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The current study is an assessment of safety risks in Indiana county jails over the last ten years. The study looks at several measures that contribute to the existing safety standards and alternatively, contributing factors to the increased safety risks related to the consequences of incarceration in Indiana county jails. Individuals in a county jail are awaiting trial, unable to make bail, or serving a sentence for a low-level criminal offense.

Studies have found that since 2010, at least one person died every two weeks in a county jail. Death as a result of unsafe jail conditions is deprivation of due process and a punishment for indigence. Death and public safety risks are important for safe communities that agency officials can significantly reduce through mitigation efforts. This study evaluates the risks and primary consequences of incarceration and the impact on public safety through public safety risk assessments. Recommendations and implications for policies are included to ensure safer communities and mitigate danger while incarcerated or held in a county jail during the pendency of judicial proceeding.

Keywords: county jails, incarceration, public safety, death, risk, HIV, tuberculosis

Incarceration in Indiana County Jails: A Risk Assessment

County jails typically hold two kinds on inmates. Some remain for only a few days while others serve sentences of less than a year. Most of the detainees held in county jails are held temporarily while they wait for their day in court. Individuals who are charged with a crime and waiting for pretrial conference, jury trial, or cannot afford to pay the specified bail amount are also held in county jails. Individuals may experience detainment for traffic offenses.

There are approximately three-thousand county jails in the United States that are managed by county sheriffs or local police departments. Understaffing, lack of funds, and no enforceable national standards to ensure jails meet constitutional requirements for inmate health and safety contribute to national and local public safety. The consequences and public safety risks for individuals and communities are significant because an individual released on pretrial release, paid the full amount of bail, or the criminal case was subsequently dismissed may introduce infections to their community.

The waiting period for release from a county jail is potentially fatal and poses a serious public safety risk to communities upon release. Ninety-two Indiana counties each operate a jail with a daily head count of forty-seven thousand (47,000) and an annual population of one hundred twenty-two thousand (122,000). Indiana has an incarceration rate of seven hundred

sixty-five (765) per one hundred thousand (100,000) people, including prisons, jails, immigration detention, and juvenile justice facilities, meaning that it locks up a higher percentage of its people than any democracy on earth. In 2018, twenty thousand six hundred forty-one (20,641) inmates were held in an Indiana county jail per day (Carson, 2021). Between 2008 – 2018, the number of deaths in Indiana county jails averaged twenty deaths per day (Carson, 2021).

Public safety risks upon an individual’s release from jail include tuberculosis (“TB”) and human immunodeficiency virus (“HIV”). According to the Center for Disease Control and Prevention (“CDC”), TB is caused by a bacterium that attacks the lungs, kidney, spine, and brain. Individuals infected with TB can easily spread it to friends, family members, community members, or coworkers. TB bacteria spread through the air when a person with TB coughs, speaks, or sings, and a person nearby breathes in these bacteria and become infected (CDC, n.d.). HIV attacks the body’s immune system and is fatal if left untreated (CDC, n.d.). HIV easily transmits to family members, namely from having sex and from mother to baby. Sharing needles, syringes, and other drug injection tools are ways this fatal disease can spread in a community. A rare but other method of infection is being injured with a contaminated sharp object (CDC, n.d.).

From 2000 to 2018, detainees not convicted of a crime were three times as likely to die in a county jail than an inmate who is serving a short sentence (Carson, 2021). As with any community living space, security measures at county jails keep detainees and jail staff safe, however residual risks (DHS Risk Lexicon, 2010), pose a threat to public safety. In 2020, the State of Indiana reported twenty-six deaths, with suicide accounting for half of those deaths.

Inmate deaths in 2020 averaged seventeen across the top ten Indiana Counties (ICJI, 2021).

A conditional probability (DHS Risk Lexicon, 2010) of an individual who will either threaten or attempt suicide is higher among those who suffer from drug or alcohol intoxication. Almost half of those who die by suicide do so within the first seven to fourteen days of incarceration (Carson, 2021). Prioritizing assessment and treatment over incarceration would drastically reduce the number of deaths and risk of spreading TB and HIV to communities.

Further, community-based resources provided to inmates during the reentry period would reduce

the risk of spreading infectious diseases. Local county jails do not have the resources afforded to state and federal prisons, where inmates serve longer sentences.

Inmates in county jails lack the resources afforded to state prisons but have similar needs.

County jails are in dire need of resources to combat the risk of death and combat the spread of infectious diseases. County jails pose the largest threat to community safety due to the relatively short time of incarceration. Overcrowding and lack of medical care and testing due to an absence of funding and resources allows infectious diseases to flourish in county jails. County jails do not have reporting requirements for deaths, number of infectious disease cases, and death as a result of infectious diseases that the state and federal prison system have. It is difficult to implement good policy to combat this issue without proper data and documentation.

A risk-based approach is appropriate for standard reporting measures and recommendations for treatment programs and assessments. The data available involving deaths within the first two weeks of detainment in county jails and the rate of infection are expected consequences. Uncertainties are those cases where detainees say they are not at risk of harming themselves upon initial intake and subsequently threaten or attempt suicide. Alternative futures analysis would assist local government officials, sheriff departments, and police departments on funding needed to implement safe practices and testing for inmates and detainees (Aven, 2015). Literature Review

Risk of Death While Incarcerated

In January 2022, approximately one thousand five hundred (1,500) inmates were being transferred from the local jails in Marion County, Indiana, namely Jail 1 and Jail 2 to the new Community Justice Campus. During this transition, one man who had just arrived at the new Community Justice Campus days prior died by suicide. In 2021, over one-thousand inmates at

the Marion County Jail in Marion County, Indiana, threatened suicide. The Marion County Sheriff’s Office reported ten suicide attempts and seven deaths by suicide (Spinelli, 2022). Marion County Sheriff Kerry Forestal stated detainees are asked if they are at risk of harming themselves during booking into the jail. Allocating mental health resources to Indianapolis’s Adult Detention Center at the Community Justice Campus is one way the Marion County Sheriff’s Department is addressing this residual risk phenomenon (Spinelli, 2022).

The plight of mental illness is four to six times higher for detainees than the general population. Incarceration or short-term confinement has a significant impact on the health and safety of detainees as the risk of suicide is higher in jail than prison. The rate of death and suicide in county jails are greater than in state prison. This is due to the immediacy of an individual’s arrest, specifically the cause and the result of the arrest (Littman, 2021). The lack of mental health care in the United States is egregious, but even more problematic in county jails. Jails are notoriously understaffed, and detainees who suffer from mental illness and at risk are overlooked and die from abuse or neglect (Littman, 2021; Spinelli, 2022).

The reporting mechanism for deaths and suicides in county jails is nonexistent, as there is no required reporting system for county jails like state and federal prisons. Similarly, county jails are managed by elected sheriffs who have little control over the budget, construction, and renovations of a new jail. Reporting deaths and death by suicide is largely at the discretion of the sheriff and county jail staff (Littman, 2021; Reuters, 2020). Jails refused to disclose their death tolls respectively, so over the course of a decade, a separate investigation by Reuters uncovered detainee deaths in five hundred large jails across the country (Littman, 2021).

From 2009 – 2019, the death rate in Marion County Jail in Marion County, Indiana was more than double the national average with approximately forty-five deaths. The Marion County

Jail is a sixty-five-year-old facility, and the county has not had a new jail built or renovated in over fifty years (Reuters, 2020; Spinelli, 2022). Over this period of time, two consecutive elected sheriffs implored local officials for funding to hire more staff and build a new facility, but were subsequently dismissed. Reuters (2020) notes the following:

In 2016, the sheriff called the suicide problem an “epidemic,” but county officials denied requests for more funding. While the county knew it had a suicide problem, there was no way to know how it compared. Like all other officials, Marion County’s leaders had no access to the Justice Department figures.

Overcrowding and understaffing is a main cause for concern for jails across the country, and there is no exception for the local county jails in Indiana. Suicide accounts for more than twenty-five percent of all deaths in county jails in the United States, and Marion County Jail has an average of three to five deaths for every one-thousand inmates (Reuters, 2020).

Reuters investigators sent over one thousand five hundred public record requests to five hundred county jails that hold seven hundred fifty or more inmates per day, requesting information necessary to collect data on inmate populations and deaths. A visualization of how the number deaths in local county jails in the State of Indiana compare to deaths in the Marion County Jail is presented in Figure 1.

Consequences and Public Safety Risks for Communities

The conditional probability (DHS Risk Lexicon, 2010) is high considering inmates who are released from county jail often return to low-income communities. Inmates who return to society after they served their sentence are at a higher risk of chronic, infectious, and mental illness, largely due to substance abuse in economically disadvantaged communities. Access to health services is challenging for individuals reentering society, together with a lack of mental

health services. HIV is prevalent in economically disadvantaged communities and five times higher in incarcerated populations.

Figure 1

Deaths per Year in Indiana County Jails and Marion County, Indiana

Note: Data derived from Bureau of Justice Statistics and Reuters Dying Inside.

Additionally, individuals who reenter into society engage in high risk behavior, namely abusing substances and do not practice HIV prevention procedures. Lack of housing and employment are factors that contribute to substance abuse post-release (Luther et al, 2011).

Economic deprivation and failure to obtain employment and suitable housing are contributing factors to criminal behavior as a response to stress. To cope with stress, an individual will engage

in substance abuse (Agnew, 1999). Inmates who are from low income neighborhoods are more likely to suffer from substance abuse and are at an increased risk of becoming infected with HIV or TB. Local county jails do not have the budget to test incoming inmates for infectious diseases. By the time the new inmates have spent some time in the community living space, other inmates have been exposed and are at risk of contracting the disease.

County jails do not have the budget to test or treat inmates before they are released from jail. Community members are exposed when these individuals return to their communities.

Additionally, the reintroduction of substance use as a coping mechanism for stress experienced from reentry repeats the cycle of reckless social behavior and further exacerbates the spread of HIV in these communities. This issue is exacerbated by overcrowding, another budgetary constraint for county jails (Kane and Dotson, 1997; Littman, 2021; Reuters, 2020).

Twenty-four jails in south and southcentral Indiana were used in a study that assessed the risk of HIV in rural jails. A questionnaire and follow up interviews were used to collect data. The data showed that the inmate population in these jails largely understood the risks and transmission of HIV and preventative measures, namely using condoms, sterile needles, and abstinence. Condoms and sterile needles are items not available in jails and contributes to the spread of HIV within the jails (Kane and Dotson, 1997), which presents reoccurring problems during reentry.

More contagious than HIV that is prevalent in county jails is TB. TB is spread by coughing, sneezing, or laughing, by an infectious person through airborne droplets (Kane and Dotson, 1997; CDC, n.d.). Overcrowding increases the risk of contracting HIV and TB. Similarly, inmates with limited access to health care and are HIV positive are at an increased risk of becoming infected with TB, as TB is a cofactor of HIV infection (Kane and Dotson, 1997).

In 2018, twenty-eight counties in Indiana reported cases of TB. Marion County, Indiana had the highest number of TB cases from 2009 through 2018, with over thirty-eight percent of all cases in the state of Indiana (ISDH, 2019). In 2016, there were reportedly five hundred twenty- eight TB cases that resulted in death in county jails in the United States.

TB-related deaths have increased in Indiana between 2014 through 2018, with the number of TB-related deaths being four, two, five, six, and ten respectively. Of the ten deaths in 2018, eight were directly related to TB infection, with two cases being diagnosed with TB after death (ISDH, 2019). A visualization of the number of TB cases and related deaths in Indiana county jails are Indiana presented in Figure 2.

TB will continue to be a problem in county jails if resources Transmission of M. tuberculosis continues to be documented within correctional facilities, primarily as a result of undiagnosed TB. Inmates with undiagnosed TB disease place other inmates and correctional staff at risk for TB, and when released, these persons also can infect persons living in surrounding communities.


In 2016, Mayor Hogsett’s Criminal Justice Task Force recommended prioritizing assessment and treatment over incarceration for those who struggle with mental health or substance abuse disorders at the new Community Justice Campus (“CJC”). The CJC was built on Indianapolis’s southeast side of downtown and includes the Marion County Jail. Recently, the Department of Justice awarded a one million dollar grant to the Marion County Sheriff’s Office to increase their programs, namely a suboxone program that provides medically assisted treatment for individuals going through detox (Spinelli, 2022).

Figure 2

Tuberculosis Cases in Indiana from 2009 to 2018 compared to TB-related deaths from 2014 to 2018.

Note: Data derived from Indiana State Department of Health.

The inmate mortality data collected by the Justice Department’s Bureau of Justice Statistics are withheld from the public, citing a law enacted in 1984 that limits the release of the data.

Due to the discretionary release of death data and nonexistent reporting methods, local government officials could use a Bayesian Probability (DHS Risk Lexicon, 2010) model to create policies to reduce the risks posed to communities. Data collected from the Marion County Sheriff’s Office suboxone program and programs implemented at the CJC may condition the need for local reporting standards and funding for local county jails.

State and federal prison systems routinely test for infectious diseases (Littman, 2021; Reuters, 2020). Inmates in county jails are serving shorter sentences and return to the community in a shorter amount of time than inmates in state or federal prisons. Infections spread more rapidly in county jails. Moreover, state prison systems have reentry programs that assist inmates in obtaining a driver’s license and find suitable housing and employment. These resources are not extended to county jails.

Interventions in prisons and community treatment after release provide great success for Inmate HIV, TB, and substance abuse (Luther et al., 2011). Funding for continued HIV and TB tests for incoming detainees and current inmates should be afforded to county jails. Programs implemented to mitigate the risks of substance abuse and recidivism shall reduce the risk of transmission and keep communities safe.

By: Jennifer M. Tursi, Candidate for Master of Science in Criminal Justice and Public Safety Paul H. O’Neill School of Public and Environmental Affairs


Agnew, Robert. 1999. “A General Theory of Community Differences in Crime Rates.” Journal of Research in Crime and Delinquency 36:123-155.

Aven, T. (2015). Risk Analysis. (2nd ed). John Wiley & Sons, Ltd.

Carson, Ann E. (2021). Mortality in Local Jails, 2000-2018 – Statistical Tables. Bureau of Justice Statistics.

Center for Disease Control and Prevention. (n.d.). About HIV.

Center for Disease Control and Prevention. (n.d.). How TB Spreads.

Department of Homeland Security (2010). DHS Risk Lexicon. Risk Steering Committee.

Eisler, P., So, L., Szep, J., Smith, G., and Parker, N. (2020, October 16). Dying Inside. Reuters.

Indiana Criminal Justice Institute. (2021). 2021 Annual Report: Death in Custody Reporting Act. Report.pdf.

Indiana State Department of Health. (2019, April 29). Tuberculosis Control Program.

Kane, S., & Dotson, C. (1997). HIV risk and injecting drug use: implications for rural jails.

Crime and Delinquency, 43(2), 169-185. Littman, Aaron. (2021, May). Jails, Sheriffs, and Carceral Policymaking. Vanderbilt Law Review. 74(4):861-950.

Luther, J. B., Reichert, E. S, Holloway, E.D., Roth, A.M., and Aalsma, M.C. (2011, November 8). An Exploration of Community Reentry Needs and Services for Prisoners: A Focus on Care to Limit Return to High-Risk Behavior. AIDS Patient Care and STDs. 25, 475 – 481.

Spinelli, C. (2022, January 18). Inmate death at new Marion County jail, officials increase mental health services. Fox 59 News.



  • David

    Jennifer’s article was longer than most on your website. It was really informative and I like that she used sources to show what she did.

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