The Alarming, Inexcusable State of Mental Health Care in State Prisons


As I write this, many of the headlines in the news are about the so-called “shocking” suicide of alleged child sex trafficker, Jeffrey Epstein, who, allegedly, hanged himself while incarcerated in a Federal New York prison.  What is so shocking? The only thing shocking to me about this event is how the news media and on-lookers, including United States Attorney Bill Barr, think it is shocking for someone, who was known to be suicidal, predictably, takes their life by suicide.  I suppose it is only Mr. Epstein’s wealth and his ties to well-known, rich, influential people, including many politicians, that makes U. S. Attorney Barr suddenly express surprise and concern that incarcerated people are attempting suicide, many successfully, when many of them should have been on suicide watch in a Crisis Stabilization Unit (CSU) or an Acute Care Unit (ACU). We can do without the mock concern on the part of the U.S. Attorney.  This is happening right under his nose in  prisons every day and he only expresses concern when it is a wealthy person who does it?

Jeffrey Epstein’s suicide was foreseeable and predictable. Now it is being reported that he was not on a suicide watch, even though he had previously attempted suicide less than two weeks earlier. The prior suicide attempt placed him in the high-risk category for attempting again. Coupled with the fact that he was in prison for the first time awaiting trial with an indictment list that, if proven, would keep him in prison for the rest of his life (another risk factor for attempting suicide), Mr. Epstein was high risk for suicide attempt and should have been on suicide watch.

Unfortunately, this blatant disregard for the lives of inmates who are either mentally ill or acutely psychotic ( or both) and the risk it creates for them to take their own life, is prevalent in our nation’s jails and prisons.  It is particularly alarming in Georgia prisons.  As recently as just last week, the Macon Telegraph issued the results of its study into prison suicides and announced that Georgia’s rate has reached crisis proportions. Between 2014 and 2016, state records show that 20 state prisoners had taken their own lives. In the nearly three years since, 46 prison deaths were deemed suicides. Georgia’s prison suicide rate — at 35 suicides per 100,000 — is nearly double the national average. Between 2013 and 2014 alone, U.S. state prison suicide rates rose by nearly a third. And Southern states including Georgia, Alabama and Texas saw even larger increases in their rates. Georgia correctional officials believe one in five people incarcerated in state prisons have a documented mental health need.

Prisons owe inmates a duty of ordinary care regarding both their physical and mental health care while incarcerated. It is the same standard of care that any physician owes to anyone who is in the general public and not incarcerated. The standard of care a medical provider owes to someone who they are treating does not change by the locale of the person being treated, even though it is my experience that many prison healthcare providers attempt to argue the standard is lower in prison. But I am 100% certain it is not. These psychiatric providers, usually in the guise of simply mental health counselors or Licensed Clinical Professionals (not psychiatrists), have a duty to treat inmates exactly as private paying patients. That rarely happens.

Take for example this real story in a case in which I represented an inmate’s mother and that I just recently settled:

Young inmate, age 19, has a history of at least 3 prior suicide attempt, one of which was in prison when he overdosed on drugs (let that sink in for a minute…an inmate can O.D. on drugs in prison). The mental health providers in the prison knew about his prior attempts.  The young inmate is on anti-depressants. He then had an abrupt change of behavior one day when he refused to see his mother and grandfather, who had been coming to see him every weekend for the two years he had been in prison. His mother than calls the mental health unit manager and informs them that her son had prior suicide attempts and was worried he might try again given the fact he wouldn’t see her. The prison mental health staff meets with the young inmate, who informs them that he now sees and hears Satan, and Satan told him not to see his mother, Satan told him to do what he says and he will get rich and  get out of prison early, that he has been practicing Black Magic with Satan and as long as he does what Satan tells him to do he will be fine and will soon be out of prison. The young man is tearful and sad throughout this meeting. Mental Health Unit Manager and Mental Health Counselor meet and devise a plan for the inmate. The plan: to have him meet with a psychiatrist in 5 days to address the effectiveness of his medication.

Can you guess what happens?

Yes, of course you can, because it was entirely foreseeable and predictable. In less than 24 hours after seeing the mental health staff, he attempted suicide by hanging in his cell.

The young man survived the attempt, but lived for 3 years in a nursing home with profound brain damage due to suffocation.

This young man had at least 8 known risk factors for suicide:

  1. He was young (19 years old)
  2. He was in an adult prison
  3. He was on anti-depressants
  4. He had 3 prior suicide attempts, one in prison
  5. He had an abrupt change in behavior
  6. He had auditory hallucinations
  7. He had visual hallucinations
  8. He was dysphoric (sad)

These are all risk factors that trained medical professionals are supposed to recognize and act on. This young man needed emergency psychiatric treatment. A simple shot of Haldol would have saved him. He needed to be moved immediately to a Crisis Stabilization Unit (CSU). This prison was a mental health prison and had a CSU readily available for him. Yet all he got was an appointment for 5 days later. Ironically, he died in a nursing home on the third anniversary of his last suicide attempt.

Things need to change in our prisons. Let’s not forget that this young man shouldn’t have even been in an adult prison to begin with. He was just 17 years old when he was incarcerated. He should have been adjudicated in the juvenile justice system. But he was not. This needs to change. Representative Mary Margaret Oliver, representing the 82nd Georgia House District, has tried for years to change this, including sponsoring legislation that would allow minors to be treated as minors when they are under the age of 18. Only 6 states in the United States, Georgia being one of them, permit juveniles to be tried as adults for crimes. Regardless of this, there were so many warning signs and red flags with this young inmate whose mother I represented that arguably, even someone without any mental health training should have picked up on and done something. Tragically, nothing was done. He would have been released from prison at age 26 with his entire life ahead of him. He had a loving, supportive family who would have done anything to make sure he didn’t recommit a crime once out. He just had to survive until he got out. Our prison system was not going to let that happen.

Yes, Georgia has made great strides in criminal justice reform under the direction of Governor Deal and Supreme Court Justice Michael Boggs. They have reformed some sentencing and reentry of inmates into society; but now reform needs to come to the mental healthcare provided to our inmates.  Without that, we can’t really be serious when we say we want inmates to rehabilitate themselves while serving nor can we expect reentry into our society to go smoothly.


Robin Frazer Clark is a trial lawyer who pursues justice for those who have personal injury claims as a result of being injured in motor vehicle wrecks, trucking wrecks, defective products, defective maintenance of roads, premises safety, medical malpractice and other incidents caused by the negligence of others.  Ms. Clark is the 50th President of the State Bar of Georgia, a Past President of Georgia Trial Lawyers Association, a Past President of the Lawyers Club of Atlanta and has practiced law in Georgia for 30 years. She is a member of the International Society of Barristers and of the American Board of Trial Advocates. Mrs. Clark is listed as one of the Top 50 Women Trial Lawyers in Georgia and is a Georgia Super Lawyer.

Robin Frazer Clark ~ Dedicated to the Constitution’s Promise of Justice for All.



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