The number of Americans dying while incarcerated has surged while the US prison population has increased by 500% over the last 40 years

Why are so many people dying in US prisons and jails?

On 10 July 2015, 28-year-old Sandra Bland was pulled over in Prairie View, Texas, for what she was told by Texas state trooper Brian Encinia was failing to use her turn signal.

Three days after Bland’s arrest, she was found dead in her jail cell. The death was ruled a suicide but remains shrouded in mystery over how a wrongful arrest stemming from a minor traffic violation resulted in death.

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“She was arrested and alleged to have put this officer’s life and safety in jeopardy. Really what happened is he didn’t like that his authority was questioned,” attorney Cannon Lambert, who represented Bland’s family, told the Guardian.

For many campaigners Bland’s death in custody, one of the most famous in recent years, demonstrates the widespread reforms needed in the criminal justice system, including tackling racial profiling by police, ending prohibitive bail sums, remedying the lack of mental healthcare, adequate supervision and resources for prisoners in custody, and the need to reduce mass incarceration. It also highlights the fact that these circumstances have led to an epidemic of deaths in America’s prisons and jails.

Surges in the number of Americans dying while incarcerated have occurred against a backdrop of an increase in the US prison population by 500% over the last 40 years. Based on the latest national figures available from the Bureau of Justice Statistics, 4,980 prisoners in US correctional facilities died in 2014, a nearly 3% increase from 2013. In state prisons, the mortality rate was 275 for every 100,000 people, the highest since data collection began in 2001.

Since 2014, a Guardian investigation has found several states, including Texas and Florida, with the first and third highest prison populations in the US, respectively, have reported either record mortality rates in prisons or jails or significant surges. Today, 2.3 million people are currently imprisoned, a proportion of the population that substantially outpaces every other nation in the world.

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While the majority of deaths in prison are due to natural causes from an ageing prison population, there have also been significant rises in mortality rates due to suicides, homicides, accidents, drug and alcohol-related events, and untreated medical issues.

In Utah, at least 71 people died in jail over the past five years, with half those deaths a result of suicide and most within a week of an individual entering jail. The state’s jails have the highest death rate per capita in the US.

In August 2018, 16 deaths in Mississippi jails in a single month prompted an FBI investigation.

In California, a US supreme court order to reduce the state’s prison population resulted in prisoners being transferred to county jails. Unequipped to handle the influx, those prisons have experienced spikes in homicides.

Prisoners in Michigan are dying at the state’s highest rate in decades and 2018 saw the most prison fatalities in the state since at least 1994, though prison deaths are not consistently tracked by the state.

Texas, with the highest prison population in the US, has seen a 20-year high in prison suicides and 2018 was the state’s highest number of in custody prison deaths since at least 2005.

A record number of prisoners committed suicide in South Carolina in 2018 as homicides within the state prison system are on the rise.

Concerns over the surges in prison deaths across the US are part of a nationwide trend.

A 2017 report published by the Rand Corporation on identifying the needs to reduce prison mortality rates suggested several high-priority needs to reduce prison mortality rates.

“A national medical examiner system should be implemented because of the additional rigor these professionals have and more consistency with how they do investigations and classify cause of death,” said Joe Russo, the lead author of the report, in an interview.

The report noted an underlying issue in addressing prison mortality rates is the insufficient reporting methods used by various jurisdictions throughout the US.

For instance, the state of New Jersey has one of the highest mortality rates in their county jails in the US, but exact numbers remain unknown because of unreliable data collection and reporting.

Based on available data, county jails in New Jersey saw a 55% increase in prison suicide mortalities between 2012 to 2016. The New Jersey department of corrections announced some changes in December 2018 to address prison suicides, but prison reform advocates are pushing for more reforms.

“Robust, meaningful oversight and accountability is required at many levels; of medical contractors, of jail policies and practices, of county decision-making and reporting,” said Tess Borden, a staff attorney at the ACLU of New Jersey.

In many of New Jersey’s county jails with the highest suicide rates, a private medical contractor, CFG Health Systems, provides medical services to eight out of 10 of them.

Florida has experienced similar issues with privately contracted medical services. The state’s prison mortality reached a record 428 deaths in 2017 and has risen steadily since 2000. Private medical service providers at Florida prisons have been reported to provide no medical care for some prisoners or treating serious medical conditions with ibuprofen, contributing to these spikes in prison deaths.

Other countries have a lot of oversight, the US does not Dr Josiah Rich

“Other countries have a lot of oversight, the US does not,” said Dr Josiah Rich, director of the Center for Prisoner Health and Human Rights and professor of medicine and epidemiology at Brown University. ”

During this same period of rising mortality rates in Florida prisons, the state government made drastic cuts in staffing and prison programs.

In Alabama, significant budget shortfalls and widespread understaffing in prison and jails throughout the state contributed to surges in prison mortality rates. About 15 suicides have occurred in Alabama prisons since December 2017, and the state prisons have a homicide rate 10 times higher than the national average.

“There are a lot of people working to try to fix the problems in the Alabama department of corrections, with understaffing being the root of the problem,” said Ashley Austin, a law fellow at the Alabama Disabilities Advocacy Program.

The Department of Justice noted in April 2019 that Alabama’s prison system probably violates the US constitution in its failure to adequately provide safe conditions for prisoners. Only one-third of the state’s correctional officers are authorized to adequately operate the prisons, while the state’s prisons are overcrowded by nearly twice their designed capacity.

Prisons and jails throughout the US are continuously plagued by surges in mortality rates due to varying degrees of underfunding, understaffing, negligence and a system inadequately in place to address serious mental healthcare and medical issues of individuals who inevitably find themselves caught within the criminal justice system.

More than half of state and sentenced jail prisoners meet the criteria for drug dependence and abuse. Around 14.5% of men and over 31% of women in prison suffer from serious mental health illnesses. Once in prison or jail, many of these individuals receive little or no treatment for their illnesses.

Janice Dotson Stephens was one of those individuals. The mentally ill 61-year-old died in Bexar county jail, Texas, on 14 December 2018 after spending five months in jail for a misdemeanor charge of criminal trespassing on a $300 bond. She never saw a courtroom during that time span while waiting for a psychiatric evaluation that was never conducted.

“We received the medical records two weeks ago. We discovered she lost 136 pounds in 150 days and they knew when she was booked she had hypertension and schizoaffective disorder, it was already in their database,” said attorney Leslie Sachanowicz, who is representing the family in a lawsuit against Bexar county, the arresting officer, and the health services provider.

He said that her medication history while she was in custody was entirely blank.

“There was no treatment for Ms Dotson-Stephens,” he said.