People old enough to remember the Andy Griffith Show may recall the good-natured character named Otis, who would work all week and then drink all weekend, sleeping off his intoxication in a jail cell or “drunk tank.” Half a century later, the practice of arresting and jailing intoxicated people has become a significant driver of mass incarceration. It also plays an important role in causing jail-attributable deaths.
The modern iteration of the drunk tank is something called a sobering cell. This is a holding cell, usually in the intake area of a county jail, where a person who is thought to be acutely intoxicated will be held anywhere from a few hours to a couple of days.
One of the dangerous aspects of this practice is that the person thought to be intoxicated is often put into one of these cells before they receive the standard medical screening by jail health staff. The rationale behind this is that medical staff can’t perform their screening until the person is more compliant.
This gamble is based on the idea that health and security staff know what is causing the behavior they see, and that there isn’t anything else happening that could result in death or disability.
Once in these cells, people may be observed intermittently through a locked door by security or even health staff. But the overall intent is for them to calm down and stop whatever behaviors they were exhibiting. In my career in correctional health, I have investigated numerous jail-attributable deaths that resulted from this very practice.
When a person is put into a locked cell, their behavioral issues may have been removed from staff. But they are not being medically monitored and they can develop deadly complications of their intoxication, or life-threatening illness from other substance use, mental health or medical concerns that are extremely common in jail settings. Imagine a patient who is intoxicated with alcohol but who also has insulin dependent diabetes. Or a person intoxicated with methamphetamine but who is also veering into alcohol withdrawal, which can be fatal. Looking through a vision panel in a cell door, it’s basically impossible to tell the difference among these types of health concerns or whether a person is dealing with one or multiple issues.
These sobering cells don’t exist in a vacuum, however. Jails and prisons are built to confine and punish, and there are plenty of other health problems that can lead to being locked alone in a cell for incarcerated people.
For example, it is routine for people in the throes of a mental health crisis to be put into a cell, often termed a “safety cell,” where they are naked except for a suicide resistant smock or blanket, and watched continuously by a correctional officer. Suicide is the leading cause of death in U.S. jails. The label above the cell is not important, but the practice of putting people who require more medical monitoring and care into isolation setting is a common driver of jail-attributable deaths.
There are less dangerous and expensive alternatives to arrest and isolating intoxicated people in jail sobering cells. Houston, Texas, has a decade of experience diverting people into a clinical recovery center that been part of local reforms, resulting in a 95 percent drop in jail admissions for intoxication, from 20,508 in 2010 to 835 in 2017.
This recovery center provides safe monitoring, transportation home and referral to medical and mental health care, all things that are sorely needed but usually lacking in jail settings.
This alternate pathway frees up law enforcement and court resources to focus on genuine public safety concerns. It also provides relief for the only other option in most places, the local hospital emergency department. Similar approaches are underway in other cities including San Jose, Calif.
By replicating this model, we can direct people with substance intoxication into a clinical pathway that decreases their risk of death in a jail sobering cell, and increases their likelihood of receiving meaningful treatment afterwards. We can also use this as an important pivot to reduce the rate of jail-attributable deaths throughout the nation’s 3,000 county jails.
Dr. Homer Venters, MD, MS, is president of the nonprofit organization Community Oriented Correctional Health Services and author of “Life and Death in Rikers Island.”