By Rye Druzin
San Antonio Express-News
SAN ANTONIO, Texas — A buzzer screeched, opening the heavy steel-and-glass door as a jail guard peered out at the visitors. As the door swung open, the silence of the Suicide Prevention Unit permeated the room — until it was broken when an inmate pounded on his door with his fists.
The SPU and adjacent Mental Health Unit are for the most suicide-prone individuals from Bexar County Jail’s population of roughly 3,800 inmates. The special units are part of the jail’s mental health system that begins at booking and attempts to evaluate and treat the mental health of the tens of thousands of inmates who come through the jail every year.
In 2015, there were three suicides in the jail. For nearly the first six months of this year, there wasn’t a single one. Suddenly, there have been three in three weeks, prompting an investigative visit from state officials and a redoubled effort by local officials to ensure its processes keep inmates safe.
“We are obviously concerned about the recent suicides and are evaluating our current practices to determine if any changes should be implemented,” said Don Finley, spokesman for University Health System, which provides mental health and medical services to the jail.
Finley said there haven’t been any changes in terms of the system’s screening or follow-up process compared to last year.
Bexar County Sheriff Susan Pamerleau said her department is continually reviewing its policies.
“We’re continually evaluating because every case is different, and it’s a matter of being cognizant of the individual circumstances,” the sheriff said.
The inmates who committed suicide recently are: Jesus Jose Lopez, 18, on July 15; Jonathan Campos, 22, July 9; and Victor Casas, 40, June 28. Lopez and Campos were in jail on capital murder charges, while Casas was being held on an aggravated assault with a deadly weapon charge.
All three hanged themselves using bedsheets attached to some form of an “anchor point,” the term that jail officials use for objects such as light fixtures, bunk beds and other stationary objects in a cell.
Pamerleau estimated that 21 percent of jail inmates suffer from some form of a mental health issue.
James Keith, spokesman for the Bexar County Sheriff’s Office, said that Campos was being held in Special Management Housing when he committed suicide, while Lopez and Casas had been in general population housing.
While three suicides in three weeks is high, Keith emphasized that there had been 924 suicide attempts this year so far. More than 1,300 were recorded in 2015.
He also pointed out that none of the three were under a mental health watch.
“We haven’t had a suicide in the mental health unit for a while because there are so many checks and measures in place,” Keith said.
The process to head off suicides by inmates brought into the Bexar County Jail begins at booking, where inmates are asked to self-report their medical and mental history.
“We have to ensure that we get their answers to the suicide, medical, mental health questions — first and foremost that’s one of the jail standards immediately when they come into the facility,” said Bexar County Captain Laura Balditt.
The impetus for that information is on the inmates, who can come into the jail in any state of mind.
“When I’m arrested if I just robbed a bank, I don’t have my health records in my back pocket, I don’t have all that stuff with me,” Keith said. “A lot of it is going to be, I’ve never been in this facility before, I’m not in the system, it’s going to be whatever I tell you.”
Balditt said that if an inmate answers a “positive trigger question” -- it could be a medical or mental health question -- he will be escorted to the medical screening area where the inmate is evaluated by a mental health professional, a mandate of the Texas Commission on Jail Standards.
If an inmate is determined to have a mental health issue and to be a risk to himself or others, the inmate will not go into a holding cell.
“We will not put him behind a closed door; we will put him on the bench in front of the sergeant’s desk,” Balditt.
There are several options for an inmate to go from there if he is required to be under watch, including a special mental health cell in a general population unit, the suicide prevention or mental health units or the lower-grade Clinical Observation Unit.
The observation unit is an open room with 26 beds and a few plastic tables or chairs. A detention officer sits behind a desk with multiple screens; some watch the living area, while others monitor the showers. Balditt assured that the shower cameras blur out an inmate’s private parts.
In a building where inmate clothing usually takes the form of orange jumpsuits, the inmates in the observation unit wear a sleeveless, poncho-like garment made of a dark green quilted material -- what Balditt referred to as “suicide smocks” -- which reduce an inmate’s ability to use clothing for a suicide attempt.
During a recent visit, half of the inmates lay motionless in their beds, while the other half were in various levels of dress. Some had worked their smocks around their lower bodies, several exposing heavily tattooed chests. Others wore their smocks from neck to ankle, looking like medieval foot soldiers.
A mental health worker entered the observation unit, calling a name and pulling the inmate into the unit’s entryway to discuss the possibility of him bonding out of jail. Balditt said the conversation between the two was about how the inmate was doing, what resources he would have if he were to get out, and what could be done to give the inmate a better chance of succeeding on the outside when he left.
Checks like that by a medical health professional happen every day, Balditt said. If an inmate is deemed to no longer be a risk to themselves or others, he will move from the observation unit back into general population.
The jail has 129 medical employees, of which 25 are full-time mental health and psychiatric providers, including counselors.
Keith said that as of Tuesday there were 29 inmates under observation throughout the jail.
In addition to the 26-bed clinical observation unit and the suicide and mental health units, there are specially designed single-bed units within larger general population blocks. With up to 70 people, general population blocks can be loud, raucous areas. One inmate was getting a haircut, while others watched the news. A combination of their conversations and the tinny voices coming out of the television echoed throughout the concrete block.
“Everybody’s hanging themselves here,” one inmate quipped darkly before entering his cell block.
At one of the general population units, Balditt asked a detention officer to open the cell next to his workstation. Behind the heavy steel door was a dazed-looking black inmate in a suicide smock, standing by the bed, which was anchored to the floor. The door has a window in it, but there are no other windows in the room. A triangle-shaped light fixture is mounted on the wall.
Balditt asked the inmate how he was doing, if he had any medications and how long he had been in jail. Three days, he said.
“You look good!” she said to the inmate before closing the door.
The inmate is monitored every 15 minutes by the officer in charge of the unit, Balditt said. If he is determined to be better, he will be released back into general population. If not, he will join the other men in the observation unit when a bed becomes available.
The recent suicides have officials reflecting on possible causes.
Keith said that some people coming into jail are at the lowest points of their lives. Balditt agreed.
“My opinion is the charges can affect someone,” Balditt said. “Capital murder, is there anything in store or in your future?”