DALLAS (AP) — When Sandra Bland died in a small Texas jail last week, she became just the latest name on a long list of inmates whose deaths were determined to be suicides.
Bland's death following her arrest for a minor traffic violation added fresh fuel to the national debate over police use of force on blacks. It also focused new attention on the longstanding problem of inmates who take their own lives.
The traffic stop "is one issue and that will be dealt with," Lt. Gov. Dan Patrick said earlier this week. "But she lost her life in the jail. And that's what we have to look at." If the correct procedures had been in place, "maybe she would be alive today."
Suicide is the leading cause of death in jails after natural illness. In fact, inmates take their own lives three times more often than the average population, according to a 2010 study cited in the National Study of Jail Suicide.
Since 2000, the total number of jail suicides has remained fairly constant — around 300 a year, according to the federal government's Bureau of Justice Statistics. Improved awareness and monitoring have helped make suicides far less common than in the 1980s or 1990s.
"You talk to any sheriff 20 years ago and they would say suicides are not preventable," said Lindsay Hayes, author of the national study. "Today, more often than not, a sheriff is going to be much more proactive or better-read about that issue."
Statistically, white male inmates are most likely to die by their own hand, both nationally and in Texas. Women make up just a fraction of total jail suicides, and Bland was the only black woman found to have killed herself in a Texas jail since 2009.
The heightened risk of suicide behind bars results from various factors, including those that arise from the jail environment itself.
"Suicides are often spontaneous and notoriously difficult to forecast," said a 2013 article on Texas jail suicides in the LBJ Journal of Public Affairs published by the University of Texas. "Some stressors may come from the jail environment itself where isolation, loss of control, conflict with other inmates or staff, frustration with legal proceedings, or distress and shame over incarceration may flare suicidal tendencies."
State law requires county jails to determine an inmate's suicide risk and whether enhanced security measures are needed. The state only requires that an inmate be observed in person at least once every hour. An inmate who may be suicidal or who displays bizarre behavior must be checked every 30 minutes.
A suicide prevention plan filed by the Waller County Jail, where Bland was found dead July 13, requires all jailers to get two hours of annual mental health training. It also says inmates with high suicide risk should be observed every 5 minutes.
The four-page plan was filed in 2010 with the Texas Commission on Jail Standards, which released it Friday to The Associated Press.
The plan sets out the same requirements for all inmates deemed suicidal: a paper gown instead of cloth, isolation in a single cell and no allowances for personal property or linens. Michele Deitch, a University of Texas law school lecturer, said those guidelines could make things worse for lower-risk inmates and cause them to lie about their thoughts.
"By making it such a restrictive and harsh setting, you're making it less likely that someone is going to actually reveal they have suicidal thoughts," she said.
Deitch argued the plan did not require enough training for jail staff, based on best practices set out by mental health experts. The plan also only requires investigations of "completed suicides" and not all attempts, and doesn't require creating cells without hooks or other problematic features.
Waller County Sheriff Glenn Smith has said Bland was not on suicide watch and was supposed to be observed once every hour. But he also acknowledged that jailers at least once violated state rules by interacting with her via intercom and not in-person.
The intercom conversation, during which Bland asked how to make an outgoing call using a phone in her cell, came about an hour before her body was found July 13 hanging from a noose fashioned from a plastic garbage-can liner.
Two jailers who assessed Bland when she was being booked in the county jail were "adamant" that she appeared fine, the sheriff said.
When the 28-year-old Chicago-area woman was booked into the county jail on July 10, records show, she reported having attempted suicide after a failed pregnancy. Her sister said the miscarriage happened in 2014. Other booking papers indicated Bland did not have suicidal thoughts at the time of her arrest.
The commission cited the jail last week for violating standards on staff training and observation of inmates, and the sheriff said he was forming a task force to review jail procedures.
Nationally, about 33 percent of all inmate deaths resulted from suicide from 2010 through 2012, compared with 29 percent for the same time period in Texas.
Women have been responsible for just 14 of the 140 inmate suicides in Texas since September 2009, when the jail commission began tracking deaths, according to data released to The Associated Press immediately after Bland died.
With jails becoming the largest providers of mental health treatment in many communities, they need more resources and better standards to keep up with increasing demand, Deitch said.
"All of those factors combined with the trauma of suddenly being in jail — the realization of the enormity of what has just happened to them — all of those things can be combined to make them particularly vulnerable in that setting," she said.
Associated Press Writer David Warren contributed to this report.