A psychiatrist who's worked with inmates where Jeffrey Epstein was held weighs in on his death
- The Justice Department confirmed in a letter to lawmakers Friday that a "doctoral-level psychologist" signed off on taking criminal financier Jeffrey Epstein off suicide watch.
- Forensic psychiatrist Ziv Cohen, who has been evaluating inmates at the Metropolitan Correctional Center where Epstein was held, weighed in on the matter in an interview with Insider.
- Cohen said he thinks that "at MCC, they're well aware that suicide is a serious problem, and they're well aware that this is something they are trying to address on a daily basis."
- However, he also said that Epstein's case "seems to be a question of whether something went wrong in their ability to address the situation."
- Visit Business Insider's homepage for more stories.
The Justice Department confirmed in a letter to lawmakers Friday that a "doctoral-level psychologist" signed off on taking criminal financier Jeffrey Epstein off suicide watch on July 29. A little under two weeks later, he was found dead in his cell on August 10.
According to the letter, the psychologist deemed constant observation as "no longer warranted" for Epstein, despite being on suicide watch less than a week before.
"The Department and the Bureau take seriously the responsibility to ensure the safety and security of all inmates in the custody of the Bureau," the letter stated.
Forensic psychiatrist Ziv Cohen has been evaluating inmates at the Metropolitan Correctional Center, the high-security prison where Epstein was held, for about ten years, he told Insider. Although the Justice Department affirmed that a "doctoral-level" psychologist cleared Epstein, a psychiatrist is needed to meet the regular standard of care in a prison.
"The psychiatric standard of care requires that a doctoral level clinician make the decision to remove an inmate from suicide watch. Ideally, this would be a psychiatrist," Cohen wrote in an email. "If a psychologist were to make the decision, it should be in consultation with a psychiatrist, given the serious consequences of this decision."
Cohen, who previously worked on a case involving suicide in prison, believes Epstein's estate has a case against MCC
In his time as a forensic psychiatrist, he served as an expert witness on a case related to the psychiatric standard of care in order to prevent suicide in prison. The plaintiff was a veteran who was imprisoned for driving while under the influence and later died by suicide on his second day of incarceration after a psychiatrist determined that he was not a danger to himself.
In the case, Cohen said that it was "almost certain" that the plaintiff would be in opioid withdrawal when he was assessed by the psychiatrist, putting him at "higher risk of committing suicide," thus not meeting the standard of care required for him.
The same idea could be echoed in Epstein's case, after the change in lifestyle for the disgraced financier could have been a trigger for suicide - going from his high-life as a multi-millionaire to an inmate in a federal prison, Cohen said.
Last week, Epstein's defense team blasted the "medieval conditions" of the federal prison and announced that they are launching their own investigation into their employer's death. However, it does pose a problem that Epstein's case may not appeal to the masses.
"Part of the problem for them, I think, is that Epstein doesn't cut a very sympathetic figure, and in the criminal justice system, that matters," Cohen said. "If the system plays itself out in front of people, whether they're jurors or judges, these are people."
However, the forensic psychiatrist added that, "if you look at it dispassionately, you do have to acknowledge that no one should die in jail."
Some inmates are good at hiding their intent to commit suicide
In the case of Jeffrey Epstein, Cohen said that there are a variety of questions that needed to be considered before taking the registered sex offender off suicide watch, including what clinical basis was the decision made, and did the psychologist determine that these criteria were met?
"Typically, one would require a stable mood, absence of suicidal thoughts, ability to communicate openly with staff, a safety plan - patient agrees to notify staff if he feels unsafe - and close follow up of the patient by mental health staff as a minimum for removing someone from suicide watch," Cohen wrote in an email.
Nonetheless, Cohen said in an interview that a main question to be taken into consideration is this: "is the risk for suicide in and of itself enough to warrant a higher level of vigilance, even in the absence of showing signs or symptoms?"
"The kinds of signs or symptoms you would see in someone, there's a broad range," Cohen said. "Some inmates are very good at hiding how they're feeling, and so that is why you have to have a very high index of suspicion, and you want to be very cautious and err on the side of caution with inmates that may be at risk for suicide."
Read more: Epstein died by suicide using his prison bed sheet while his guards slept, according to report
There is a tiered system of supervision for an inmate taken off suicide watch
Epstein was put on suicide watch - or constant observation - after he was found with bruises on his neck on July 23. After he was taken off suicide watch on July 29, prison guards were required to check on him every 30 minutes.
"If you're going to take someone off suicide watch, it's not a categorical decision," Cohen said. "It's not, 'you're on suicide watch,' or 'you're no longer a suicide watch.' It's actually on a spectrum; there's a sliding scale.
Cohen acknowledged the level of discomfort that comes with being on constant observation, saying that "typically, there's some pressure to take them off of constant observation, because it's not very comfortable."
He also noted that Epstein skipped a level of supervision necessary after being removed from suicide watch, in which an inmate should be checked every 15 minutes before being switched to 30-minute checks.
"This person is not quite on suicide watch, but you're going to put them in a particular level of observation and restriction that it's going to be hard for them to kill themselves," Cohen said in a phone interview. "In addition, even if they succeed in making an attempt, ... it's going to be hard for them to actually kill themselves [because] you might find them in the act, but then you're going to interrupt the act."
Suicides in prison occur at a high rate, so MCC should be "well aware" that it is a serious problem
Given the tiered system of supervision and required cellmate per prison protocol, MCC does have standards in place to prevent inmate suicide.
However, several factors of Epstein's release from suicide watch were also not up to protocol - prison guards reportedly fell asleep at their posts after working severe overtime hours, and Epstein was housed alone in his cell after the prison failed to replace his cellmate.
"As in all cases of suicide in prison, there is a real possibility that clearly followed protocols would have prevented the inmate's death," Cohen said.
The forensic psychiatrist said he thinks that, "at MCC, they're well aware that suicide is a serious problem, and they're well aware that this is something they are trying to address on a daily basis."
"There really is no jail, you know, in the country that doesn't deal with this," Cohen said. "Suicide rate in jail is about three times that of the general population."
"This seems to be a question of whether something went wrong in their ability to address the situation."