When the calls from jail out of the blue stopped in February 2024, Erik Ramsey’s household began worrying. Frequent communication was their method of attempting to assist Ramsey, 29, who’d been recognized with schizophrenia and bipolar dysfunction, get by means of the time till his scheduled launch in February 2026.
In isolation, Ramsey couldn’t make or obtain calls. He did ship just a few letters stuffed with manic ramblings that raised considerations amongst his family members.
Then got here Could 5, when a name simply after midnight from the warden at Harnett Correctional Establishment blindsided Ramsey’s household.
“Erik took his life,” Ramsey’s older brother Edward recalled the warden telling him.
“It was only a shock,” mentioned Edward Ramsey, whose brother had been in jail for lower than 4 months. “I hadn’t been capable of speak to my brother for months … I believed I used to be in a dream … To at the present time, it’s nonetheless obscure and to course of that it occurred.”
A correctional officer discovered Ramsey lifeless in his restrictive housing cell — a sheet tied round his neck hanging from the bars of his cell door — whereas making rounds round 11 p.m. on Could 4, in response to a state health worker’s report obtained by NC Well being Information.
About an hour prior, Ramsey had instructed a correctional officer that he “wanted to speak to somebody,” the report states, however the officer mentioned he was busy making rounds and mentioned they’d speak later. Ramsey had additionally refused to take his psychological well being treatment earlier within the day, in response to the report.
“There was no motive for jail to be a loss of life sentence,” Austin Holland, Ramsey’s stepbrother, mentioned. “Erik was the infant of the household. He was the enjoyment.”
Ramsey’s is only one story, nevertheless it connects to bigger traits amongst folks serving time in North Carolina prisons: an uptick in suicides in 2024, rising numbers of individuals with psychological well being diagnoses and the continuing use of solitary confinement, which the jail system refers to as restrictive housing.
Final 12 months, 13 folks died by suicide — tying the file for many suicides in a 12 months. Eight of the deaths occurred in restrictive housing, the place offenders are confined alone in a cell concerning the dimension of a parking area for 22 hours or extra per day.
To begin 2025, three folks died by suicide over 4 days in January — two in restrictive housing.
No extra suicides have been reported for the reason that Jan. 19 loss of life of 25-year-old David Whittington, who had been in jail since July 2024 for assault on a legislation officer and revocation of his post-release supervision; he was projected to be launched in September. The health worker’s report notes that Whittington had many psychological well being diagnoses and a historical past of suicidal ideation, together with a previous suicide try, and that he had been on suicide precautions on the jail about one week earlier than his loss of life.
Lewis Peiper, director of behavioral well being on the Division of Grownup Correction, instructed NC Well being Information that his division has put a variety of new applications in place to deal with psychological well being points however that it’s exhausting to pinpoint anybody issue driving will increase in deaths by suicide.
“We discover that over time, pinning [suicide] right down to only one factor appears to be form of a transferring goal of kinds,” Peiper mentioned.
Peiper mentioned the corrections division is concentrated on bolstering coaching, particularly for jail behavioral well being workers and correctional officers who’ve essentially the most contact with incarcerated folks. Nonetheless, one of many jail system’s largest tasks creating a brand new suicide prevention coaching program in partnership with UNC Charlotte researchers was simply placed on maintain; the Trump administration lower off the federal grant that funds the work.
Data present that Ramsey landed in isolation in early March as a result of he obtained infractions for assaulting a workers member and subsequently for attempting to flee — habits his household believes was a manifestation of his psychological sickness.
Greater than eight months after his loss of life, when his post-mortem report was launched in mid-January, Ramsey’s household discovered concerning the gravity of Ramsey’s psychological misery. Based on notes within the health worker’s report, Ramsey made a number of suicidal statements throughout his time in jail and even tried suicide the month earlier than his loss of life by consuming batteries and taking tablets.
That data got here as a physique blow to family members, Holland mentioned. They weren’t conscious he was in disaster and have been outraged that they weren’t given the chance to speak to Ramsey to attempt to get by means of to him amid his psychological well being struggles.
“Him not speaking to us was the punishment for him being mentally unwell and having manic moments,” Holland mentioned. “They took away the factor that might have helped him.”
Division of Grownup Correction Communications Director Keith Acree mentioned the division doesn’t notify relations about suicide makes an attempt — except the try ends in hospitalization or a vital medical situation — as that data could be thought-about protected well being data that can not be disclosed with out a person’s written authorization. He additionally mentioned that phone privileges in restrictive housing are “not automated” and are decided by the jail warden based mostly on management and security concerns.
Acree mentioned he couldn’t touch upon Ramsey’s case, citing division coverage.
‘Sign of a failing system’
The Division of Grownup Correction broadcasts when a suicide happens by posting a information launch on its web site. NC Well being Information requested the health worker’s investigation and post-mortem stories for every one who died by suicide going again to 2016. They include various levels of element. Some present extra perception into contextual circumstances, reminiscent of histories of psychological sickness and substance use, a latest sexual assault or disputes with different incarcerated folks. Different stories simply have a short account of the timeline of discovering an individual lifeless.
Since 2016, a complete of 81 folks have died by suicide in North Carolina prisons. Almost 60 % have occurred in restrictive housing.
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Folks in jail disproportionately have greater charges of psychological sickness than the overall inhabitants, in addition to greater charges of self-harm.
Based mostly on NC Well being Information’ evaluation of the deaths, about three-quarters of suicides are amongst white males, although lower than half of the whole jail inhabitants is white. Solely 4 have been ladies.
Of those that died by suicide, it’s a mixture of people that had life sentences or a long time left to serve and others nearing their launch dates. Fourteen individuals who took their lives had lower than one 12 months left to serve.
For instance, 28-year-old Samuel Shore was as a result of be launched from jail in April however as an alternative died by suicide at Greene Correctional Establishment in January after serving shut to 3 years for driving whereas intoxicated.
“When persons are dying inside prisons by suicide, I feel that’s a sign of a failing system — a damaged correctional system that depends on punishment as an alternative of rehabilitation,” mentioned Craig Waleed, mission supervisor for Unlock the Field, a marketing campaign in opposition to solitary confinement at Incapacity Rights NC.
Growing deaths
Suicide numbers seem small stacked up in opposition to the practically 32,000 folks within the Division of Grownup Correction’s amenities on daily basis. However on common, the speed of suicide in jail is barely greater than North Carolina’s general suicide price. North Carolina’s suicide price from 2013 to 2022 was 15.5 folks per 100,000 on common, whereas the state jail’s suicide price was 19.6 per 100,000 on common throughout the identical 10-year timeframe.
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Over the previous decade, the variety of annual suicides in jail has gone up and down, however the leap in 2024 is hanging.
The jail suicide price in 2024 was equal to 40.8 folks per 100,000 — probably greater than two instances the general state price, which has held pretty regular over the previous decade. North Carolina’s general suicide state price in 2022 — the final 12 months of full knowledge — was 16.5 folks per 100,000.
North Carolina isn’t alone in going through a rise in jail suicides. Nationwide, suicide is a number one reason behind loss of life in correctional amenities. From 2001 to 2019, the variety of suicides elevated by 85 % in state prisons and 61 % in federal prisons, in response to knowledge from the Bureau of Justice Statistics.
Kate LeMasters, a researcher on the College of Colorado Anschutz College of Medication who has studied suicides in correctional amenities — together with in North Carolina prisons — mentioned that these deaths shouldn’t be occurring. Jail programs are tasked with sustaining the security and safety of these of their custody, and that features holding folks alive, she mentioned.
Whereas advocates and researchers acknowledge that zero suicides is probably not doable, they are saying rising deaths are an indication of bother.
“Suicides in jail is a public well being disaster,” LeMasters mentioned. “These deaths shouldn’t be occurring. We’ve created, and are more and more reliant on, a system that’s not set as much as deal with and enhance folks’s psychological well being.
“A rise in suicide is indicative of the larger psychological well being disaster occurring in these amenities,” she mentioned.
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Rising psychological well being caseload
The rise in suicide deaths comes at a time when an growing proportion of individuals in North Carolina prisons have a recognized psychological sickness. Over the previous decade, the proportion of the jail inhabitants on the psychological well being caseload has doubled, in response to division knowledge. Now, one-quarter of the jail inhabitants — about 8,000 folks — has a psychological well being prognosis requiring therapy, Peiper mentioned.
The jail system’s psychological well being caseload has grown by 2,000 folks since 2020, and Peiper mentioned it’s a problem to fulfill the rising want.
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Peiper mentioned he wants extra workers to do that work, however he wouldn’t go as far as to say the suicides present a niche in psychological well being care.
“As a result of the numbers fluctuate from 12 months to 12 months, I don’t know if that might account for the years that have been decrease the place we nonetheless had lots of people needing psychological well being therapy and elevated staffing wants,” Peiper mentioned.
Peiper additionally famous that many individuals who commit suicide are usually not on the psychological well being caseload.
“They’re overlapping populations, however they’re not the identical inhabitants,” he defined.
That’s in line with the medical experts’ stories reviewed by NC Well being Information; solely a portion of the instances included medical histories of psychological well being issues like melancholy, bipolar dysfunction, post-traumatic stress dysfunction and others.
The overwhelming majority of suicides in North Carolina prisons have been by hanging — mostly utilizing a mattress sheet — in response to NC Well being Information’ overview of the reason for loss of life on post-mortem stories. One other eight have been from overdoses. The reason for loss of life in 10 suicides stays pending, as medical experts’ stories haven’t been made public.
Along with suicide, the Division of Grownup Correction encounters a variety of different self-injurious behaviors amongst its inhabitants.
In 2024, 2,941 self-harm incidents occurred that required a self-injury danger evaluation, in response to division knowledge offered to NC Well being Information. Of these, 32 % included some sort of motion, reminiscent of chopping or burning oneself with scalding water, whereas the remaining 68 % have been written or verbal threats.
Peiper mentioned the jail system’s coverage is to put folks deemed suicidal beneath “fixed statement” the place they’re positioned in a cell with line-of-sight of the particular person and given tear-resistant gadgets, reminiscent of a security blanket, security smock and vinyl-covered mattress. A behavioral well being clinician meets with the incarcerated particular person each day to evaluate their security and whether or not they can return to their common housing unit, he mentioned.
After Ramsey’s suicide try a month earlier than his loss of life, he was changed on this suicide behavioral look ahead to in the future, in response to his health worker’s report.
Psychological deterioration
Along with many individuals coming to jail with psychological sicknesses, incarceration itself may also trigger psychological deterioration and anguish. Analysis exhibits greater charges of self-harm amongst incarcerated populations.
Ramsey matches these traits. He was despatched to jail for a string of armed robberies his household mentioned he dedicated in 2019 amid deteriorating psychological well being. After his arrest, he was recognized with schizophrenia and bipolar dysfunction.
His psychological well being stabilized after he was given psychiatric treatment, his household mentioned. And when Ramsey entered jail in January 2024, his household had already made plans for a way greatest they may help him — prime amongst them was staying in frequent communication.
They created a schedule. Ramsey known as his stepbrother on Mondays, his brother on Wednesdays and his mother and father on Fridays. His relations made positive to choose up each name.
“Listening to from us — that was his method of staying grounded,” mentioned Holland. “He knew that for him to remain rooted in actuality, he wanted to listen to from his household.”
Some days once they talked he sounded drained, however Holland mentioned his brother was all the time trying towards the long run — eyeing his 30s as a contemporary begin.
However then, his household mentioned, the telephone communication vanished as soon as Ramsey was positioned in restrictive housing in March. That put the household on edge, however a jail workers member instructed Ramsey’s father in April that he may go to him in a month on Could 21, and so they set their sights on that.
However the go to by no means occurred. By that point, Ramsey was lifeless.
Ramsey’s household is satisfied that jail, notably time in solitary confinement, worsened his psychological well being signs and that he couldn’t get the assistance that he wanted.
“Erik by no means tried suicide whereas not in jail,” Holland mentioned. “This wasn’t a foregone conclusion. This wasn’t a child who had been depressed since he was eight and was all the time going to finish this fashion. That’s not this story.”
Analysis persistently exhibits that solitary confinement impacts bodily and psychological well being, growing dangers of tension, self-harm and suicide.
Waleed from Incapacity Rights NC is aware of firsthand the toll of solitary confinement. He spent two 30-day stints locked in a restrictive housing cell alone for all however one or two hours a day whereas incarcerated in New York. He mentioned it solely took just a few days earlier than he felt himself begin to unravel and he started hallucinating.
“If somebody is in a scenario like that, lengthy sufficient, they start to doubt every thing about what’s actual and what isn’t — even their very own actuality or their very own existence,” Waleed mentioned.
Data present that Ramsey was in restrictive housing for practically two months earlier than he died by suicide. NC Well being Information analyzed a database compiled by Incapacity Rights NC that accommodates the housing standing of individuals within the state jail system based mostly on weekly knowledge posted by the Division of Grownup Correction. The database revealed that others who died by suicide in restrictive housing spent as little as one week there earlier than their loss of life, together with two of the three suicides this 12 months. The third one who died by suicide in 2025 spent a few 12 months in restrictive housing earlier than his loss of life for varied infractions from flooding his cell, disobeying orders and assaulting workers.
Elevated danger of suicide in solitary
Christine Tartaro, a researcher at Stockton College in New Jersey who has studied correctional suicide for over 25 years, mentioned time spent in solitary places folks at greater danger for suicide.
“When persons are alone, not solely is there doable motivation to take one’s life, however the alternative grows exponentially,” Tartaro mentioned. “Individuals are solely trying in on you each every so often, and suicide by hanging solely takes a few minutes.”
Regardless of the identified harms of solitary confinement, about 6 % of North Carolina’s practically 32,000 incarcerated persons are held in restrictive housing.
Tartaro, who has studied state and federal suicide prevention plans throughout the nation, mentioned one of many methods states have sought to stop suicide deaths is by lowering restrictive housing. That’s as a result of corrections departments throughout the nation — together with in North Carolina — have persistently discovered extra suicides happen there.
For years, advocates have been pushing for the Division of Grownup Correction to scale back — and even get rid of — using solitary confinement. They’ve known as on the jail system to undertake the Nelson Mandela Guidelines — a set of requirements on the therapy of incarcerated folks worldwide that prohibits extended solitary confinement of greater than 22 hours a day for greater than 15 consecutive days.
Former Gov. Roy Cooper’s Job Drive for Racial Fairness in Legal Justice beneficial implementing this commonplace in 2020, however then-Secretary Todd Ishee mentioned he didn’t suppose complying was possible and was gradual to make modifications.
However the Division of Grownup Correction’s new secretary, Leslie Cooley Dismukes, who assumed the function in January, instructed NC Well being Information that the division is working towards following the Nelson Mandela Guidelines.
Modifications are being made in three phases, she mentioned. First, the division revised its disciplinary insurance policies in December to scale back lengths of keep in restrictive housing for sure infractions and is working to streamline the disciplinary investigation course of. This summer season, the division additionally plans to reinforce step-down and diversion housing to facilitate extra different choices to restrictive housing or clean the transition again to the overall inhabitants.
Advocates are hopeful these reforms to restrictive housing could make a distinction.
“I feel that it’s vital to cease placing so many individuals in solitary confinement as a result of what we discover is that many instances persons are in solitary confinement not as a result of they’re the worst of the worst, however as a result of they’re feared of being violent, or they’ve had another sort of infraction, or the manifestation of some sort of psychosis,” Waleed mentioned.
When inserting somebody in restrictive housing, Peiper mentioned, further behavioral well being screenings are required to evaluate one’s psychological well being in addition to additional monitoring by correctional officers. That’s in recognition that it’s typically a extra weak setting.
“There’s a ramp up of eyes on, improve of screening, improve in contacts which are occurring,” Peiper mentioned.
Nonetheless, he mentioned that the Division of Grownup Correction tries to put folks with psychological sickness in different settings from restrictive housing, reminiscent of inpatient psychiatric therapy items at Central Jail or the North Carolina Correctional Establishment for Ladies. Therapeutic diversion items — treatment-oriented jail housing items for folks with a psychological sickness staffed by behavioral and nursing professionals along with correctional officers — with 68 whole beds throughout three prisons and behavioral well being outpatient therapy items with 300 beds throughout one other 4 prisons are additionally an choice, he mentioned.
In 2024, 67 folks went to the therapeutic diversion items, in response to division knowledge shared with NC Well being Information. These items, first carried out in 2016, have been studied and proven to scale back disciplinary infractions and self-harm whereas an incarcerated particular person is positioned there, however an extra examine revealed that charges of self-harm elevated as soon as an individual returned to common inhabitants housing.
Whereas the research demonstrated that the therapy items have constructive impacts, Peiper mentioned increasing these therapy slots would require a big improve in funding, staffing and area.
These are assets the Division of Grownup Correction doesn’t presently have, notably because the system has struggled with power staffing shortages for the reason that pandemic. General, the Division of Grownup Correction — an company with greater than 18,000 full-time workers — has a emptiness price of 24 %, in response to a March 4 presentation to state lawmakers. Well being care positions have a fair greater emptiness price of 28 %.
Because of useful resource constraints, Peiper mentioned the Division of Grownup Correction’s behavioral well being staff developed a mannequin for a brand new housing unit to serve folks with psychological well being points that required much less workers: outpatient therapy items. Offenders housed in these items obtain routine group and particular person remedy classes and extra monitoring and help.
The primary behavioral well being outpatient therapy unit launched at Maury Correctional Establishment in November 2021, and since fall 2024, three extra prisons have opened these items. Based on division knowledge, by the tip of 2024, these items had 1,059 admissions.
Whereas these choices exist, they solely serve a fraction of the 8,000 folks on the Division of Grownup Correction’s psychological well being caseload. In consequence, NC Well being Information nonetheless discovered examples, reminiscent of Ramsey’s, the place folks with recognized psychological well being points landed in restrictive housing anyway. A division spokesperson mentioned they may not touch upon whether or not options to restrictive housing have been thought-about for Ramsey.
Forty-year-old Henry Bost, recognized with melancholy and on the jail system’s psychological well being caseload, spent about 4 months in restrictive housing earlier than he died by suicide on Could 4, 2022 — lower than a 12 months earlier than his projected launch. Earlier than that, he had been out and in of isolation for weeks at a time all through 2021 for varied infractions. Since that January, he had been seen as soon as per thirty days by psychological well being workers however refused his scheduled appointment on April 26, saying he was “having a nasty day” however denied suicidal ideation, in response to the health worker’s investigation word.
‘A possibility to come back house’
After every suicide, Peiper mentioned an interdisciplinary staff of jail workers discusses and evaluations the incident to determine any locations for reform.
Peiper mentioned the Division of Grownup Correction watches for traits, nevertheless it’s typically exhausting to identify patterns for them to intervene in.
This isn’t the primary time there’s been a notable improve in jail suicides.
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After an uptick in suicides in 2018 — when 11 deaths occurred — the jail system assembled a Suicide Prevention and Self-Directed Violence Workgroup led by Peiper that met in 2019 to look extra carefully at suicide prevention. A number of suggestions have been made within the workgroup’s April 2020 ultimate report, reminiscent of enhancing screening and workers coaching.
Over the previous 5 years, jail officers have continued to implement and broaden initiatives that stemmed from that group, Peiper mentioned.
One instance is a peer observer program, which trains and deploys incarcerated folks to look at and interact with fellow incarcerated folks in psychological misery on suicide watch. This system was first piloted at Mountain View Correctional Establishment in 2019 and has since expanded to incorporate 67 peer observers at 5 prisons throughout the state. Corrections leaders additionally established a overview committee that meets month-to-month to debate system-level plans for among the most difficult individuals who have frequent occurrences of self-harm.
However among the change has come slowly. The primary modifications to workers coaching got here in 2022 when revisions have been made to the annual self-injury and suicide prevention coaching for all workers. Implementation of among the group’s different suggestions remains to be pending.
Peiper mentioned motion has been taken on all of them and the motion ahead continues, however there have been challenges. The pandemic diverted vitality that will have gone towards implementation of the modifications. The Division of Grownup Correction turned a separate cupboard company in 2023, and Peiper mentioned the changeover introduced new logistical points. Staffing shortages and funding challenges have additionally stymied implementation.
One of many jail system’s largest tasks in response to the 2019 workgroup to develop a brand new suicide prevention coaching program for behavioral well being workers in partnership with UNC Charlotte researchers — one which has already been the topic of educational papers — was anticipated to be accomplished in September and rolled out to workers. Nonetheless, the Division of Grownup Correction mentioned it obtained a stop-work order on the mission on March 27; the federal authorities terminated the grant cash that had connections to COVID-era funding.
The Division of Grownup Correction can also be partnering with the American Basis for Suicide Prevention and the Nationwide Institute of Corrections to implement different coaching efforts.
Peiper mentioned whereas behavioral well being workers have a big function to play in suicide prevention, he’s additionally centered on getting correctional officers and incarcerated folks themselves the information and instruments to concentrate on warning indicators and modifications in habits that might sign suicide danger and the best way to reply.
Peiper mentioned he hopes the modifications they’ve deliberate will lower jail suicides, however he additionally mentioned suicides are sometimes unpredictable.
For Waleed, who spent eight years incarcerated in New York, the prevalence of suicide in jail is a mirrored image of what he mentioned is the unhealthy and traumatic atmosphere that takes a toll on these imprisoned, notably in solitary confinement. Elevated suicide charges amongst previously incarcerated North Carolinians level to how the trauma lingers.
About 95 % of incarcerated folks have a launch date, and Waleed mentioned they deserve a chance to come back house.
Ramsey’s household had already began planning for that day — counting right down to February 2026. His father had simply retired and was wanting to spend his time with Ramsey. Now, they’re unexpectedly adjusting to life with out him.
“He ought to have been secure in jail — sufficient in order that he may have a life,” Holland mentioned. “We actually thought that at 30 he was going to get to begin over once more, and we have been excited for it.”
This story was produced with help from the Investigative Enhancing Corps by means of a partnership with Report for America and NC Well being Information. Melanie Sill was the story editor.
This text first appeared on North Carolina Well being Information and is republished right here beneath a Inventive Commons Attribution-NoDerivatives 4.0 Worldwide License.
