attorney General.

H1 Reports of deaths in custody will increase as laws and acts are passed to help the reporting of deaths in custody.

H0 Reports of deaths in custody will remain constant as laws and acts are passed.

H1 will be tested by comparing the reports of deaths in custody submitted each year to the

Attorney General. Using a double line graph, the increases or decreases will be noted each year then compared to the year laws or acts were passed regarding death in custody reports. H0 will be proven right if the deaths in custody reports remain the same between

1980 through 2015. Additionally, several other reported demographics within each report will be examined to better understand causes of deaths in custody in California.

Terms & Definitions

To aid the reader in understanding the study, there are terms that need to be defined. Custody is used to reference when an individual is under supervision by law enforcement officials, whether in transit to a hospital or in a jail cell. AB 619 explicitly states when the freedom of an individual is limited by a law enforcement official, the arresting law enforcement official is responsible for the well-being of the individual.

The definitions for the manner of deaths needs to be stated. There are 10 terms that are used in the data set that will be used in this thesis. Pending Investigation is used when the information is pending at the time the report is submitted to the Department of

Justice. Natural is used when an inmate dies due to natural circumstance such as old age, chronic illness, or disease. Accidental is a result from an injury caused by an unforeseen, unplanned, or negligent circumstance. Suicide is reported when an individual takes one’s own life voluntarily and intentionally.

There are four different categories for homicide within the reports.

1. Homicide, Willfull (Law Enforcement Staff) is a death at the hands of a law

enforcement officer that is determined, upon investigation, to be willfull.

2. Homicide, Willfull (other inmate) is a death at the hands of another inmate

that is determined to be willfull.

3. Homicide Justified (Law Enforcement Staff) is a death at the hands of a

law enforcement officer that is determined to be justified after

investigation.

4. Homicide Justified (other inmate) is a death at the hands of another inmate

that is determined, upon investigation, to be justified.

Lastly, execution is defined for the inmate who is condemned to be executed by order of court. Cannot be determined is used when a subject’s death cannot be determined. Law enforcement officials use other when an inmate dies and the cause of death does not fit into the categories listed above. These terms are defined to understand the terminology used when deaths in custody are reported.

Organization of the Study

Chapter 1 has explained the purpose of this study, the methodology, and the terms that are used in this research. Chapter 2 provides a relevant review of literature regarding effects of incarceration and research studies that explain possible causes of in custody deaths. Chapter 3 will explain the methodology used in this study, along with the analysis of data. Chapter 4 examines the results of the analyzed data. Finally, Chapter 5 offers a summary of the research presented in this study, a discussion of limitations, and possible future studies.

Chapter 2

Literature Review

On any given day, there are 1.5 million Americans imprisoned (Wildeman,

Carson, Golnelli, Noonan, & Emanual, 2016). The United States has the highest number of prisoners per capita than any other country in the world (Fazel & Baillargeon, 2011).

The correctional system has grown so rapidly that it can be compared to the American system of higher education (Massoglia & Pridemore, 2015). This large number should prompt interest in the health and wellbeing of jail and prison inmates (Wildeman, et al.,

2016). Most deaths in custody are isolated from the public, but if there is a systematic problem, these deaths should be known (Vaughan, Zabkiewicz, & Verdun-Jones, 2017).

Deaths in custody are an important problem in the correctional system of the United

States. These deaths often occur without an obvious cause to reporting officials, which can falsify recorded data (Nugent, Orellana-Barrios, & Buscemi, 2017). Understanding the relationship between health and the causes of deaths in custody has not been well researched (Vaughan et. al, 2017). A study by Vaughan et. al (2017) emphasizes that the challenge of preventing deaths in custody is the increase of the vulnerability of mentally ill inmates in the criminal justice system. Additionally, any patterns or trends relating to deaths in custody should cause concern for healthcare professionals and correctional staff

(Carter & Goodwin, 2013). The following literature will review recent studies in this field covering topics such as deaths in custody, health care in prisons, mental health of inmates, suicides in prisons and jails, and the impact law enforcement officers have on

the deaths of inmates. The five topics reviewed below will aid in understanding the reasons for deaths in custody.

Deaths in Custody

Between 2001 and 2006, roughly 3,000 inmates died each year while in the custody of state prison facilities across the United States. An estimated 1,000 inmates died while in custody at jails (Lloyd, 2012). Moreover, suicide is the leading cause of death in prisons and jails, which accounts for half of all types of deaths (Fazel &

Baillargeon, 2012). Grant et al. (2007) studied the past two decades of deaths in custody to attempt to find a causal factor or factors of cause of death. In doing so, Grant et al.

(2007) found that before 1980, deaths in custody were not thoroughly reported, but beginning in 1980, deaths in custody were categorized as undetermined or natural causes.

The study done by Grant et al. (2007) is an example how deaths in custody have not been recorded properly due to the missing information in reported deaths. There still is not a solution suggested for decreasing the deaths in custody.

The creation of the Death in Custody Reporting Act (DICRA) in 2000 was an initiative by Congress to create uniform reporting of inmate deaths across the country

(Lloyd, 2012). A state is eligible to receive a ‘truth-in-sentencing’ incentive grant by reporting the deaths in custody. The legislation passed by Congress does not contain any penal sanctions for states that do not report deaths in custody. The punishment for states that do not comply results in the loss of the grant. The DICRA expired in 2006 and was not renewed again until 2009.

States continued to comply by reporting the deaths to the Bureau of Justice

Statistics (BJS) (Lloyd, 2012). The BJS created the Deaths in Custody Reporting

Program (DCRP) to collect the records of deaths in custody, even though states were not mandated to do so. In an effort to collect the deaths in custody reports accurately, Zeng et al. (2016) sought to compare the deaths recorded by the DCRP and the National Death

Index (NDI). Zeng et al. (2016) found the DCRP did not collect information on the manner of deaths for suicides, like hanging, until 2008 and the same for drug intoxication until 2009. Moreover, Zeng et al. (2016) found there were higher rates of missing data for deaths occurring in jail than in prisons. Comparing the deaths recorded between the

DCRP and the NDI, Zeng et al. (2016) evaluated the feasibility of combining the two programs in order to record all deaths correctly and accurately. The linking of the DCRP and the NDI reports has proven to be efficient as the percentage of cases that were unable to be matched declined over time from 7.3 percent in 2007 to 5.8 percent in 2010 (Zeng et al., 2016). Combining these two programs has helped to bridge the gap between the missing and unknown deaths in custody.

Representative Bobby Scott introduced the DICRA of 2009 to create a bill, not an amendment. The DICRA passed in 2013, and it broadens the reporting requirement to include federal law agencies. Additionally, it requires the Attorney General to study and report on the information produced in compliance with the new DICRA (Lloyd, 2012).

The information gathered should be used to improve current legislation on the deaths in custody across the United States.

Although Congress requires states to report the deaths in custody, there is no uniformity among states. Lloyd (2012) explains states report deaths in three general categories: investigation, reporting, and notification. States with investigative components generally promote transparency and accountability of reporting deaths in custody. Texas, New York, and Kansas are used as models for promoting transparency and accountability with each death in custody. The state of Texas records the entire investigative process, which requires the facility employee in charge to notify the nearest justice of the peace and report it to the local district judge. In New York, the Correction

Medical Review Board investigates the cause and circumstances of any death in a correctional setting (Lloyd, 2012). It is important for a trained medical investigator to research what was the cause of death in order to understand what occurred and what lead to the inmate’s death. Many states report inaccurate cause of deaths, which can impact research and legislation. Lastly, the Kansas Bureau of Investigation is required to investigate the death and report its findings to the Senate Judiciary Committee and the

House Corrections and Juvenile Justice Committee of the Kansas legislature (Lloyd,

2012). The deaths in custody that occur in Kansas’ jails and prisons are reviewed and researched by legislators that can influence legislation to decrease in deaths in custody.

California, South Carolina, and Tennessee have statutes, which lack the investigative component, but require more than a notice of death (Lloyd, 2012). The

California statute requires the agency in charge of the correctional facility to report a death in custody directly to the Attorney General, as mandated by the Californian

Government Code Section 12525. South Carolina requires deaths to be reported to the

Jail and Prison Inspection Division of the Department of Corrections. If deaths are not reported, the facility will be charged with a misdemeanor and a fine (Lloyd, 2012).

Unfortunately, there is no information as to what is done with the reports after they are submitted to the Jail and Prison Inspection Division. The state of Tennessee requires the reports of deaths be submitted to the Commissioner of Corrections and the state senator

(Lloyd, 2012). States such as California, South Carolina, and Tennessee are recording and reporting these deaths, but there have been not any investigations regarding the cause of deaths, which can hinder these states from understanding the cause of deaths among inmates.

Georgia, New Hampshire, and Oklahoma require the medical examiner be notified so that he or she may determine the cause of death in all cases involving deaths in custody (Lloyd, 2012). Colorado and Nebraska require the local coroner to make the determination on a death (Lloyd, 2012). If the local coroner is determining the death, then these states are failing to investigate and report these deaths to the state. Massachusetts requires any person with knowledge of a death in custody to notify the chief medical examiner of the location and the known facts of the death (Lloyd, 2012). States that are identifying an inmate’s death and failing to investigate the cause of death will not be able to decrease the deaths in custody nor will they improve the correctional system.

Wangmo, Ruiz, Sinclair, Mangin, and Elger (2014) interviewed 33 participants which consisted of lawyers and forensic doctors who worked in the prison context regarding the investigations of deaths in custody. Wangmo et al. (2014) found that conducting an autopsy for all the deaths in custody irrelevant of the cause of death could reveal the

systemic causes of deaths within jails and prisons. Therefore, states that only state the death of an inmate can be more proactive by identifying the cause of deaths, whether the cause is due to medical symptoms or systematic conditions.

These are just some examples of states that do more than required by law or do the bare minimum required when a death in custody occurs. New York is the only state to be the most transparent and accountable in reporting the deaths in custody. Roughly half of the states across the country address the issue of deaths in custody (Lloyd, 2012).

Reporting the deaths in custody can be beneficial to state correctional facilities and to

Congress, because the reports will help institutions realize the best models of reducing deaths in custody, while still being transparent with the public. States should report the deaths, communicate with other states, and share information to help reduce the deaths in custody across the nation. Lloyd (2012) recommends a more proactive system of corrections, in which our current correctional policies should be more focused on what is wrong rather than wait to address a problem.

As more research continues to evolve on the deaths in custody, there is a common suggestion among the literature for a standard definition of deaths in custody. Due to the inconsistent definition of deaths in custody, research on this issue is limited. Ruiz,

Wangmo, Mutzenberg, Sinclair, and Elger (2014) argue for a definition to include different causes of deaths and deaths that could be related to the prison environment.

Ruiz et al. (2014) conducted semi-structured interviews of experts who have knowledge of legal, ethical, criminological, and/or forensic factors related to deaths in custody. The interviews consisted of open-ended questions in order to collect information pertinent to

deaths in custody. The qualitative methodology used by Ruiz, et al. (2014) describes three themes that arose when discussing deaths in custody: actual place of death, different causes of deaths, and preventive solutions.

Ruiz et al. (2014) aimed to define deaths in custody, but there are hoops that prisons, jails, and police departments will go through to avoid reporting a death in their custody. For example, Ruiz et al. (2014) found some prisons and jails will transport an inmate to another jail or prison when he is severely sick to avoid the death in their jail or prison. A death that occurs during transportation should be associated with the jail or prison that was transporting the inmate. Ruiz et al. (2014) argued for “natural” deaths to be included in reports of deaths in custody. Inmates may die due to an unavoidable cause or chronic illness, and some correctional and police departments will not report those deaths. Moreover, Ruiz et al. (2014) argue the deaths of sick inmates may be due to a lack of medical treatment and necessary care, and these types of deaths should be included in the definition. Including the place and cause of death as part of the definition ensures authorities will report the death of an inmate at any stage of custody, even while in transport to a local hospital or another jail or prison.

An important study to review is one done by Okoye, Okoye, and Lynch (2012) in the state of Nebraska. The researchers studied five different causes of deaths in custody: natural deaths from cardiac arrhythmia, suicide from overdose, suicidal hanging, natural death from hemorrhage, and homicidal death due to restraints. Okoye et al. (2012) began by explaining deaths in custody were a rare occurrence in Nebraska. During the study, researchers learned the causes of these deaths and sought to reduce the deaths. Local and

state law enforcement officials instituted suicide prevention procedures in all correctional facilities (Okoye et al., 2012). Law enforcement agencies in Nebraska participated in several training workshops about different types of physical restraints since 2003, which has also contributed to the decrease in deaths in custody (Okoye et al., 2012). Okoye et al. (2012) state that deaths in custody are rare and often preventable events.

Research is limited to female inmates. As females only compromise a small percentage of inmates across the nation, it is often difficult to conduct research on female inmates. Wildeman et al. (2016) conducted a study on the mortality rates of white, black, and Hispanic males and females between 2001 through 2009. Wildeman et al. (2016) found Hispanic females are the population who had the least amount of deaths while incarcerated. Wildeman et al. (2016) hypothesized Hispanic females had a low mortality rate in prison due to the high mortality rate Hispanic females experience outside of prison. The study done by Wildeman et al. (2016) is a small glimpse of female inmates in prisons and jails.

Deaths in custody are not a rare occurrence. The responsibility of an inmate’s death does not rest solely on the correctional faculty or the police officers, but rather on the entire nation. Assuring the deaths in custody are recorded appropriately and efficiently can help researchers, state officials, and Congress to help in reducing the amount of deaths that are happening every day across the nation. A universal definition of deaths in custody is crucial to reduce the deaths in custody.

Health Care in Prisons & Jails

Throughout the past 30 years, the number of inmates in jails and prisons across the United States has increased, yet their health status has worsened (Bryant, 2013).

Every inmate has the right to be treated humanely and the right to have their life protected even while in custody (Wangmo et al., 2014). An inmate’s death while in custody is likely to occur when he or she is treated inhumanely and without adequate health care. Surprisingly, health care in jails and prisons was not always mandatory in the

United States. The Eighth Amendment to the United States Constitution requires that prison officials provide a system of readily access to health care (Aufderheide & Brown,

2005). In 1973, inmate J.W. Gamble injured his back while doing intensive farm work in a prison in Texas (Simon, 2013). Gamble received medical assistance, but was not fully healed before he was forced to go back to work; however, he protested not to go back to work in the fields of Texas (Simon, 2013). As a result of the protest, Gamble was placed in segregation where he developed his second medical condition, high blood pressure

(Simon, 2013).

After not receiving proper health care, Gamble filed a pro se petition with the prison. Estelle v. Gamble (1976) established that persons in a correctional setting are entitled to health care because they cannot freely arrange it on their own (Maroney,

2005). In doing so, Estelle v. Gamble established adequate health care for inmates, to include mental health care. The Court granted inmates a clear right to medical access, but failed to dictate what constituted adequate health care for inmates (Simon, 2013).

However, the funding for correctional health care has not kept pace with the increasing

number of inmates. Moreover, the sparse funds that are allocated to the correctional system are divided up among all correctional facilities (Bryant, 2013). The lack of funding decreases an inmate’s chance of receiving the proper health care while in custody.

Inmates are not the only group affected by the minimal funding allocated to correctional facilities. Correctional nurses within the jails and prisons are also impacted by the lack of funding, which can negatively affect the medical attention inmates receive.

Correctional nurses are often not prepared or educated on the responsibilities jail and prison inmates require. The training and education of correctional nurses is limited, even though correctional nurses are considered to be the backbone of correctional health care system (Maroney, 2005). Nurses are expected to help inmates with any medical problem, while still maintaining a secure environment.

It is often difficult for correctional facilities to staff nurses and physicians because health care in prison is not widely accepted in society and the pressure on medical professionals to deal with all types of health problems. Maeve and Vaughn (2001) explain why correctional facilities are very difficult to staff in order to provide health care for inmates. Correctional nurses and physicians have lower salaries compared to medical staff in the free world. Not only is the salary not attractive, but the location and resources available to nurses and physicians is very limited and remote, which makes the employment even less desirable (Maeve & Vaughn, 2001). One of the most important factors that contributes to the hardships of hiring medical personnel in correctional facilities is the value of these positions. Maeve and Vaughn (2001) explain correctional

nurses and physicians are not valued among the general public and not highly prized among health professionals. The lack of support from the professionals in their field and from society creates an obstacle that correctional nurses and physicians have to overcome every day.

It is often difficult for nurses to practice different elements of health care in one setting. Zimm (1998) explained how correctional nurses often wear multiple hats while in jails and prisons to include: elements of outpatient care, emergency nursing, psychiatric- mental health, occupational health, and community health (as cited in Maroney, 2005).

Correctional nurses work in a difficult environment, which is not always supported by our community or lawmakers. It was not until 1985, the American Nurses Association first published standards for nursing practices in correctional facilities, and was later updated again in 1995 (Maroney, 2005).

Correctional nurses often deal with the pressure of security, victimization, manipulation, and violence from the inmates they are attending to. Nurses who were interviewed by Maroney (2005) stated there were times when they were not able to help inmates due to security reasons, or inmates were not able to be taken to the hospital due to low correctional officer staffing. Nurses face victimization because they are often powerless in the environment and are often ignored, disrespected, and constrained by correctional staff and administration while trying to do their jobs (Maroney, 2005).

Inmates attempt to manipulate nurses into getting what they want instead of what they need. Lastly, the threat of violence is always high in jails and prisons. Nurses interviewed by Maroney (2005) explained it was good to have positive relationship with the

correctional officers, but it was often difficult when the officers used excessive violence on inmates that required medical help. Correctional nurses are held responsible for the health of inmates even if it is beyond their knowledge.

Even with correctional nurses going beyond what is expected, the health care of inmates is still inadequate. Prison populations are known for having high rates of medical problems that continue to contribute to the poor prisoner health (Vaughan et al., 2017).

Inmates have high rates of chronic medical conditions, like substance abuse and mental illnesses (Wilper et al., 2009). There is limited research on the medical treatment of inmates housed in federal, state, and jail facilities across the United States. Wilper et al.

(2009) seek to identify access to five health care measures within prisons and jails: access to medical examinations, pharmacotherapy, prescription medication, laboratory tests, and adequacy of acute care. Wilper et al. (2009) studied 800,000 inmates across the United

States and found inmates have one or more chronic medical conditions. Furthermore, their study found an inmate’s access to medical care appears to be poor, even more so in jails. Wilper et al. (2009) suggests making health care systems in prison nonprofit and autonomous from prison authorities, educating inmates on health issues, and increasing the availably of mental health treatment will improve the health care throughout all prisons and jails.

The growing inmate population increases the need for better health care within correctional facilities. Binswanger, Krueger, and Steiner (2009) explain the worsening health and increased risks of death of inmates when released from prison can be attributed to the lack of health care inmates receive while incarcerated. The study done by

Binswanger et al. (2009) researched how different socioeconomic factors like age, education, and birthplace affect the differences in medical conditions across inmates in jails and prisons and non-institutionalized adults. When inmates were compared to non- institutionalized adults, Binswanger et al. (2009) found inmates had lower odds of obesity, but higher odds of chronic medical conditions like arthritis, cancer, hepatitis, and hypertension. The results from Binswanger et al. (2009) study suggest that correctional facilities should consider improving the health care administered to inmates to reduce the chance of inmates developing or maintaining the chronic illnesses listed above. It is important for correctional staff and administration to understand that inmates need better health care because inmates will be released from jails and prisons with worsening health, which will burden our society.

More mentally ill patients began to move into state prisons and jails as the state asylums closed or reduced the number of beds available. Smith (2016) stresses the overwhelmed health care services in jails and prisons are not enough for the increasing number of inmates with chronic and acute illnesses. Providing health care services to inmates at times is very risky. Nurses face a constant battle between protecting the patient’s rights and causing deliberate harm (Smith, 2016). It is important to remember the safety of health care providers is a priority when treating inmates as inmates pose a threat to security. Bryant (2013) argues there is a debate about the quality, quantity, and type of health care prisoners should receive. Advanced practice nurses (APN) are challenged by the limited resources they receive, deciding what is medically necessary, the pressure of maintaining a safe environment, and avoiding the manipulation from the

inmates (Bryant, 2013). Bryant (2013) argues APNs should develop clinical guidelines, and specific health care programs for correctional facilities. In doing so, inmates can receive medical attention while incarcerated that can help reduce the possibility of death and better health upon release.

Inmates have the right to seek medical attention by professionals. Lindquist and

Lindquist (1999) studied jail inmates and their use of medical attention. Inmates who have long sentences are more likely to seek medical attention more frequently than inmates serving shorter sentences (Lindquist and Lindquist, 1999). It is argued that these inmates seek more medical attention due to the worsening of chronic illnesses while serving their long sentences. However, Lindquist and Lindquist (1999) found inmates also seek more medical attention as a change in routine from work duties, to deliver messages, or escape the monotony of incarceration (Lindquist and Lindquist, 1999).

Inmates who abuse their right to medical attention create a stigma for the inmates who actually require medical attention. The stigma can cause correctional physicians and nurses to provide inadequate health care for inmates who require it.

Harner and Riley (2013) conducted a study based on the mental health of incarcerated women in maximum security prisons. Women are often limited to the resources they need to treat their mental conditions (Harner & Riley, 2013). Female inmates indicated their mental health conditions worsened due to increased fear, stress, and the limited access to mental health services (Harner & Riley, 2013). Additionally, incarcerated women acknowledged they did not have control of their health care while serving time, and they were disempowered by the service professionals of the

correctional facility (Harner & Riley, 2013). Research regarding female inmates is not as prevalent as male inmate research. Even though females represent a small number of inmates across the country compared to male inmates, the health care in the correctional system needs to be addressed and improved.

The health care system within the correctional facilities needs to be improved.

Empowering and supporting correctional nurses can also improve health care for inmates.

Society may believe inmates do not need health care, but how can society expect inmates to be released and rehabilitated when they have higher rates of chronic illnesses than the general population? Improving the health care in correctional facilities will be more beneficial to society in the future.

Mental Health of Inmates

There was a period in California when people suffering from mental illnesses were able to receive help from their local mental hospitals. The Short-Doyle Act of 1957 helped those in need of help. The Short-Doyle Act allowed cities to establish local mental health services and the state would match the cost (Auerback, 1959). The Short-Doyle

Act helped to establish two different services for the community: three kinds of clinical facilities directly serving patients (outpatient services, inpatient services, and rehabilitation services) and two kinds of services promoting the mental health of the community (informational and educational services to the public and mental health consultation for public health departments, schools, probation officers, etc.) (Auerback,

1959). The Act allowed several counties to open mental health centers, but within a year, there were two pressing problems. First, there was a shortage of trained personnel at the

mental health centers (Auerback, 1959). Secondly, these centers were overwhelmed with demands and referrals from the community (Auerback, 1959). With the increasing demands, these mental health centers did not last long in the communities and hindered any support from the community to become permanent centers.

Today, jails and prisons serve as the new asylums. In 1963, President John F.

Kennedy signed the Community Mental Health Act. The Community Mental Health Act provided federal funding for the construction of community-based preventive care and treatment facilities (Pan, 2013). This Act was intended to have the community help the mentally ill citizens, as a community, and not solely on the shoulders of nurses. In 1980,

President Jimmy Carter signed the Mental Health Systems Act. Carter intended for this

Act to reconstruct the community programs for mental health and improve the services for the people suffering from chronic mental illness (Pan, 2013). However, within a year,

Carter’s goals for the country were squashed. In 1981, President Ronald Reagan signed the Omnibus Budget Reconciliation Act that repealed Carter’s community health legislation. The Act ceased state’s grants intended to provide services for the mentally ill.

The Reagan administration aimed to decrease spending, and by cutting the mental hospital budget, it led to a 30 percent spending decrease on mental health care that year

(Pan, 2013).

With the deinstitutionalization of mental health facilities, many mentally ill patients were placed within jails and prisons. According to Adams and Ferrandino

(2008), state hospitals had 550,000 psychiatric patients in 1956. After deinstitutionalization, there were about 61,700 patients left in mental health facilities in

the United States in 1996 (Adams & Ferrandino, 2008). As more mentally ill inmates enter the correctional facilities, their needs create challenges for the correctional staff and nurses. There are instruments and assessments used in order for correctional facilities to assess the new inmate’s security risk and mental health. However, Adams and Ferrandino

(2008) argue that the assessments are only beneficial for assessing inmate’s security threat level, as they do not help the mentally ill inmates. Adams and Ferrandino (2008) argue the assessments do not recommend the appropriate treatment, which is due to the lack of rehabilitative programs within prisons. Additionally, if the mental health assessments were continuous they could help to predict changes of the mental health of inmates (Adams & Ferrandino, 2008).

Deinstitutionalization across the United States has increased homelessness, decreased the number of psychiatric beds available, and has made police officers the frontline mental health workers (Stanek, 2012). More importantly, deinstitutionalization has seen an increase of violence from the mentally ill which are then housed in correctional institutions without the proper treatment (Stanek, 2012). In Hennepin

County, Minnesota, the Sheriff’s office has seen the negative effects of the incarcerated mentally ill inmates. As inmates wait for availability at the local mental health hospital in

Minnesota, the Sheriff’s Office has created a mental health unit to allow appropriate treatment for mentally ill inmates. These law enforcement officers receive extensive training on caring and treatment for the mentally ill inmates (Stanek, 2012). Jails across the nation should have more mental health units in order to reduce the harmful effects of the environment on mentally ill inmates. Jails cannot substitute as the appropriate

solution in housing mentally ill inmates as jails are not equipped to handle mentally ill inmates (Stanek, 2012).

Fazel and Baillargeon (2011) researched the health of prisoners and found a prevalence of mental disorders among inmates. There is more evidence of mental illness among inmates from high-income nations like the United States, than low-income countries like Mexico or Brazil (Fazel & Baillargeon, 2011). Roughly, one in seven prisoners has a treatable mental illness, but may not receive treatment due to funding

(Fazel & Baillargeon, 2011). Many mentally ill inmates are placed in solitary confinement because correctional staff do not know how to treat them, which only worsens the inmate’s illness. The use of solitary confinement for the mentally ill inmates exacerbates their preexisting conditions (Fazel & Baillargeon, 2011). The need for space in mental hospitals is crucial for helping the mentally ill inmates while they are incarcerated.

Inmates with mental health conditions are often forgotten about when they enter jail or prison cells. Wilper et al. (2009) found that a smaller portion of inmates with a mental illness were taking prescription drugs at the time of the arrest and were not given medication while they were incarcerated in jail. When inmates do not receive the proper medical attention while in custody, they can be severely affected. Inmates who suffer from schizophrenia and bipolar disorder do not receive psychiatric treatment when arrested or while in custody in jail (Wilper et al., 2009). Walters and Crawford (2013) note that some correctional facilities can have major effects on inmates with mental

illness. Environments, like jails and prisons, tend to aggravate the mental health conditions of inmates who are not medically treated.

As mentioned previously, inmates in jails and prisons are known for having higher rates of medical problems to include chronic psychological illnesses (Vaughan et al., 2017). A study done by Vaughan et al. (2017) examined the deaths in custody in a

Canadian prison, and found that mentally ill inmates are just as helpless as those incarcerated in the United States. Vaughan et al. (2017) found that 32.6 percent of all deaths in custody are attributed to a mental illness, and the percentage is due to a large number of inmates who suffer from a mental illness or substance abuse. Offenders with mental illnesses in prisons and jails often have multiple disorders and are more susceptible to being bullied by other inmates (Aufderheide & Brown, 2005). A difference between the Canadian and American correctional system is that the United States closed a majority of their asylums and the mentally ill do not have any other source of shelter or help.

Inmates who have a history of a mental illness and do not receive treatment while incarcerated are more likely to hurt themselves than inmates who are not considered mentally ill (Smith, 2016). The self-injurious behavior while incarcerated was studied by

Smith (2016) to understand the impact it has on inmates and correctional staff. Smith

(2016) found very few studies had researched self-injurious behavior in prison. Smith

(2016) interviewed one inmate incarcerated in high-level security prisons who had a history of self-injurious behavior (SIB). There are several common themes Smith (2016) found among inmates who exemplify SIB: extremely abusive family, substance abuse,

violence and trauma, prior history of SIB before incarceration, privately SIB, and co- occurrence. This finding is consistent with previous research in which studies indicate many SIB offenders enter correctional facilities with a history of SIB (Smith, 2016).

Rather than helping the inmates who practice SIB, correctional facilities often punitively punish them and place them in isolation, which can trigger past experiences of abandonment. Inmates who practice SIB need medical attention, and do not belong in a correctional facility. The mental health of these individuals worsens while being incarcerated who receive more punishment rather than help (Smith, 2016). There is agreement among professionals in the correctional facilities that these facilities are not well-equipped to support and treat mentally ill inmates who practice self-injurious behavior (DeHart, Smith, & Kaminski, 2009).

Personal and environmental factors are known to have a correlation among incarcerated individuals with mental illnesses. Walters and Crawford (2013) researched the correlation between major mental illness (MMI) and violent history (VH) to study if

MMI inmates are more prone to violence. They found that when MMI and VH are combined among inmates, there is a greater possibility of future disciplinary problems while incarcerated. Therefore, Walters and Crawford (2013) conclude that inmates and offenders with a history of a mental illness and violence should be high priority to correctional administrators and staff when receiving medical attention. While conducting the intake screenings, questions regarding mental health history and prior violence needs to be addressed thoroughly. Understanding how aggressive environments trigger cues

among the mentally ill in prison can help correctional facilities decrease the possibility of an inmate lashing out (Walters & Crawford, 2013).

There are prisons and jails that do not have any sort of standard for handling mentally ill inmates. Alabama’s correctional facilities were in dire need of improvement in order for mentally ill inmates to receive medical attention (Gater, 2008). A court order mandated Alabama’s correctional facilities to improve its correctional services for mentally ill inmates (Gater, 2008). As inmates are incarcerated, the jails and prisons in

Alabama were ordered to do thorough screening and evaluations to provide appropriate treatment and standard of care (Gater, 2008). The most common mental illnesses seen throughout the jails and prisons of Alabama include: depression and anxiety, schizophrenia, psychotic illnesses, bipolar disorder, and residual substance abuse issues

(Gater, 2008). These illnesses are heightened as inmates enter jails and prisons for the first time and are not treated accordingly. In the state of Missouri, the Correctional

Medical Services (CMS) offer specialized psychiatric units for those inmates whose illness require more treatment (Gater, 2008). The different programs implemented throughout the correctional facilities are costly and are dependent on the correctional staff, which are not fully supported by tax payers.

The U.S. Department of Justice created a special report on June 2017, regarding the problems of the mental health of prison and jail inmates. Bronson and Berzofky

(2017) reported the prevalence of mental health, specifically serious psychological distress (SPD) inmates experience while being incarcerated. More than half of the prisoners who had met the threshold for SPD had received treatment since entering a

correctional facility (Bronson & Berzofky, 2017). However, only 35 percent of the inmates interviewed at the time of the study were currently receiving treatment for a mental health illness that was categorized as a SPD (Bronson & Berzofky, 2017). Female inmates are at a higher risk of a mental illness while incarcerated (Bronson & Berzofsky,

2017). Bronson and Berzofsky (2017) researched the indicators of mental health problems reported by prisoners and jail inmates between 2011 through 2012. In the study,

Bronson and Berzofsky (2017) found an estimated 65.8 percent of female inmates in prison had a history of a mental health problem compared to an approximate 34.8 percent of male inmates. There were approximately 20.5 percent of female inmates in prison that suffered from serious psychological distress compared to 14 percent of male inmates

(Bronson & Berzofsky, 2017). The female inmates are two times more likely to have a mental illness than male inmates, but females are very underrepresented in the correctional setting. The report by the Department of Justice sheds light to the treatment of mentally ill inmates across prisons and jails in the United States.

As many inmates struggle with mental illnesses there is urgency for inmates to receive proper treatment while incarcerated. The correctional facilities have seen an increase of mentally ill inmates as deinstitutionalization has taken place across the United

States. Mentally ill inmates suffer from lack of medical assistance and the continuous self-injurious behavior of which many correctional staff do not know how to address. The self-injurious behavior and lack of medical attention often leads to suicide among these mentally ill inmates.

Suicides in Prisons & Jails

As Bonner (2000) stated in his research, society and health resources need to consider that the high rates of correctional suicides create a national health problem.

Suicides throughout jail and prison settings are the third most common death after natural causes and AIDS (Suto & Arnaut, 2010). As previously mentioned, the number of inmates with mental health illness has been steadily increasing in jails and prisons since the closure of many asylums across the United States. The number of suicides is not accurate, as many suicides in jails and prisons are categorized as accidental deaths (Suto

& Arnaut, 2010). Kupers uses the term “invisible suicides” to include the deaths that occur when inmates fight armed guards, tough prisoners, or failure to pay off debt within prison which lead to an inmate’s death (as cited in Suto & Arnaut, 2010). Whether suicides were obvious or invisible, they occur in prisons and jails every day across the nation.

According to Nugent et al. (2017), inmates who commit suicide in jail tend to be younger and only incarcerated for a few days. Young adults have higher rates of suicides in jail due to the uncertainty regarding their legal process, the jail environment, and the initial stages of confinement (Bonner, 2000). Prison suicides are partly influenced by the prison setting, as many unlivable prisons have higher suicide rates (Liebling, 2017).

Inmates suffer from suicide ideation. Suicide ideation is an important term as it relates to incarcerated individuals. Suicide ideation is defined as the suicidal thoughts individuals have to hurt themselves or commit suicide (Daigle & Naud, 2012). Suicide within prisons and jails is high in all countries (Daigle & Naud, 2012). Daigle and Naud (2012) study

suicide ideation as a phenomenon that is defined by two factors that influence or heighten suicidal thoughts based on an inmate’s life experiences. The first factor impacts individuals who break the law and are inherently more exposed to numerous risk factors for suicidal behavior. For example, inmates that suffer from a mental illness have more suicidal risks in which they have before, during, and after incarceration (Dailge & Naud,

2012). The second factor for high-risk suicidal inmates are affected by being imprisoned, which creates a new life event which stresses healthy individuals to a breaking point

(Daigle & Naud, 2012). The second factor is very dominant in new inmates who may not be accustomed to prison life. Daigle and Naud (2012) argue for programs to be created for individuals who are identified as suicidal while in prison as they are easily accessible rather than when they are released from jail or prison an inmate’s mental health is the first indicator to any suicidal behavior, which can be treated.

Similar to Daigle and Naud (2012), Smith, Selwyn, Wolford-Clevenger, and

Mandracchia (2013) also researched the increase risk of suicide between primary and secondary psychopathic traits. Primary psychopathic traits are theorized to be genetically influenced and have characteristics that lack of empathy, lack of remorse, and are egocentric (Smith et al., 2013). Secondary psychopathic traits arise as a result of environmental pressures like severe neglect, trauma or abuse that cause individuals to be antisocial, impulsive, and sensation seeking (Smith et al., 2013). These types of psychopathic traits have been known to increase suicide among inmates in jails and prisons (Smith et al., 2013). The results from the study done by Smith et al., (2013) indicated that individuals with secondary psychopathic traits are more likely to attempt or

commit suicide, due to the correctional environment. The two different types of traits are not easily recognizable as inmates enter jail or prison, which can influence the inmate to have suicide ideation.

Blaauw, Winkel, and Kerkhof (2001) studied the relationship between bullying and suicide among inmates in prisons and jails. Other researchers have studied the negative relationship between bullying and suicide. As previous studies found, when suicidal inmates were bullied, it increased the possibility of them committing suicide

(Blaauw et al., 2001; Liebling, 2002). Blaauw et al. (2001) found many victims of bullying included first time offenders, mentally ill inmates, and inmates with a history of suicide. The severity of bullying can really influence suicidal behavior among inmates

(Blaauw et al., 2001). Inmates who are mildly bullied may have interpreted it as a catastrophic event, which pushed them over the edge to commit suicide (Blaauw et al.,

2001). Jails and prisons should be able to recognize bullying among inmates, and separate the vulnerable inmates in order to decrease suicides in these correctional facilities.

Deaths in custody cause alarm for correctional personnel as they are responsible for inmates. Inmates are monitored and supervised throughout the day; therefore, suicides lead to signs of failure of each correctional facility (Camilleri & McArthur, 2008).

Blaauw et al. (2001) studied the bullying among inmates in correctional facilities.

Similarly, Liebling (2017) studied the bullying of inmates by the correctional staff and its effects on inmates. Unnatural deaths in prison are controversial, as inmates should have access to health care while incarcerated. In Liebling’s (2017) case study, an inmate

incarcerated in a segregation unit is repeatedly bullied by correctional officers. One day, the inmate decides to participate in a protest with others due to the unsanitary food they receive every day. The inmate suffered more staff bullying and intimidation after the protest. Days after the protest, the inmate was found dead in his cell; he had committed suicide due to the verbal abuse he received from the correctional officers (Liebling,

2017). However, the inmate’s investigation noted he had committed suicide due to the bullying of other inmates (Liebling, 2017). Instances in which correctional facility, inmates and staff are hurting the inmates are to be reported and addressed. Deaths in custody arise concerns and questions of accountability, quality of life, legitimacy, and the health of inmates (Liebling, 2017).

A problem jails and prisons face is appropriately identifying suicide risks while conducting a mental health assessment when inmates become incarcerated. A small minority of inmates manipulate the mental health system in order to get what they want, instead of what they need. The manipulation from inmates creates a stigma among health care providers that inmates do not require help, which leaves inmates who are actually mentally ill helpless. Smith et. al (2013) stress suicide ideation to be the primary indicator in assessments to help decrease the amount of suicides in jails and prisons. There are 34 studies showing that clinical factors have a clear correlation with suicide in custody to include suicidal ideation, a history of attempted suicide, and a present psychiatric diagnosis (Fazel & Baillargeon, 2012). If used correctly, appropriate mental health assessments can reduce the suicides in prisons and jails.

Camilleri and McArthur (2008) suggest some prevention strategies to reduce suicide among inmates suggested by based on the suicidal research done in Australian prisons. There are three main prevention strategies suggested be implemented in all jails and prisons in all countries. First, correctional facilities should provide a range of crisis- management options for inmates to help reduce inmate’s risks of committing suicides.

Second, correctional staff need to reduce the use of seclusion or solitary confinement among inmates, and instead provide therapeutic interventions for long term high suicidal risk inmates (Camilleri & McArthur, 2008). Finally, an important suggestion is to adopt a case-management approach with clear and precise mechanisms to help individuals reduce the risk of suicides (Camilleri & McArthur, 2008). Along with these suggestions, prisons and jails in the United States have created “profiles” of inmates who are more likely to commit suicide. The profile created includes demographics, prison context, personal experience, self-injury variables, and mental health status, which has helped to identify inmates who may be at risk of suicide. Camilleri and McArthur (2008) suggest

Americans apply these profiles to all inmates while they are entering the prison system, and share the profile so it can be practiced across the world.

The profile of suicidal inmates needs to be refined and improved. There are differences between suicide attempters and suicide completers in jails and prisons. The two types of suicide victims are generally under 25 years old, have attempted suicide before and have a history with substance abuse (Daniel, 2006). The difference between the attempters and the completers is in how these inmates carry out their acts; attempters will slice their wrists, while completers will use hanging or overdosing on drugs (Daniel,

2006). It is important to note that juveniles placed in adult detention facilities are eight times more likely to commit suicide than those place in juvenile detention facilities

(Daniel, 2006). Daniel (2006) outlines a suicide prevention program throughout the research to outline a program that will help reduce the number of suicides in jails and prisons across the nation. Roughly 30 percent of inmates who commit suicide do not have a psychiatric disorder and it is difficult to help inmates that do not show signs of suicidal thinking (Daniel, 2006). It is often difficult for intake assessments to label an inmate suicidal without the correct information, but it is more difficult to label an inmate suicidal if the inmate has never had any previous mental health problems (Fruehwald, Frottier,

Matschnig, & Eher, 2003).

Suicide prevention has become an important problem among correctional facilities. There are many factors that play a role in suicide among inmates, but if facilities are practicing prevention strategies suicides will decrease across time. Hayes

(2012) studied the difference of suicides in a 20-year span nationwide. In previous studies, more than half of inmates in jails were found to committed suicide within the first 24 hours of incarceration, but Hayes (2012) explains that less than a quarter of inmates commit suicide within 24 hours. Moreover, facilities that experienced more suicides had suicide prevention policies and intake assessments for inmates, but the prevention programs were found to be questionable (Hayes, 2012). As mentioned previously, intake assessments should be continuous for inmates as inmates change for better or worse. Suicide is an important factor to consider when discussing deaths in custody.

Law Enforcement Training & Use of Force

Law enforcement officers are the first point of contact with suspects. When responding to emergency calls, law enforcement officers do not know the mental health condition of the suspects (Vaughan et al., 2017). If the suspects are uncontrollable, police officers will use force to ensure their safety and the safety of the community. It is suggested that a better approach be practiced in order for police officers to be able to identify the warning signs of a mentally ill suspect. Vaughan et al. (2017) mention sharing more mental health information with police can possibly help front-line officers to use information appropriately when responding to calls. Additionally, educating the law enforcement officers and the correctional staff of the mental health of inmates can help reduce punitive punishment of the mentally ill inmates.

The definition and usage of excessive force by law enforcement personnel is routinely questioned by society. Excessive use of force is defined as “any force, such as the utilization of physical force, chemical agents, electronic control devices, or restraints that is above and beyond what is necessary to control a confrontational situation”

(Rembert & Henderson, 2014). Excessive use of force is not only used by police officers, but also correctional officers on prisoners. Excessive use of force often leads to severe injuries that can lead to death. Rembert and Henderson (2014) studied the use of force by correctional officers by analyzing legal cases under Hudson v. McMillian (1992), which set forth a determining liability for correctional officer’s use of force. In analyzing these cases, Rembert and Henderson (2014) found patterns of excessive use of force by correctional officers, which can assist prison administrators and staff to practice non-

deadly use of force methods to maintain order. Correctional officers typically use excessive force when they are unable to decipher a threat, and the use of force is intensified by the negative attitude of officers towards inmates (Rembert & Henderson,

2014). The safety of everyone in correctional facilities is top priority, which includes the safety of inmates. Correctional officers need training to assist them in assessing the threat of violence, not violence towards the inmates.

The use of force is decided by law enforcement officers within seconds. When the use of force leads to a death, it is scrutinized by the media and public, which creates a negative view of police officers. Flosi (2011) explains how police officers have to use more force than the force used against them, which is why officers are not usually injured when confronting suspects. Flosi (2011) studied the use of different weapons used by law enforcement officers that could cause a death in custody, and the training officers used to determine the appropriate detaining method. Flosi (2011) found the use of pepper spray or OC spray did not contribute to the cause of death, and that officers use it to lessen the threat towards them. Additionally, the use of TASERs also had a minimum impact on the deaths of custody as long as they were not shot near the heart of the suspect (Flosi, 2011).

Excited delirium is used as an explanation for sudden deaths in custody. Some police officers and doctors do not recognize excited delirium a medical term, but Ross and Chan (2006) define it as a syndrome that manifests itself with bizarre, violent, and agitated behavior that can be caused by substance abuse and mental illness (as cited in

Flosi, 2011). Excited delirium has been used more recently to explain sudden in custody deaths because more law enforcement officers are being trained to better handle the

mentally ill. When suspects suffer from a mental illness and have not received proper treatment, they often get into trouble with the law. Flosi (2011) explains when the mentally ill need treatment they often experience an excited delirium. The best option is to detain the violent suspects and help them get the proper treatment they need, but that can be dangerous for the suspects and the law enforcement officers. Inmates who suffer from a mental illness are often the victims of deaths in custody from lack of proper medical attention when entering correctional facilities.

The role of restraint has contributed to the recorded deaths in custody. Duxbury,

Aiken, and Dale (2011) sought to study national and international findings regarding safe and effective restraint techniques of aggressive and violent individuals. Vulnerable populations within the study included individuals who were more at risk from restraint due to their biophysical, interpersonal or situational factors. Between 1999 to 2010,

Duxbury et al. (2011) found there were no safe restraint positions without adding more risk, especially among the vulnerable groups. The safest way would be to have a violent individual in a room by themselves, however there is risk in getting the individual into the room against his will (Duxbury et al., 2011). Duxbury et al. (2011) suggests law enforcement personnel be trained in assessing individual’s health needs after suspects have been detained. It is important to keep close supervision on individuals who are restrained in order to prevent further trauma and possibly a death in custody. In the past, inmates who had committed suicide were often found approximately 30 minutes have the death when officers or correctional nurses came around to check in on inmates (Duxbury et al., 2011).

Ho et al. (2009) studied the deaths in custody due to police use of force by collecting all recorded deaths in custody across a 12-month period. During this time period, there was public concern that law enforcement officers were using less-than-lethal force which contributed to the arrest related deaths; however, the medical community argued it was due to the mental state of inmates during arrest (Ho et al., 2009). During the

12-month period, researchers had difficulty in collecting data due to the lack of participation from states with the Death in Custody Reporting Act of 2000. Ho et al.

(2009) focused on a small number of deaths which consisted of 21 suspects that died while undergoing arrest. Of the 21 deaths, 19 died due to police use of deadly force after the suspect tried to assault the police officer with a deadly weapon; the other two suspects unknowingly collapse while charging towards police officers (Ho et al., 2009). The study did not analyze the use of alcohol or drugs with the arrest related deaths, but concluded there is a problem with law enforcement agencies reporting the deaths that occur while arresting individuals.

Deaths in custody need to be reported correctly and accurately. With the help of the BJS and the DIRCA, deaths in custody can be researched to decrease the number of deaths across the nation. Healthcare in correctional facilities needs to improve to better assist mentally ill inmates. With improved health care, correctional nurses and staff can focus on identifying suicidal inmates. As more inmates are given additional medical attention can cause a decrease in deaths in custody. Finally, training law enforcement officers to correctly arrest mentally ill suspects can also assist to decrease the number of deaths in custody.

Chapter 3

Methodology

Preceding chapters have addressed the deaths in custody topic. Jails and prisons are mandated to report any death that occurs while in custody to the Attorney General.

Open Justice is an initiative created by the California Department of Justice to create transparency between the department and society. Open Justice publishes criminological data acquired throughout California to help address problems of crime, sexual assault, arrests, and juvenile crime pertaining to the criminal justice system. In 2016, Open

Justice published the deaths in custody across California between 1980 to 2015.

This study is a secondary analysis of data collected by the Department of Justice and made available the through Open Justice Program. This study will analyze certain variables: deaths per year, race/ethnicity, California county reporting a death in custody, reporting agencies, manner of death, and means of death.

The study was collected across a 35-year span. Beginning in 1980, data was reported for every death occurring in custody in a California jail or prison until 2015. For this 35-year period, the data set contains 16,101 deaths reported to the General Attorney for both male and female deaths in custody. There are reported deaths in custody that were not recorded correctly due to limited information which can be a limitation during the analysis of the data.

Since 1980, multiple laws were implemented that changed and improved the reporting of deaths in custody. Using the data set by Open Justice, it is important to analyze how the changes have impacted the reporting of deaths while in custody. By

accounting for all the deaths that occurred each year between 1980 until 2015, a line graph will display the increases and decreases of deaths in custody. This analysis will help understand the effect of whether national and state laws passed have a positive or negative correlation to reported deaths in custody in subsequent years.

Additionally, the data set collected by Open Justice has numerous variables reported to the Attorney General when inmates died to include: means of death, manner of death, location and facility where death occurred, custodial responsibility, race, gender, and county that were recorded among the reports. These factors will be used to analyze if there is a pattern or a commonality of deaths of inmates while in custody. The five variables this research will examine include:

1. Race/Ethnicity

2. County

3. Reporting agency

4. Manner of death

5. Means of death

The inmate’s race and ethnicity are part of the death in custody report and it is important to research if there are more deaths among one race or ethnicity. The list of races and ethnicities collected in the data set include: Black, Chinese, Cambodian

Filipino, Guamanian, Other Asian, Hispanic, American Indian, Korean, Laotian, Other,

Pacific Islander, Samoan, Hawaiian, Vietnamese, White, and Asian Indian.

The data set includes 10 different locations where the death of an inmate could have occurred. A death at a Crime/Arrest Scene is used when the subject died at the scene of

the crime or arrest. A death at the Local Hospital is defined when an agency or facility uses a local hospital to treat acute conditions or injuries, and it also includes if the subject is declared dead in an ambulance while in transit to a hospital. A subject’s death at a State

Hospital is defined as the Department of State Hospitals that was formerly known as the

Department of Mental Health (DMH).

Death in a City Jail is defined as a facility under the control of the police department.

Death in a County Jail is defined as a facility under the control of the county Sheriff’s department. Adult Camp or Ranch is the death at a community correctional facility or conservation camps. Similarly, a Local Juvenile Facility/Camp is a death at a juvenile camp, facility, or ranch under the control of the county probation department.

Deaths that do not fall under the categories above will be listed within the California

Department of Corrections and Rehabilitation. Since 1980, there have been some departments within the California Department of Corrections and Rehabilitation that are listed as areas in which deaths in custody have occurred. The Adult Operations and Adult

Programs was formerly known as the California Department of Corrections (CDC) and the Division of Juvenile Justice was formerly known as the California department of the

Youth Authority (CYA). These two programs now reside within the Department of

Corrections and Rehabilitation. Finally, if a death in custody location is not located in any locations mentioned previously, the location will be reported as Other.

There are 5 different options for reporting agencies. Police officers, probation departments, Sheriff’s department, state authorities and other local authorities. Using a

pie graph, the data will help to see which law enforcement agency reports the most deaths in custody.

Lastly, the manner of deaths and the means of deaths will be analyzed by using bar graphs in Microsoft excel. The manner of deaths listed in the reports include: suicide, accidental deaths, natural deaths, homicide justified, homicide willful, execution, pending investigation, cannot be determined, and other. Means of deaths listed in reports include: handgun, rifle/shotgun, club/blunt object, hands/feet/fists, knife/cutting instrument, hanging/strangulation, drug overdose, mandated method, pending investigation, not applicable (natural), cannot be determined, and other. Analyzing these categories will help to improve the literature and knowledge of deaths in custody.

Scope & Limitations

Throughout this study, there will be some limitations that will be acknowledged.

The biggest limitation of this research study is deaths in custody not reported as often as they should be. Some deaths may not be considered a death in custody or reports could be submitted incorrectly. Therefore, while studying the data set, it is important to recognize that there are deaths not accounted for.

Another limitation in this study is the legal changes that occurred between 1980 and 2016. There have been some amendments to the original act for the state of

California and the United States that require deaths in custody to be reported. Legal changes like these can cause a delay in ensuring the reports are up to standard with the law. Additionally, there is no punishment for jails or prisons that do not report every death in custody, which can lead to less deaths reported.

This is a research study that focuses on the deaths in custody that occur in the state of California. The study cannot be generalized, and it can cause a limitation for future studies. However, it does provide information for researchers or legislators to learn and implement change in order to decrease deaths in custody. After reviewing the changes from 1980 to 2015, it is important to share the knowledge with other state legislators to improve the treatment of inmates in custody.

Lastly, it is very important that law enforcement officials accurately report the causes of death. However, there are many reports that have unknown causes of death.

This is a major limitation in studying what is the most common death while in custody.

Similarly, reporting officials may not know the actual cause of death and thus input it incorrectly. Limitations are expected. Understanding the limitations of the research can aid in concluding results.

Chapter 4

Data Analysis

The current research focuses on the deaths that occurred while in custody in

California between 1980 and 2015. The first section will analyze the patterns that occurred between 1980 through 2015 to understand the increase and decrease of female and male deaths. The second section will compare the race of female and male deaths in custody that were reported. The next section will analyze the California counties that had a majority of female and male deaths, and what factors contribute to those numbers, and the fourth section will compare what agencies reported the most deaths in custody.

Lastly, there will be a comparison of the manner and means of female and male deaths as the best way to understand why these deaths in custody occur.

Deaths occurring between 1980-2015

Between 1980 and 2015 there were approximately 16,101 reported deaths in

California. Of those 16,101 deaths, there were 15,160 male deaths and 941 female deaths.

There is an alarming difference between males and female reported deaths. Figure 1 shows an increase throughout the years in reported deaths in custody, but some years have steep increases and decreases. The most reported deaths of females for any single year within the 36-year time period was 50 in 2006. In the same year, there were 680 reported male deaths in custody, which caused an alarming spike in reported deaths in custody that year among both male and females. The Bureau of Justice Statistics reported the prison population across the United States grew at a faster rate in 2006 than in the previous 5 years (Sabol, Couture, & Harrison, 2007). According to the BJS, California

had 4,836 more inmates in prison in 2006, and California had the highest number of incarcerated individuals that year (Sabol et al., 2007). Sabol et al. (2007) reported black males between the ages of 30 to 34 had the highest rate of incarceration by yearend 2006.

Additionally, Sabol et al. (2007) found more black females incarcerated compared to white females. The highest number of deaths in custody in 2006 could potentially be a result of the increased prison population that year.

Figure 1. Deaths in Custody in California between 1980-2015

Deaths in Custody in California Between 1980-2015

800

700

600

500

400

300 Deaths in Custody in Deaths

200

100

0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Years

Female Male

However, the year with the most reported deaths of males was 2015 with a reported 712 deaths. Figure 1 shows a sharp increase of male deaths in custody in 2015

due to 77 more deaths than the previous year. Reported death of males in custody have increased over the 36-year span, while female deaths in custody have remained steady across the time period, increasing only slightly every year. It is important to note the major difference of reported deaths in custody of males and females, as females are extremely underrepresented in prisons and jails.

Race of Deaths in Custody

The next category analyzed was race. Table 1 lists the different races and ethnicities of deaths in custody of this study. Reporting agencies are required to submit the race or ethnicity for individuals who died in custody. Both females and males had three large races/ethnicities that had the most deaths in custody. White deaths in custody were the majority with 6,320 White male deaths and 439 White female deaths. White deaths in custody almost account for half of all deaths in custody. The prison census of

2013 by the California Department of Corrections and Rehabilitation found there were

5,982 females incarcerated in California and 128,178 males incarcerated by 2013 (Devoe,

Krimetz, Vargas, Stevenson, & Bradshaw, 2013). The census found White females represented 33 percent of female inmates, and White male inmates accounted for 22.5 percent of all male inmates across California (Devoe et al., 2013). However, when comparing the prison population to the reported deaths in custody, there were more deaths among White inmates than any other race or ethnicity. Even though Hispanic,

Black, and White female representation was split evenly in the 2013 census, White females still had the most deaths in custody between 1980 to 2015. White males are a

minority among the prison population, but account for almost half of all deaths in custody.

Table 1

Race and Ethnicity of Deaths in Custody

Race & Ethnicity Gender Total Females Males White 439 6,320 6,759 Black 263 4,013 4,276 Hispanic 183 4,041 4,224 Other 16 166 182 Unknown 14 131 145 American Indian 5 137 142 Other Asian 5 67 72 Filipino 1 69 70 Vietnamese 5 47 52 Asian 3 28 31 Chinese 3 22 25 Korean 2 23 25 Asian Indian 1 23 24 Pacific Islander 0 19 19 Laotian 1 14 15 Samoan 0 10 10 Cambodian 0 9 9 Hawaiian 0 8 8 Japanese 0 7 7 Guamanian 0 6 6

There were approximately 263 Black female deaths and 4,013 Black male deaths in custody. In the 2013 prison census, Black female inmates represented 27.8 percent of female inmates, and Black males represented 29.5 percent of incarcerated males (Devoe et al., 2013). The media has focused on law enforcement’s disproportionate use of force toward Black suspects, but the prison population does not reflect Blacks having the largest prison population. Lastly, there were 183 Hispanic female deaths and 4041

Hispanic male deaths. In 2013, Hispanic females accounted for 33 percent of all incarcerated females, and males accounted for 41.7 percent of all incarcerated males

(Devoe et al., 2013). Since Hispanic females had the smallest amount of deaths in custody could help to support Wildeman et al. (2016) study which found that Hispanic female’s low deaths in custody could be correlated with the harsh life experiences outside of prison. Hispanic males account for a majority of incarcerated males, but reported deaths in custody place Hispanics as the third major group.

The differences in deaths and current incarcerated races and ethnicities could be caused by the will to survive. Comparing the 2013 census and this study’s data, a will to survive is present. The high number of recorded white male deaths can be explained by the low number of incarcerated White males. The low number of recorded Hispanic male deaths can be explained by the high number of incarcerated individuals. This pattern is only relevant to males because according to the census, females are equally represented among the three main races and ethnicities.

Deaths in Custody by California County

Table 2 shows the female and male deaths in custody by California county. The

California counties that had the most reported female deaths in custody were Madera, Los

Angeles, and San Bernardino. Madera county had the most female deaths in custody with

213 of the 941 recorded deaths, San Bernardino had the second largest number of female deaths with 165 reports, and Los Angeles reported 158 female deaths in custody. In the

2016 California census, Madera County had a population of 154,679, San Bernardino

County had a population of 2,140,096, and Los Angeles had a population of 10,137,915

(QuickFacts, 2016). Madera County has the largest female prison in California, which explains why it reported the most female deaths. It is concerning that a high number of females were reported to have died in custody in the small-populated county of Madera compared to large populated counties like Los Angeles and San Bernardino.

Table 2

Deaths in Custody by California County

California County Gender Total Female Male Solano 7 2,360 2,367 Los Angeles 158 1,931 2,089 San Bernardino 165 1,280 1,445 Kings 1 1,051 1,052 San Luis Obispo 1 859 860 San Diego 42 808 860 Kern 17 700 717 Sacramento 14 641 655 Riverside 40 536 576 Monterey 4 544 548 San Joaquin 20 437 457 Alameda 30 404 434 Marin 3 430 433 Imperial 3 385 388 Orange 26 314 340 Madera 213 25 238 Santa Clara 20 207 227 Lassen 0 226 226 Fresno 18 207 225 San Francisco 16 203 219 Amador 0 204 204 Napa 26 175 201 Stanislaus 12 121 133 Contra Costa 8 116 124 Del Norte 1 106 107 Ventura 15 89 104 Tuolumne 3 87 90 Sonoma 12 67 79 Tulare 7 66 73

Table 2 Cont.

Deaths in Custody by California County

California County Gender Total Female Male Santa Barbara 7 55 62 San Mateo 3 54 57 Shasta 5 50 55 Humboldt 4 39 43 Butte 5 36 41 Out-of-State 0 41 41 Merced 5 34 39 Yolo 2 36 38 Santa Cruz 10 27 37 In-State 1 31 32 Placer 0 26 26 El Dorado 3 21 24 Tehama 2 18 20 Lake 2 17 19 Siskiyou 2 16 18 Mendocino 3 13 16 Yuba 2 13 15 Nevada 1 11 12 Sutter 1 9 10 Inyo 1 7 8 Calaveras 0 7 7 Glenn 1 4 5 Colusa 0 4 4 Mono 0 3 3 Mariposa 0 2 2 San Benito 0 2 2 Sierra 0 2 2 Trinity 0 2 2 Plumas 0 1 1

The three counties that recorded the most male deaths in California are Solano with 2,360 recorded deaths, Los Angeles with 1,931, and San Bernardino with 1,280. The

2016 California census recorded 440,207 residents in Solano County, 10,137,915

residents in Los Angeles County, and 2,140,096 in San Bernardino County (QuickFacts,

2016). Similar to the female deaths in custody, Solano County is not as populated as Los

Angeles and San Bernardino counties, yet it has the most recorded male deaths in custody. However, unlike Madera County, Solano County does not have the largest male prison or jail, so the large number of recorded deaths in custody is interesting.

Reporting Agency

As Table 3 shows, there are only five agencies that were listed as reporting a death in custody. California state prisons had the most reported deaths of female and male deaths in custody. The state reported 419 female deaths and 9,392 male deaths in custody within the 36-year span. The Sheriff departments had the second most reports of deaths in custody for males and females with 397 female deaths and 3,783 male deaths in custody reported by the Sheriff’s department across California. Police departments across

California had the third most reports of deaths in custody, with 109 female deaths and

1,854 male deaths in custody. Probation departments only reported eight female deaths and 51 male deaths in custody. Lastly, other local agencies reported eight female deaths and 80 male deaths in custody.

Table 3

Deaths in Custody by California Agency

Reporting Agency Gender Total Females Males State 419 9,392 9,811 Sheriff 397 3,783 4,180 Police 109 1,854 1,963 Other Local 8 80 88 Probation 8 51 59

Manner of Deaths in Custody

The manner of deaths in custody were recorded under the different categories shown in Table 4. The most manner of death reported were natural deaths. There were

606 female natural deaths reported and 9,477 male natural deaths reported. The natural deaths include deaths that occurred as a result of natural causes. The lack of quality health care in prisons can cause the poor health of inmates, which leads to thousands of natural deaths. Suicide was the second most reported manner of deaths in custody, which can be attributed to the mental health of inmates. There were 131 female suicides and

2,072 male suicides reported in the 36-year span. Additionally, there were 93 female accidental deaths reported and 1,205 accidental male deaths in custody reported. There were 55 female homicide justified (law enforcement staff) deaths reported and 1,287 male homicide justified (law enforcement staff) deaths reported. These deaths occurred at

the hands of law enforcement officers that were determined to be justified after investigation.

Table 4

Manner of Deaths in Custody

Manner of Death Gender Total Female Males Natural 606 9,477 10,083 Suicide 131 2,072 2,203 Homicide Justified (Law Enforcement Staff) 55 1,287 1,342 Accidental 93 1,205 1,298 Homicide Willful (Other Inmate) 2 523 525 Pending/Unknown 25 184 209 Pending Investigation 15 166 181 Cannot be Determined 10 122 132 Other 4 92 96 Homicide Willful (Law Enforcement Staff) 0 14 14 Execution 0 10 10 Homicide Justified (Other Inmate) 0 8 8

Means of Deaths in Custody

When reporting deaths in custody to the Attorney General’s office, the reporting agencies have to report the means of deaths. The most common means of death recorded were “Not Applicable” with 612 for female deaths and 9,559 male deaths. Not applicable is intended for deaths that occur due to natural causes. Combined there were 10,171 deaths reported under not applicable, but there were only 10,083 natural deaths. The next most common means of death were hanging and strangulations. There were 113 female hangings and strangulations reported and 1,870 male hangings and strangulations reported. The third most common means of death were drug overdoses. There were 82 female drug overdose deaths reported and 886 male drug overdose deaths reported. There

were deaths that were a result of a firearm or handgun. There were 52 female deaths caused by a firearm or handgun and 1,206 male deaths caused by a firearm or handgun.

Table 5

Means of Deaths in Custody

Means of Death Gender Total Female Male Not Applicable 612 9,559 10,171 Hanging, Strangulation 113 1,870 1,983 Drug Overdose 82 886 968 Handgun 39 870 909 Other 29 556 585 Firearm 13 336 349 Knife, Cutting, Instrument 3 298 301 Unknown 21 172 193 Pending Investigation 15 166 181 Hands-Feet-Fists 2 170 172 Rifle/Shotgun 5 144 149 Cannot be Determined 7 75 82 Club, Blunt Instrument 0 48 48 Mandated Method 0 10 10

Deaths in custody involve several different categories. The data indicates increases and decreases of deaths in custody over the 36-year span. The large number of deaths in custody and the causes of death shown in this study are important to analyze to better improve the correctional setting and the health care of inmates across all correctional facilities in California.

One of the four hypotheses was demonstrated. H1 was proven correct as the number of death in custody reported has increased since 1980. There were severe increases in reports of deaths in custody when laws like the DICRA passed or AB 619. In the past several years, the media has focused on the excessive use of force by law

enforcement officers on black suspects, which over exacerbates the black inmate population. According to all the deaths in custody reports that were analyzed, whites had the most deaths and a most deaths were due to natural causes.

Madera County, a small populated county, has the largest women prison and had the most female deaths in custody reported across California. Sonoma County had the most reported male deaths in custody, but the county is also relatively smaller compared to Los Angeles County. Finally, the most common manner of death in this study was a natural death, which disproved H4. Literature explains the lack of medical care inmates receive which could be the cause of natural deaths occurring while in custody. Overall, this study has looked at California’s recorded deaths in custody, and found trends that would have been seen as normal for a correctional environment. There are underlying problems in the correctional system, and researching these problems will help to fix a broken system.

Chapter 5

Conclusion

This study used reported deaths in custody between 1980 through 2015 in

California to understand what was reported of 16,101 deaths in custody. Previous literature has aimed to explain what may cause deaths in custody, but it did not focus on actual reports of deaths in custody. Using the major themes that arose while researching deaths in custody, this research has used those themes to explain the high number of deaths.

The first categories analyzed were the increase and decreases across the 36-year span of all deaths in custody in California. It was hypothesized that deaths in custody would increase if there were laws passed that would require agencies to report deaths in custody. Beginning in 1960, Senator Grunsky made it mandatory for agencies to report deaths in custody, but did not have any penalties for non-complaint agencies. As of 1980, reports of deaths in custody have been increasing. There were several spikes within the

36-year span. In 1984, there was an increase in both female and male deaths in custody.

There were no laws passed in California that could explain the spike in 1984 but a delay from the 1980 laws mandating California to report the deaths to the Attorney General.

The next increasing spike was in 1993, which triggered another amendment to the

California Government code 12525. The largest spike of the 36-year span was in 2006, which increased the reporting of deaths in custody due to the DICRA of 2004. As

California and the nation try to create uniformity for reporting deaths in custody, there is a need for improving the reporting of deaths in custody.

The second category analyzed was the race and ethnicity of deaths in custody. It was hypothesized that there would be more black deaths in custody due to the media’s focus on law enforcements use of force on blacks, but that was not the case. The majority of deaths were white female and male deaths more than any other race or ethnicity reported across California. Blacks account for the second most deaths reported, and

Hispanics account for the third largest group of reported deaths in custody. However, whites were not the largest group of incarcerated inmates, Hispanics were. If more whites are dying before they become incarcerated, it can help to explain why whites are not a majority in prison. Similarly, if less Hispanics are dying while in custody, it could explain why they are the largest group in prisons.

The third category analyzed included the California counties that reported deaths in custody. All 58 counties reported at least one death within the 36-year span. A high number of female deaths in custody were reported from Madera County, which had the largest female prison in California. However, it does not explain why they have the most female deaths with such a small population compared to counties like Los Angeles or San

Bernardino. Similarly, the county that reported a large number of male deaths in custody was Solano County. In this case, Solano County does not have the largest male prison, so the large number of male deaths is strange. The number of recorded deaths in custody per

California county should reflective the population size, but in this study, it did not.

The fourth category analyzed was the different reporting agencies that have previously reported a death in custody. The state agencies reported the most deaths in custody. This can be a result of the fact that most prisons and jails belong to the state, so

they would be the facilities reporting the most deaths in custody. In smaller counties that do not have a lot of law enforcement agencies, the Sheriff’s department reported the second most deaths in custody. A lot of the deaths in custody were recorded as natural or suicidal deaths. Due to many reports of deaths in custody, the state agencies and Sheriff’s

Departments should improve their health care within their facilities to prevent deaths in custody.

Natural deaths were the most common form of death in custody. These deaths can be attributed to the lack of medical care inmates received while incarcerated and their previous mental health. The second most common death was suicide which is attributed to the mental health and the insignificant care inmates receive. Deaths in custody can be attributed to several factors that are mentioned in the literature, but the overall correctional system needs improvement.

Implications for Future Research

This study aimed to understand the trends that occurred with deaths in custody across California. With the large sample that was gathered by Open Justice, researchers can further delve into this topic. It is important to add to the current literature and research regarding deaths in custody to help understand the correctional structure that impacts millions of lives across the United States and other countries.

There is not a common definition of a death in custody, which hinders current literature and studies. The definition of a death in custody varies from state to state across the United States, which causes different interpretations. A definition is needed. Congress needs to amend the Death in Custody Reporting Act to include a standard definition of a

death in custody. A policy recommendation for the Death in Custody Reporting Act will create a standard form for reporting deaths in custody that will be used by every agency across the United States. Each report will define a death in custody to help reporting officers become aware of applicable deaths. As Lloyd (2012) explained the different ways states report a death in custody really impacts research on this topic. As this study has shown, the reports of deaths in custody across California are inconsistent with unknown fluctuations; other states across the country may also have similar results due to the different ways of reporting a death in custody. A definition of death in custody should have a common definition like any other term used in the criminal justice field like homicide or strangled.

Future research should focus on the age of the reported deaths in custody. The birth date, month, and year is recorded for each death in custody. However, it would make it easier on researchers to annotate the age of the inmate to better understand the cause of death. The age of an inmate’s death can help to understand if causes of deaths are due to old age or a chronic illness that is left untreated. According to literature, medical care in correctional facilities is deficient and underfunded by institutions (Fazel

& Benning, 2006). This study shows that the majority of recorded deaths were natural deaths, but it shocking to see so many inmates died from a natural cause. If agencies report more specific causes of death, it can help researchers and lawmakers see what are the most common manner of deaths among inmates.

Future research should collaborate with other states to compare the deaths in custody reports. States that have large prison populations, like Texas and New York,

should be compared to California because they may have more information regarding deaths in custody. As Lloyd (2012) stated, the state of New York has the best method for recording deaths in custody, if there is collaboration between states the correctional system across the country can improve and become uniformed. While collaborating with other states, researchers may find common problems among the reports or could create a possible solution for improving the reporting of deaths in custody. Communicating with other states can have a positive influence on the reporting of deaths in custody.

This study has examined the reports submitted to the Attorney General of the deaths that occur while in custody. With the support of literature and this study, it has aided to understand the reported deaths in custody. Even though this study has not identified the causes of the massive amounts of deaths in custody, this study has highlighted the outcomes of the reported deaths. It is important to continue to add to this research to better improve the correctional systems.

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