December 6, 2022


December 6, 2022

Washington, D.C. — New research of lawsuits filed following deaths in jail custody indicates that the cause of death in more than half (59%) of the cases studied was from issues related to behavioral health conditions, which often led to suicide, fatal overdose, and complications from substance use withdrawal. The study, outlined in a new brief by the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, identifies federal and state policy options that could help remove the barriers to proper medical care and advance evidence-based treatment for mental health and substance use disorders in local jails.

According to the latest data from the Bureau of Justice Statistics, 1,200 people died in local jails in 2019, a more than 5 percent increase from 2018.
An analysis of hundreds of state and federal civil lawsuits from 2015 to 2020 by O’Neill’s Addiction and Public Policy Initiative reveals suicide was the leading cause of litigation involving jail deaths (35%). Among those cases, 19% of deaths were drug-related. Mental health issues account for 36% of the claims resulting from excessive use of force by a correctional officer, with 31% of those cases involving substance use prior to incarceration. The study also shows that nearly a quarter of in-custody deaths (23%) occurred within the first 24 hours after arrest.
The authors point out that a failure to address behavioral health needs in local jails significantly contributes to the risk of litigation related to adverse incidents and death in custody. In the cases studied, more than $292 million was awarded for the in-custody deaths. However, the authors emphasize that the sum underrepresents the actual amount paid by state and local governments, correctional officers, and health care providers, because, among other factors, 24% of the cases lacked outcome data.  
To reduce the human and financial toll of jail deaths, the authors call for the following legislative and administrative actions:

  1. Establish diversion and deflection programs to refer people with mental health and substance use issues to community-based treatment in lieu of incarceration.
  2. Develop and enforce clear protocols and training for staff and officers to better screen and immediately assist people at risk for suicide, overdose, withdrawal, or other medical issues.
  3. Increase investments and access to quality medical and psychological treatment for physical and mental health conditions, especially in the first 24 hours and first seven days after intake.
  4. Adopt state legislation requiring jails to provide medical, mental health, and substance use disorder care, treatment, and services.
  5. Eliminate the federal Medicaid Inmate Exclusion Policy to ensure Medicaid funds are available to all incarcerated individuals.

“The number of jail deaths in our country is staggering and exposes the historic challenges of treating medical and mental health conditions and substance use disorder in local jails,” said Shelly Weizman, associate director of O’Neill’s Addiction and Public Policy Initiative and lead author of the brief. “Implementing the proposals outlined in our study, including reducing our reliance on the criminal legal system for treatment of behavioral health needs, will make significant strides in bringing quality health care to local jails and will save lives. It will also help to reduce the hundreds of millions of dollars in financial costs and the legal liability for governments and jail personnel.”
A total of 1,242 civil litigation cases were studied in this analysis with a final sample size of 477 cases. Qualitative findings of the study will be released next month in the Journal of Correction Health Care.

This brief was supported by funding from the Drug Enforcement and Policy Center, Moritz College of Law at The Ohio State University. The original research described in the brief was funded by the United States Department of Justice.

Read the brief here. 


To schedule an interview with the authors of the study, please contact Cynthia Sun at