The Middlesex county jail in Billerica is boosting its efforts to prevent inmate suicides, after three inmates have taken their own lives there in the last two years.

The jail is increasing suicide prevention training for staff, improving mental health screening for inmates and has posted fliers urging family members to contact jail officials if they are concerned a loved one is in danger of self-harm, according to Middlesex Sheriff Peter J. Koutoujian.

“Mental health has become as important to our operations as security,” said Koutoujian. “One suicide is one too many.”

The sheriff’s department initiated an external audit of its suicide prevention program following a May 2017 story by the New England Center for Investigative Reporting that found at least 42 men and women had died by suicide in the state’s 13 county jails over a period of about five years. That year, two inmates committed suicide in the Middlesex county jail and another died in June 2018, county officials say.

The audit, completed in March, was carried out by Mansfield-based suicide prevention expert Lindsay Hayes. Hayes found the 2017 suicides were not preventable, but the jail's practices showed “room for improvement.”

Hayes urged the department to increase initial suicide prevention training for staff from 45 minutes to a four-to-eight-hour workshop, and to hold two hours of additional training each year. He recommended the department improve mental health screening and create better privacy for new inmates being interviewed.

Koutoujian said he has followed up on most of the recommendations, while some efforts are still ongoing. Since the audit was completed, Koutoujian has brought in eight trainers, including two role-playing actors from the federal National Institute of Corrections, to conduct a week-long crisis training for jail staff.

The department has improved suicide prevention screening by asking inmates more questions about their mental health and increased privacy for inmates by having interviews conducted behind closed doors.

The jail has covered wall ventilation grates and fixed holes in the metal frames of bunks to prevent hangings in cells, Koutoujian said, and staff members are also checking on suicidal inmates more frequently. The jail has also added a brief message to every incoming and outgoing phone call that gives the number of a suicide prevention hotline.

Suicide prevention flier
Officials at the Middlesex County jail have posted these fliers around the jail as part of an updated suicide prevention program.
Courtesy Middlesex County jail Middlesex County jail

Koutoujian, who is president of the Massachusetts Sheriff’s Association, said several other sheriff's departments are looking into the Middlesex county jail's practices, but it’s unclear how many have moved forward.

“A suicide is not a routine matter, it’s a great loss,’’ he said. “It’s never the case that suicides are part of what we do.”

K. Sophie Will is an intern at the New England Center for Investigative Reporting, a nonprofit news center based at Boston University and WGBH News.