BREAKING NEWS : Man dead after Hawthorne Suites hotel shooting Full Story

As officials investigate Jeffrey Epstein's death, here's what you should know about suicide watch in jail

Miami Herald reporter Julie K. Brown's investigative series sparked the latest round of litigation surrounding Jeffrey Epstein. She reacts to his suicide, saying she was "stunned," and insists, "we've got to keep our focus on the victims and on this particular case, which really has so many avenues that have yet to be investigated." Brown also reacts to the president's tweet about Epstein's suicide that promoted a conspiracy theory saying, "social media is not the place to get your news."

Posted: Aug 12, 2019 8:40 AM
Updated: Aug 12, 2019 8:40 AM

Chief among the questions people are asking about Jeffrey Epstein's apparent suicide while incarcerated is: Why wasn't he on suicide watch?

The accused sex trafficker was put on suicide watch last month, after he was found in his Manhattan jail cell with marks on his neck, a law enforcement source and a source familiar with the incident told CNN at the time.

Less than a week later, psychologists with the Bureau of Prisons took him off suicide watch, a source familiar with the matter told CNN.

CNN reported Sunday that the jailed multimillionaire's cell was not regularly monitored the night he is believed to have killed himself. The FBI and the Justice Department's inspector general are investigating his death.

Nevertheless, Jack Donson, a former correctional treatment specialist for the federal Bureau of Prisons, told CNN's Ana Cabrera on Saturday he didn't see a "breach of protocol."

"I don't see the egregious issue here."

Here's what you should know about suicide watch in correctional facilities, and what it involves.

What suicide watch entails

Procedures for suicide prevention may vary across the thousands of federal, state and local prison systems, but there are some general principles, according to experts who spoke to CNN.

Correctional facilities are required to have a suicide prevention program, said Lisa Boesky, a psychologist and expert on suicide in jail. These typically include, but aren't limited to, suicide screening and assessment, increased monitoring, restriction of potentially lethal items and having staff trained to intervene in a suicide attempt.

Lindsay M. Hayes, a project director for the National Center on Institutions and Alternatives and an expert in suicide prevention in correctional facilities, described two main levels of suicide watch.

The first, he said, is called constant observation, or 1:1, which means a staff member like a correctional officer is assigned to sit outside the inmate's cell and provide "continuous, uninterrupted observation."

But this method isn't used in most cases, Hayes said. "It is very time- and staff-intensive, and it's only used on the most acutely suicidal."

Hayes referred to the more common level of observation as "close observation." In most cases, inmates under this level of observation are checked on in 15-minute intervals.

"It's best to stagger the walks," he added. "So the first time you come around, it might 15 minutes, and the next time it's 12 minutes, and ten minutes, seven minutes ... so the inmate does not anticipate the round from happening."

But what's most notable about suicide watch are the privileges and possessions taken away from an inmate, Hayes said.

According to Boesky, inmates on suicide watch -- or safety watch, as she calls it -- should be kept in a suicide-resistant room. That means there's no protrusions for the inmate to hang himself on, like a vent, sprinkler head, door knobs, bars on the door, towel racks, or bunk beds, for example.

Inmates are also given limited access to things they could potentially tie around their necks, Boesky said. "They're given tear-resistant bedding, oftentimes no toilet paper, no towels, no extra clothing."

Inmates can also be stripped of their clothes and forced to wear a safety smock, which Hayes described as a heavy, quilted garment that an inmate can't use to hang himself. "If it's made correctly it can't be torn, it can't be wrapped up into a ligature," he said.

On suicide watch, inmates are also given finger food, Hayes added, and are given no utensils with their meals.

Throughout this period, the inmate should be regularly checked in on by a qualified mental health professional -- like a psychologist or social worker -- who will ultimately make the decision to take the inmate off suicide watch.

"Any time an inmate is on suicide watch, a qualified mental health professional should be checking in with them on a daily basis, providing support and to determine if the suicide risk is increasing, decreasing, or if they need to be removed from suicide precaution," Boesky said.

How inmates are taken off suicide watch

There is no preferred timeline for suicide watch, or standard of care that requires someone be placed on it for a certain amount of time, Hayes told CNN. But being under this kind of watch is very restrictive.

"In some facilities, you cannot go anywhere, you have to wear special clothing, you have to eat specific foods, you are limited in your activity," Boesky said, "and for many inmates it can make them even more dejected, despairing and hopeless."

Given the conditions, "it would be completely unreasonable and inhumane to keep an inmate who appears to be stable on suicide watch indefinitely," Hayes said.

"You just can't do that."

A clinician should decide to take an inmate off suicide watch based on a number of factors, Boesky said. "This should only be done when there is a face-to-face evaluation, and an evidence-based suicide assessment, taking into account the clinician's observations, interviews with the inmate, conversations with correctional officers, as well as known stressors in the inmate's current situation."

In a high profile case like Epstein's, Hayes said, a clinician may want to let a supervisor know they're taking an inmate off suicide watch. But it ultimately comes down to their own clinical assessment.

Boesky said a clinician shouldn't base their decision to remove an inmate from suicide precaution solely on the inmate's own report of their suicide risk. Some inmates might misrepresent their level of suicide risk in order to escape the intense restrictions they're under.

In some cases, Hayes said, "making it so restrictive isn't making them less suicidal. It's actually making them more suicidal."

After suicide watch

Boesky stresses the importance of having "a continuum of levels of suicide- or safety watch." Inmates on suicide watch, she said, should be "stepped down to lesser and lesser forms of intensive monitoring before being returned to general population."

According to Hayes, what happens after an inmate is taken off suicide watch usually depends on the clinician's assessment and the resources available. But it's not unusual for an inmate to be put under another level of observation, and be checked on every 30 minutes by correctional officers. This "could be used as a final step toward getting them off all levels of observation."

A 30-minute check should never be used, he added, on an inmate who a clinician still believes is suicidal.

An inmate who has been taken off suicide watch could also be placed in a cell with another inmate, though that can be complicated, because staff then have to find an inmate who is compatible.

Both Hayes and Boesky said correctional officers have a difficult job overseeing suicidal individuals.

And although everyone pays attention to this issue when it happens to a celebrity, suicides in jails happen every day, Boesky said.

"It is a tragedy that nobody talks about," she said, "and much must be done."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 592709

Reported Deaths: 9340
CountyCasesDeaths
Marion818931301
Lake44495668
Allen32035543
Hamilton28533305
St. Joseph26847372
Elkhart24132341
Vanderburgh18759213
Tippecanoe17482122
Johnson14583285
Porter14464160
Hendricks13931242
Madison10600213
Vigo10513174
Clark10300132
Monroe9109108
Delaware8861133
LaPorte8825155
Howard7916138
Kosciusko788877
Warrick648290
Hancock642597
Bartholomew629294
Floyd6184105
Wayne5956157
Grant5848110
Dubois546172
Boone536367
Morgan519491
Henry496164
Marshall494984
Cass473160
Noble462157
Dearborn461344
Jackson416145
Shelby404279
Lawrence382075
Clinton366340
Gibson357856
DeKalb338563
Montgomery336651
Harrison332642
Knox328239
Miami311243
Steuben308742
Adams296535
Whitley295525
Wabash293945
Ripley293745
Putnam286847
Huntington285058
Jasper284434
White268438
Daviess262172
Jefferson253138
Decatur242882
Fayette242448
Greene235660
Posey232826
Wells230147
LaGrange224761
Clay218732
Scott217337
Randolph209041
Jennings193235
Sullivan189331
Spencer182717
Fountain180425
Washington178218
Starke172041
Jay163122
Fulton160230
Owen160137
Carroll153015
Orange152133
Rush150818
Perry148727
Vermillion145533
Franklin143833
Parke12908
Tipton128432
Pike114125
Blackford108022
Pulaski95137
Newton89721
Brown85730
Benton84510
Crawford7669
Martin70413
Warren6607
Switzerland6235
Union6145
Ohio4707
Unassigned0374

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 831066

Reported Deaths: 10281
CountyCasesDeaths
Franklin97996705
Cuyahoga826131062
Hamilton61629439
Montgomery41873399
Summit33603729
Lucas30316597
Butler29859228
Stark24951413
Warren18974139
Lorain18217212
Mahoning16815336
Lake15491135
Clermont15235104
Delaware1392977
Licking12765132
Trumbull12445306
Fairfield1226080
Greene11682133
Medina11191165
Clark10648264
Wood10000154
Allen9579126
Portage8923106
Miami890573
Richland8848116
Marion7341113
Tuscarawas7162174
Columbiana7117124
Pickaway705750
Wayne6815165
Muskingum676342
Erie5943118
Hancock540490
Ross532787
Scioto523663
Geauga487755
Darke458589
Ashtabula440572
Lawrence436652
Union432828
Mercer425887
Sandusky424462
Auglaize415159
Seneca415155
Huron413638
Shelby411021
Jefferson404566
Belmont397840
Washington373140
Athens36549
Putnam365372
Madison341429
Knox337722
Ashland333838
Fulton327143
Defiance320178
Crawford315169
Preble312434
Brown298219
Logan293229
Ottawa283034
Clinton279643
Williams271166
Highland263618
Jackson258343
Guernsey244025
Champaign242827
Fayette228029
Morrow22404
Perry222618
Holmes219462
Henry211947
Hardin205033
Coshocton198920
Van Wert198044
Gallia191626
Wyandot191449
Adams165815
Pike165217
Hocking164423
Carroll150116
Paulding139921
Noble118340
Meigs103521
Monroe96129
Harrison8598
Morgan79628
Vinton67213
Unassigned00
Fort Wayne
Mostly Cloudy
26° wxIcon
Hi: 34° Lo: 21°
Feels Like: 15°
Angola
Cloudy
25° wxIcon
Hi: 30° Lo: 22°
Feels Like: 15°
Huntington
Partly Cloudy
26° wxIcon
Hi: 33° Lo: 19°
Feels Like: 18°
Fort Wayne
Partly Cloudy
26° wxIcon
Hi: 34° Lo: 21°
Feels Like: 15°
Lima
Partly Cloudy
26° wxIcon
Hi: 34° Lo: 21°
Feels Like: 16°
Evening Light Snow Tuesday
WFFT Radar
WFFT Temperatures
WFFT National

Community Events