In an effort to reduce the number of self-inflicted deaths in Maryland prisons, inmates placed on suicide watch are being monitored by unlikely aides: their fellow criminals.
Officials with the state Department of Public Safety and Correctional Services say the practice, launched last year after a spike in suicides, enlists only the most trustworthy of inmates. But some critics say it's a shortcut for staff-strapped institutions, and a report last fall recommended that one area jail discontinue the practice after finding that prisoners can agitate their suicidal peers.
Inmate observation aides in both men's and women's facilities in Maryland sit on chairs outside of cells, and work four-hour, paid shifts with a pen and logbook taking notes on the prisoner's condition. They must alert a nearby corrections officer if the inmate attempts to hurt himself.
"We leave it up to the individual institutions to pick the inmate, but they're people who demonstrate the right attitude and skill level," said Rick Binetti, a spokesman for the Department of Public Safety and Correctional Services. "It's sort of the cream of the crop of the inmates."
The program hasn't been widely adopted across the country, but the federal prison system and institutions such as New York's Rikers Island jail use prisoners to supplement observation of suicidal inmates requiring round-the-clock supervision.
Federal researchers found that suicide watches performed by other inmates reduce the frequency and length of watches, reduce costs and may even improve socialization. A 2005 study showed that the increased attention was partly responsible for a drop in the suicide rate, and boasted that the system saved $300,000 in overtime pay one year.
The study released in 2005 by researchers at Federal Medical Center in Butner, N.C., found that increased prevention awareness, including the observation aide program, had helped lower the rate of suicides among inmates in federal custody to below that of adult men overall.
The aides were empowered by "joining with an 'adversarial' system to 'do good,' " according to the report. Suicidal inmates, meanwhile, found themselves safely able to converse with peers who were coping more effectively.
But last fall, a report prepared for the Department of Justice described the use of the practice at the Baltimore City Detention Center as "very problematic." The jail has continued to enlist prisoners as aides, Binetti said.
Critics say that the program poses liability concerns as uncertified inmates are placed in a position of responsibility.
"When it comes down to it, they are still inmates, and they became inmates and were convicted of crimes because they were not reliable members of the community," said Lindsay M. Hayes, a consultant with the National Center on Institutions and Alternatives who has studied prison suicides and prevention programs. "Now suddenly they are put in positions where prison officials are desiring their reliability. It's a little bit bizarre when you conceptualize the whole thing."
While suicide remains one of the leading causes of death in many local jails, the suicide rate in corrections facilities has declined over the past two decades, according to federal statistics. It is the third-leading cause of death in state and federal prisons, behind natural causes and AIDS, and corrections officials say it has received more attention in recent years.
According to a review of data from 2001 and 2002 by the Bureau of Justice Statistics, Maryland had the fifth-highest total suicides in the country among state prison systems and the 13th-highest suicide rate.
About 23,000 people are serving time in Maryland prisons, said Mark Vernarelli, a spokesman for the Department of Public Safety and Correctional Services. His department is also responsible for the Baltimore City Detention Center, where about 4,000 defendants are awaiting trial.
Hayes said that there is a budget crisis in every jail and prison system in the country, which has led to spiraling overtime costs. He said that while corrections systems that use the observation system might report lower suicide rates, effective prevention includes many more factors, including mental health assessments and clinical staff training.
Rhode Island, for example, had an observation program from 1992 to 2000 in which trained inmate aides worked as peer counselors and "befrienders" of potentially suicidal inmates, but it was discontinued in 2000 after staffing was beefed up, spokeswoman Tracey Poole said.
"It's not that we disliked the program, but we now have staff who are trained to do more formal clinical assessments and whenever there is a report of an inmate who is thought to be suicidal ... these trained staff respond rapidly," Poole said. "We believe we have a good system in place and we don't need [the inmates'] services in the same way we did years ago."
Gary D. Maynard, state secretary of public safety and correctional services, who previously led Iowa's corrections system, adopted the observation aide program there after a spike in suicides, Binetti, the Maryland system's spokesman, said. In the four years that followed, the system recorded no suicides.
Maryland began training inmate watchers late last summer after a similar spike in 2007, with seven suicides in the second half of last year.
"The secretary found the numbers unacceptable," Binetti said.
He said there has not been a suicide since the program went into effect in December.
Wendy Hess, an attorney for the Public Justice Center in Baltimore, applauded the efforts to reduce the number of suicides, but said she found it "worrisome if the system is relying on basically untrained persons and, in particular, other inmates to monitor the safety, welfare and mental status of other inmates."
"In light of the [Baltimore detention center] report ... it does not appear that there's uniform agreement that this system achieves the goal of preventing suicides," Hess said.
Suicides in Maryland prisons, by fiscal year (July 1 to June 30):
*The last suicide in a Maryland prison occurred Dec. 16, 2007