Could Better Mental Health Care Have Saved Sandra Bland’s Life?

Officials further investigate the death of Sandra Bland’s case. Tuesday, the Standard talked about the legalities of the arrest itself. Wednesday we look at mental health procedures for Texas inmates.

By Texas StandardJuly 23, 2015 4:03 pm|

Sandra Bland, 28, was arrested and charged with assaulting a public servant on July 10. She had allegedly failed to use her turn signal while changing lanes. Bland went through intake and was booked into Waller County Jail.

Three days later, Bland was found dead. The medical examiner called it a “suicide by asphyxiation.” From all appearances, Bland had hanged herself with a plastic garbage bag accessible in her cell. Now the FBI and the Texas Rangers have launched investigations. (Although Bland’s case is being investigated like it is a murder, that doesn’t mean there’s been a conclusion that Bland was murdered.)

This means that lots of evidence is being collected, including interviews with those who knew her and those who spoke with her before and during her incarceration. There’s video footage of the stop and from the jail cameras. An autopsy report was released late Wednesday. According to the Waller County District Attorney, all this evidence will be presented to a grand jury.

But the questions remains: What actually happened when Bland arrived at the jail? And what should have happened?

Those close to her say she had good things going on in her life and no outward appearance of depression, so to them, suicide seems out of the question. But Bland told staffers at the jail she had previously tried to commit suicide, and the symptoms of depression and suicidal attempts are not always apparent to even those who are in the closest circles of a person.

According to Michele Deitch, a senior lecturer at the Lyndon B. Johnson School of Public Affairs at University of Texas at Austin, Bland’s disclosure of mental illness should have triggered a whole sequence of precautionary steps, but apparently did not. The Standard wants to know if rules had been followed from start to finish, would Sandra Bland be dead?

Deitch spent much of her career working on issues involving jail procedure, incarceration and criminal justice. The Standard’s David Brown speaks with her about her questions surrounding the case and what Texas law has to say about procedures for inmates with a disclosed history of mental illness. Below is a transcript of the conversation, edited for brevity and clarity:

Sandra Bland apparently told staff at the Waller County Jail she’d previously tried to commit suicide. This is part of the intake process that did not end up in the computer records. What happened?

“It’s hard to know. Clearly, there was some something that did not get communicated between the person who filled out the screening form and the person who entered that information into the computer.”

Is that a common issue?

“There are going to be problems of transcription. But when it comes to issues involving suicide and medical issues, there’s nothing more important for jailers to get right.”

What are the questions that people are being asked once they begin that journey into the jail?

“Every jail has or ought to have a form that asks incoming inmates questions about their medical history: their history of suicide, any medications that they’re on and any chronic health problems. Whether they’re pregnant if it’s a female. They really need to know anything that may cause an urgent medical need.”

These the folks who run the jail have to count on the candor of the person who is coming into the jail at that point. There’s a lot of stress and a lot of confusion often during that process.

“That’s exactly right. And that’s one of the reasons why best practices require that the person who conducts that initial screening is someone with some kind of medical training. Ideally, if there is a person at the jail who is a mental health or a health staff member that person would do it. If the jail does not have someone like that on staff, then the intake screening officer ought to be someone with specific training.”

In this case, if someone like Sandra Bland says “I have attempted to commit suicide in the past,” what would be the procedure from that point? Is she treated differently? Are there certain changes in the circumstances under which she’s held?

“Once that information is recorded on the screening form it becomes a triage process and it should trigger an immediate referral to mental health personnel, as well as an evaluation by those health personnel to figure out if she does present a current medical or mental health or suicide risk. If she is identified — as she would have been here — as someone with a recent history of suicide attempts, then that triggers her placement into a setting where she gets a different level of observation. She should be on checks that occur much more frequently than the general population inmates.”

I noticed that you’re saying “should.” Is that a matter of Texas law — or for that matter, federal law — that someone must be observed more closely if they say that they’re suicidal? Or is this something that jails have the option to do?

Under Texas law, an inmate who has indicated any history of suicide attempts should [have observed physical supervision] at least every 30 minutes. But nationally what is known to be best practices requires even more frequent observations — at least every 15 minutes or more frequent, if they’re in an active suicidal state.”

Based on the stories that we’re hearing about Sandra Bland, what is the takeaway? What are the questions that you’re asking right now?

“I have a lot of questions about whether the screening process was conducted accurately. They do appear to have completed forms, but there are discrepancies among the forms with regard to her suicidal history and her medicine…. I’d like to know what kind of training the staff who conducted those intake screenings had. I’d like to know what kind of setting she was placed in and what staff were directed to do in terms of frequency of observations. Also, she was apparently put in a cell that had plastic garbage bags available. Which is bizarre to me. And really inexplicable from a standpoint of suicide prevention for all inmates. But for an inmate who has been identified as having previously had a suicide attempt, it’s unfathomable that they would put her in a cell with access to that kind of tool.”