There were nearly 500 incidents in Arizona’s prison system when convicts attempted to either hurt or kill themselves in 2015, despite efforts to push for better mental health treatment and a legal settlement ordering the Department of Corrections to improve psychiatric services.

Two inmates, one from the Florence prison and another from the Tucson facility, recently died in the span of three weeks.

David Fathi, director of the American Civil Liberties Union’s National Prison Project in Washington, D.C., and co-lead counsel on a federal lawsuit against DOC, believes the rising number of suicide or self-harm attempts last year – 2014 had 379 attempts – is “definitely cause for concern because a certain number of suicide attempts are successful and lead to death.”

The most common forms of self-harm were cutting at 197, overdose at 146, and blunt force with 93 attempts. In 2015, six died as a result, according to a recent report by the DOC on inmate self-harm, assaults and deaths.

One prisoner at the Dakota Close Unit in Yuma has been on suicide watch continuously since December. According to a Feb. 8 letter from the Prison Law Office, a California-based nonprofit that provides free legal representation to inmates, the prisoner last was seen by a psychiatrist on Jan. 4. The prisoner told a psychiatric associate on Feb. 3 that he wanted “to kill himself with a plan.”

Another prisoner at Dakota Close attempted suicide by cutting his neck and wrist on Feb. 3. He was found in pools of blood on the restroom floor, according to the same letter from the Prison Law Office. He was seen by a doctor on Dec. 29, who, after noting the prisoner’s anxiety and a previous suicide watch in August, ordered a checkup in one month.

Thirty-six days after seeing the doctor, he tried to kill himself. The recommended appointment never happened, according to a letter from the Prison Law Office on Feb. 8 to DOC attorney Daniel Struck.

“In a word, it’s a nightmare for anyone who has a serious chronic illness or for anyone who has an emergency such as heart attack or stroke or things that are not as easy to predict,” said Donna Leone Hamm, a former Arizona judge and executive director of Middle Ground Prison Reform, a prisoner rights advocacy organization in Arizona. “It’s literally life-threatening to rely on the healthcare system in place in the Department of Corrections.”

In March 2012, the ACLU and the Prison Law Office filed a federal lawsuit, Parsons V. Ryan, against the department, alleging years of neglect involving the health needs of more than 34,000 state prisoners. It also alleged improper and excessive use of solitary confinement, resulting in serious harm and unnecessary deaths, according to the ACLU.

In 2014, the Department of Corrections, the ACLU, the ACLU of Arizona and the Prison Law Office agreed on a settlement and it was approved by a federal court in Feb. 2015. The DOC agreed to address more than 100 issues with psychiatric medical staffing, record keeping, and pharmaceutical care, including ensuring that inmates consult with a licensed mental health provider upon arrival and that inmate prescriptions are filled within two business days.

“Every inmate on a suicide watch is seen every day by a licensed mental health clinician or a registered nurse,” said Andrew Wilder, a spokesman and director of communications and media relations for the DOC. “Each such inmate is also observed by correctional officer staff consistent with the level of watch.”

The settlement provides for ongoing monitoring and oversight by the prisoners’ lawyers to ensure the state is complying with its terms. Hamm concedes the settlement was a step in the right direction, but argues it’s not forceful enough.

“It allows the DOC to have a two week notice before the monitors come to see them,” Hamm said.

Fathi recognizes “that change in a large institution doesn’t happen overnight.”

Both parties agreed to a graduated series of improvements. The first year of the settlement agreement ended in February.

“So for the first year of the settlement agreement’s life, they had to hit 75 percent compliance on each measure. They did not come close to that on a number of critical measures. In February 2016, the compliance threshold went up to 80 percent and in 2017 and thereafter, it will go up to 85 percent,” Fathi said.

The DOC’s Wilder asserts the allegations are wrong.

“Anecdotal complaints are not evidence of substantial non-compliance among a patient population in excess of 35,000. Contrary to the allegations of this ACLU lawyer, the court has not made any judicial finding of substantial non-compliance by the department or by Corizon, its private inmate health care provider,” Wilder wrote in an email to Cronkite News. “Their allegations are not meritorious and the department is confident that the court will agree when these issues are ultimately presented for judicial resolution.”

Through monthly monitoring by the Prison Law Office, the ACLU has sent over 200 letters advocating for prisoners with urgent health needs.

“We filed this case almost exactly four years ago in March of 2012, alleging essentially two things, that the medical, mental health and dental care in the Arizona State Prisons was so deficient that it violated the eighth amendment, which prohibits cruel and unusual punishment. And secondly, that the use of extreme and prolonged solitary confinement in the Arizona prison system also violates the eighth amendment,” Fathi said.

The settlement requires the state meet 112 separate performance measures every month at each of its ten prisons, with the goal of ensuring adequate health care and to impose some limits on the use of solitary confinement.

The term solitary confinement is a topic of debate between the DOC and ACLU.

“The Department does not have inmates in ‘solitary confinement.’ Even the Parsons Stipulation Agreement does not use this term, because solitary confinement does not exist in the Arizona prison system,” Wilder wrote.

Fathi said, however, that “Isolation and solitary confinement are defined by the U.S. Department of Justice as ‘the state of being confined to one’s cell for approximately 22 hours per day or more, alone or with other prisoners.’ ”

“Under that definition, solitary confinement unquestionably exists in ADC (Arizona Department of Corrections). As you will see from the Parsons settlement, there are prisoners who are in their cells for all but 6 hours per week,” he added.

Wilder, however, said the minimum out-of-cell time is 7.5 to 9.5 hours per week depending on the prisoner.

According to the Prison Law Office and ACLU, the DOC is “on the whole, wildly out of compliance on a number of critically important measures having to do with both medical care and mental health care.”

One of the mental health performance measures requires some prisoners, inmates who have been recently taken off of psychotropic medications and require follow-up, to be seen within 30 days of discontinuing medication. Those inmates, known are defined as having mental health needs and who require outpatient treatment.

The Prison Law Office and ACLU assert the DOC is only 17 percent compliant on this measure.

Other mental health performance measures mandated in the federal lawsuit included mental health services, uninterrupted medication refills and how often prisoners in maximum security were seen by mental health staff on weekly rounds. For those and other standards, DOC’s compliance ranged from 44 percent to 72 percent over a five-month period in 2015.

“Every inmate entering the prison system is thoroughly evaluated via a formal intake process, which includes an assessment of all then-current prescription medications. Whenever clinically indicated, current medications continue to be prescribed in accordance with a drug formulary,” Wilder said in his email.

The settlement performance measures include increased vigilance of inmate self-harm.

“It can even happen that self-harm, when a person cuts himself or hurts himself in another way, not intending to die, those can be fatal too in many cases. So any time you have prisoners inflicting harm on themselves, that’s cause for concern and certainly the fact that it’s rising is concerning,” Fathi said.

However, because of the mandate in the settlement to keep better records, the rising numbers could be a result of increased vigilance.

“We have to consider the possibility that for whatever reason, maybe because of increased vigilance as a result of this lawsuit, they are just counting attempts that would have escaped their attention before. But on the whole, it certainly is concerning that the numbers are going up,” Fathi said.

Self-harm and suicide attempts are much harder to accurately count than completed suicides, “because some of those don’t come to the attention of prison staff or some prisoners may later deny that it was a suicide attempt and say it was an accident,” Fathi said.

When asked how inmates acquire contraband to commit self-harm, Wilder said:

“ADC inmates in maximum custody or detention are not permitted to have a shaving razor; they are issued electric clippers for grooming. Inmates in close, medium and minimum custody are permitted to have a shaving razor, similar to those available at a grocery store. Some misuse their razor to harm themselves or others. Inmates receive medication. Some misuse their medication by hoarding it to harm themselves, achieve a drug-induced high, or trade as commerce.”

Wilder said DOC provides inmates with group and individual therapy and treatment.

“There currently are over 10,000 inmates across all custody levels in outpatient treatment,” he said. “There are seven residential programs providing treatment to over 400 inmates. These inmates are provided weekly groups and monthly individual treatment.”

Another 80 inmates get inpatient treatment in Phoenix with daily mental health contact, individual therapy sessions at least once every seven days, and a psychiatric session every thirty days, Wilder said.

Correction: An earlier version of this article incorrectly identified the number of attempted suicides and deaths. There were nearly 500 convicts in Arizona’s prison system who attempted to hurt or kill themselves. Two inmates have died by suicide this year.

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