Locked in solitary confinement, coming off of heroin and cut off from her prescribed anti-depressant medication, Heather Price of Tipp City told her Miami County jailers she wanted to kill herself.

And that’s exactly what she did.

Two hours after a social worker cleared her to be taken off suicide watch in May 2011, guards found the mother of a 3-year-old hanging by the neck from a bed sheet tied around a plumbing pipe in her cell, according to a federal wrongful death lawsuit filed in November. Brain dead, the 27-year-old Price died at Upper Valley Medical Center five days later.

Price’s story is hardly unique. Suicide, while uncommon, is the leading single cause of death in U.S. jails with several hundred reported cases per year, a third of all jail deaths.

But while many suicides are unavoidable, a Dayton Daily News investigation found cases across Ohio where suicides were preceded by red flags that went undetected, misread or ignored. Some jails had multiple suicides in a short period, which experts say can be a sign of weaknesses in security, inmate screening, treatment and staff training. In some cases, the suicides led to costly lawsuits for counties, their contracted mental health providers and their insurers.

“Punishment doesn’t mean locking people up in isolation and letting them suffer from their demons without treatment,” Cincinnati attorney Jennifer Branch said. “That’s the definition of cruel and unusual punishment. These cases should be a reminder to the jailers that they have a responsibility to treat mental illness, not just the illnesses they can see.”

A national study in December shows that after years of decline, the number of jail suicides increased in 2009 and 2010, the most recent years studied. Another national study in 2010 showed that while the jail suicide rate, now 42 per 100,000 inmates, is a third of the 1986 rate, it remains three times higher than in the general populace.

“It’s a huge issue,” said Betsy Johnson of the Ohio chapter of the National Alliance on Mental Illness, or NAMI. “The stories are heartbreaking.”

Experts agree that it’s impossible to prevent all suicides in jails, cauldrons of emotional tumult where an assortment of criminals, mental patients and drug addicts hit rock bottom. Often, sheriffs say, death comes without warning and despite their best efforts.

“Jails are the largest mental health facility in a county now,” said Sheriff Gene Kelly of Clark County, where two inmates killed themselves in 2010. He said his jail has strict policies to screen and monitor inmates for suicidal behavior and place them on suicide watch if necessary. “Yet with all that, it is difficult to (stop) people who are intent on harming themselves.”

The Dayton Daily News investigation found:

• Four Butler County Jail inmates hanged themselves in a 12-month span in 2006 and 2007, leading the American Civil Liberties Union of Ohio to unsuccessfully call for a Justice Department investigation. The jail had another suicide last July. After years of litigation, the final piece of a $300,000 settlement of a federal wrongful death lawsuit in a 2007 suicide was approved in probate court two weeks ago. The lawsuit said Timothy Hughes, 19, was improperly turned down for psychiatric care and single-celled in violation of a policy adopted after the previous three suicides.
• In Clinton County, inmate Laura North hanged herself in an isolation cell in December 2009 about two weeks after she was removed from suicide watch and given a mental health care plan, the jail reported to the state. Less than two months later, another inmate used a shaving razor to fatally slash his neck and wrists.
• Three inmates killed themselves in the Licking County Jail in 2011. They included a man on a form of suicide watch who, permitted to walk freely on a second-story cellblock, jumped over a railing to his death.
• In Portage County, three jail inmates killed themselves within 16 months in 2010 and 2011. They included a man who told jailers he was bipolar and another who was a known suicide risk but wasn’t on suicide watch.
• Two Pickaway County inmates committed suicide within a five-month period in 2006 and 2007, resulting in a total of $280,000 in legal settlements. In one case, a man with a known history of suicide attempts — he had doused himself with gasoline in an attempted self-immolation during a previous incarceration — was jailed without his anti-psychotic drugs in August 2006, according to a settled lawsuit. He hanged himself with a phone cord. That November, according to a lawsuit, a jail psychiatrist changed Breha Smith’s psychotropic meds but wouldn’t see her for a followup, even after she complained of side-effects that were making her “crazy.” She, too, hanged herself.

Meanwhile, the state prison system is reviewing its suicide prevention efforts after eight inmates killed themselves in 2012, double the 2011 number. “We need to continuously improve our training efforts to recognize warning signs,” said Stuart Hudson, prison medical services chief. There have been 60 suicides in state prisons since 2004. Nine of them were at Lebanon Correctional Institution, the most recent one last month. That’s second only to the maximum-security Southern Ohio Correctional Facility at Lucasville. Prison officials said Warden Ernie Moore was not available for comment.

The Correctional Institution Inspection Committee, the state legislative’s prison watchdog, reported Jan. 29 that while the mental health rolls at the prisons are up, the system’s “mental health services have experienced drastic cuts,” with the budget for those services cut by $30 million from fiscal 2010 to fiscal 2013.

Ohio jails, which are required to report suicides to the Ohio Department of Rehabilitation and Correction, reported 10 suicides in 2011 and nine in 2012, according to records provided by the department to the Daily News. But the newspaper found the department’s records don’t include numerous suicides that have been reported in news accounts. For example, only two of Montgomery County’s five suicides since 2010 show up in the records.

“The reporting of this data is problematic across the country,” said Lindsay Hayes, a Massachusetts-based suicide prevention consultant. “It’s not a statistic that jail administrators and sheriffs take much pride in.”

NAMI’s Johnson said inconsistency in reporting makes it difficult to determine the scope of the problem, discern trends and evaluate individual cases.

She also said Ohio’s county and municipal jails vary widely in the quality of mental health care and suicide prevention. “Training’s a big issue and something that’s sorely missing,” she said. “There are some that are doing well and others that are just handcuffing people to chairs until they can move them somewhere else.”

1 jail inspector

Johnson is working with a state committee to improve jail standards, but she is concerned about how well any new standards would be enforced. She noted that jail inspections by the state are rare, with only one inspector remaining due to budget cuts at the state’s Bureau of Adult Detention.

“All the standards in the world won’t help if there’s nobody to monitor,” she said. “One (inspector) for the state of Ohio is an abomination. We should be ashamed of ourselves.”

Late last year, the Correctional Institution Inspection Committee, which inspects state prisons and monitors inmate complaints, dropped plans to expand its reach to local jails.

Al Gerhardstein, a Cincinnati civil rights attorney whose practice includes wrongful death in custody cases, said the grand jury system, the other entity charged with inspecting jails, “doesn’t know what they’re looking for” when it comes to evaluating mental health services and suicide prevention practices.

While suicides in state prisons tend to involve violent criminals despondent about their long sentences, incident reports indicate that victims of jail suicides are charged with a variety of offenses, from non-violent drug and property crimes to sex offenses and aggravated murder.

The Montgomery County Jail has had five suicides since 2010, three of them in 2010. Sheriff Phil Plummer said the deaths came without warning and internal investigations found that guards followed proper procedures.

Plummer said he believes jail suicides often are driven by the explosion in heroin addiction and cuts in mental health services, including the closing of Dayton’s state mental hospital in 2008. He said it’s difficult to find local treatment options for psych patients who act out and are arrested. Almost one in 10 incarcerations in 2012 , 2,400 of them, needed mental health care.

“We need to go back to paying for mental health and drug treatment,” he said. Then, tapping his fingers on the jail’s list of suicides, he said, “I mean, we’re paying anyway. We’re paying, but the state’s pushing (the responsibility) down to the counties.”

Mike Brickner, public policy director for the ACLU Ohio, agrees. He said mentally ill people and drug addicts too often aren’t treated until they break the law in connection with their illness or addiction. “We’re relying on the criminal justice system to criminalize these people before we’ll treat them,” he said.

Because jail inmates typically are held for only short sentences or until trial, Brickner said, some counties pass the buck on providing costly psychotropic medication. “We hear from people who are schizophrenic or bipolar that they can’t get medication,” he said. “The counties are hopeful that the person will be released before they have to provide it, because it’s expensive.”

Guards often don’t trust inmates to be honest about their need for psychotropic drugs, Hayes said. “Inmates are by their nature perceived to be manipulative,” he said. “You (as a guard) lose your patience and you half-listen to what they’re saying, if that.”

Hayes said another problem is that suicide watch is unpleasant for both inmates and guards.

“Although it’s not intentionally punitive, it has all the appearances of being a punitive thing,” he said. “Nobody wants to be in a (suicide prevention) smock. It’s humiliating.” If a guard asks if they still feel suicidal, “they’re probably going to say, ‘Heck, no. Give me my clothes back.’ Then within a couple of hours, they’ve killed themselves.”

For jailers, “everybody’s job is much easier if there are no inmates on suicide watch,” Hayes said. “Everybody’s workload increases. So instead of asking, ‘Are you suicidal?’, it’s ‘You’re not suicidal, are you?’ ”

Needles in a Bible

According to a federal lawsuit, a confluence of these factors came into play in the death of Heather Price.

Born Oct. 1, 1983, Price, whose father died when she was an infant, turned to drugs and alcohol when her mother died of breast cancer in 2007, the lawsuit said. Public records show she had numerous minor brushes with the law. Because of her addiction, Price’s only sibling, Amy, who brought the lawsuit, obtained custody of her young son.

Jailed on a low-level drug possession charge on May 22, 2011, Price drew 10 days of solitary confinement May 26 when guards found two hypodermic needles hidden in her Bible. The lawsuit said she had just completed taking heroin withdrawal medication and was unable to continue taking prescribed anti-depressants because of her confinement.

On May 27, 2011, Price told her jailers she was feeling suicidal and needed in-person counseling and her medications. She was placed on suicide watch with 10-minute checks and video observation, according to the lawsuit. After about two hours, she spoke with a contracted social worker on the phone.

“Heather was informed (by the social worker) that she would have to wait for the jail physician to prescribe her medications and she was threatened with further punishment of being placed back on suicide watch if she could not cope with her feelings or if she continued to vent negatively,” the lawsuit said. She told the social worker she wouldn’t hurt herself and was returned to solitary at 2:15 p.m. At 4:41 p.m., she was found hanging in the cell. She died June 1 after being removed from life support.

The lawsuit asks for unspecified damages, but also “that the county and sheriff be made to apologize and promulgate, adopt, train, maintain and enforce appropriate policies to prevent future instances of the type of misconduct described” in the suit.

Miami County and its mental health providers in December denied the lawsuit’s allegations of inadequate training and policies, malpractice and negligence. Sheriff Charles Cox did not respond to a request for comment. The case is pending.

Treating mental illness

The Butler County case of Timothy Hughes reached final settlement after the Sixth Circuit U.S. Court of Appeals ruled that the jail’s contracted psychiatrist did not have immunity from being sued. County officials settled earlier, with no admission of blame, after a court ruled Sheriff Richard Jones lacked immunity.

Held on drug and robbery charges, Hughes hanged himself shortly after being placed in isolation for fighting in April 2007. Days earlier, he had asked to see a doctor and resume taking anti-depressant drugs, but a social worker who assessed him wouldn’t refer him to the psychiatrist, the lawsuit said. No one oversaw the social worker’s decisions, it said.

The suit also contended officials at the jail, which had a suicide just the previous week, violated their own suicide prevention policy by single-celling Hughes.

Chief Deputy Anthony Dwyer said jail officials acted properly and have sound policies. “I would have been comfortable going before a jury and defending our actions in this case,” he said.

“The majority of the people coming into our facility are in crisis mode and the majority have mental health issues,” Dwyer said. “If an inmate is set on committing this terrible act, it’s almost impossible, if not totally impossible, to stop them.”

But Cincinnati attorney Jennifer Branch, whose firm handled the Hughes case and who is investigating the suicide last summer of Butler County inmate Jason Myers, said, “there’s an ongoing problem at Butler County. As far as I can tell, they haven’t changed their systems as to how they treat mental illness.”

Branch said families of inmates hope their loved ones get treatment in jail and a chance at a new start.

“My clients were loved by somebody,” she said. “They suffered a horrible end. They couldn’t get treatment. Their only escape was suicide.”