Clark County Jail Chief Ric Bishop in the new mental health unit at jail in Vancouver, Washington.

Clark County Jail Chief Ric Bishop in the new mental health unit at jail in Vancouver, Washington.

Conrad Wilson/OPB

As Clark County Jail Chief Ric Bishop walked through his facility’s new mental health unit, he pointed out the subtle ways these cells are different from others at the jail in Vancouver, Washington.

“All of the renovations in here were done at the direction of our mental health professionals,” he said on the tour he gave OPB last fall before the unit opened. The county spent $545,000 to improve the mental health unit, now up and running.

In the sparsely furnished, concrete cells, the beds are low to the ground. Hooks and protrusions have been removed.

The changes are important because according to a 2010 study by the National Center on Institutions and Alternatives, 93 percent of inmates who died by suicide killed themselves by hanging.

Jail suicides have been a particular problem in Clark County, where nine inmates killed themselves over the last five years, one just last month.

Those numbers are higher than at four other county jails OPB looked at around the region.

For example, there were two suicides at the at the Multnomah County Jail during the same period, even though the facility has several hundred more inmates.

“You get a wide spectrum of people that come into the jail,” said Nancy Griffith, director of corrections health at the Multnomah County Health Department. “You get people who are mentally ill and potentially may or may not be suicidal. But you also get a huge volume of other folks who don’t fit within that category. And the risk for everyone often is escalated because of the jail setting.”

Getting locked up in jail is overwhelming at first, Griffith said.

More than 40 percent of people in Multnomah County jails have mental health problems. And 29 percent are African Americans. African Americans only make up six percent of the population.

More than 40 percent of people in Multnomah County jails have mental health problems. And 29 percent are African Americans. African Americans only make up six percent of the population.

Conrad Wilson/OPB

“For most of us, the ways we deal with being overwhelmed is that we talk to somebody, or we go do something or … we drink or use,” she said. “All of those usual coping skills are taken away from you.”

Being cut off from the outside world, coupled with the uncertainty of what will happen next, can lead people to imagine the worst, she said.

“People who wouldn’t be suicidal, wouldn’t struggle on the outs, they may feel like that’s an option for them in a jail,” Griffith said.

Jails that have the greatest success at reducing suicides have not only safe housing units, but access to mental health staff, said Lindsay Hayes, project director at the National Center on Institutions and Alternatives.

“It’s very difficult to predict human behavior,” Hayes said. “However, because these individuals are confined in your correctional system, you can do more by the fact that they’re confined than is possible if they were out in the community.”

In the last year, Multnomah County has increased the number of mental health councilors to 13 to accommodate 24-hour-a-day staffing, seven days a week.

Multnomah County Jail also has three psych-nurse practitioners, two psych-nurses and a psychiatrist from Oregon Health and Sciences University who works out of the jail one day per week, Griffith said.

The Clark County Jail also has ramped up staffing. In 2013, Clark County increased the number of mental health councilors from two to three, mostly to add staff during nights and weekends. Bishop said there’s a psych-nurse practitioner on site 32 hours per week.

“If you’re a family member or a friend who has a concern about someone in the facility harming themselves, there’s a 24-hour phone number that you can call and get help for that person right away,” he said.

And though the total number of suicides over the last five years was high, there has been a recent decline.

In 2013, there were no suicides at the Clark County Jail. And in 2014 there was one.

Last month’s suicide was the only one so far in 2015. Bishop said it’s still under investigation.