How Incarcerated People Are Helping Prevent Suicide Behind Bars

(NC Health News, Rachel Crumpler) — For up to four hours at a time, William Buhl attentively monitors a person who is on suicide watch at Nash Correctional Institution — a medium custody prison in Nashville. Buhl sits at a table outside a cell with a direct view of his subject. He observes their behavior, records notes every 15 minutes and offers an open ear.

He’s there as a peer observer — a fellow incarcerated person who has been screened and trained to observe and engage with people in mental distress and on suicide watch.

It’s a duty Buhl and other peer observers said they don’t take lightly. The objective is to keep people alive and see them improve.

“Lives are important, and they’re valuable,” Buhl said. “Somebody out there loves us.”

Prison officials launched the Peer Observer Program as a suicide prevention strategy recommended by the department’s Suicide Prevention and Self-Directed Violence Workgroup. The group convened after a spike in suicides in 2018, when 11 people died in custody — up from six the year before.

Buhl became one of the North Carolina prison system’s first peer observers in November 2019 as part of the program’s pilot at Mountain View Correctional Institution, a medium security prison in Mitchell County.

He was motivated to take part because, about a year before, he lost a friend to suicide. Someone, he said, who was more like a brother.

Buhl, who has been incarcerated for nearly 20 years, can better relate to the struggles in prison that may contribute to mental deterioration: separation from family, the toll of long sentences, and interpersonal conflicts within cell blocks. His shared lived experience often means the people he observes are more likely to open up to him.

“Another inmate will talk to another inmate quicker, a lot of time, than they will staff, especially when they realize that we’re wearing the same clothes they are,” Buhl said.

In 2024, peer observers worked 5,356 hours conducting suicide watches, according to Department of Adult Correction data provided to NC Health News.

Lewis Peiper, chief of behavioral health at the Department of Adult Correction who led the workgroup, said they learned about using peers to help monitor people on suicide watch from Gary Junker, the head of behavioral health at the time. Junker had helped implement a peer observer program at the federal prison in Butner when he worked there.

“They found that not only is there benefit to staff — for the staff not sitting on the watch — but it improved the experience of the watch for the people involved,” Peiper said. “Sometimes a person in a uniform within a prison population, they can be seen almost as an adversary … Having a peer, it can kind of just lower the tenor.”

A 2005 peer-reviewed evaluation paper on the federal peer observer program called it a “win-win solution.” The researchers found people spent less time on suicide watch when watched by another incarcerated person without compromising the standard of care. The researchers also found that observers themselves felt personal gain from being able to help.

Modeled after the federal program, Peiper said the use of peer observers in North Carolina prisons has so far been effective. A March 2022 cost-benefit analysis report by the North Carolina Division of Prisons’ Innovation Institute recommended expanding the program, which has slowly spread to 72 peer observers serving across five prisons.

“It’s simple, yet it works,” Peiper said. “It has an impact on the environment and the experience of suicide watches on the individuals and on the prison.

“There’s something powerful about when you bring folks in and have them trained into a role,” he said. “It’s a trusted role. It’s got guardrails on it for safety purposes, but they become great ambassadors for mental health. And they can have a reach well beyond what a licensed psychologist might be able to have on their own.”