The last time Tanna Jo Fillmore talked with her mother, she was in a Utah jail, angry and desperate. She’d called every day that week, begging for help.

I need my medicine, she demanded.

At 25, Fillmore had long struggled with mental illness, but Xanax and hyperactivity medication had stabilized her. Now, she was locked up on a probation violation, and she told her mother the jail nurse was refusing to provide her pills. In their final conversation, Fillmore threatened to kill herself.

Melany Zoumadakis arranges photos and flowers that she brought to the grave of her daughter, Tanna Jo Fillmore, on April 26, 2019, in Salt Lake City. Fillmore killed herself in 2016 while being held on a probation violation. She had threatened to harm herself after she told her mother she was being denied her prescription medicines. Her mother has filed suit. (AP Photo/Rick Bowmer)
Melany Zoumadakis arranges photos and flowers that she brought to the grave of her daughter, Tanna Jo Fillmore, on April 26, 2019, in Salt Lake City. Fillmore killed herself in 2016 while being held on a probation violation. She had threatened to harm herself after she told her mother she was being denied her prescription medicines. Her mother has filed suit. (AP Photo/Rick Bowmer)

Melany Zoumadakis was so alarmed she immediately called her daughter’s probation officer, who assured her Fillmore was being closely monitored. But on Thanksgiving 2016, a day after that threat, Fillmore hanged herself in the Duchesne County Jail.

Her case is not isolated. Increasingly, troubling questions are being raised about the treatment of mentally ill inmates in the nation’s 3,100 local jails, possible patterns of neglect — and whether better care could have saved lives.

A joint investigation by The Associated Press and the University of Maryland’s Capital News Service finds many jails have been sued or investigated in recent years for allegedly refusing inmates medication to help manage mental illness, ignoring cries for help, failing to properly monitor them, or imposing excessively harsh conditions.

Melany Zoumadakis wipes a tear while visiting the grave of her daughter, Tanna Jo Fillmore, on Friday, April 26, 2019, in Salt Lake City. More than two years after her daughter's suicide, her mother says she still grieves and thinks about her constantly. Fillmore told her mother she desperately needed her prescription medicines, but a jail nurse wouldn't provide them. Her mother has filed sued. (AP Photo/Rick Bowmer)
Melany Zoumadakis wipes a tear while visiting the grave of her daughter, Tanna Jo Fillmore, on Friday, April 26, 2019, in Salt Lake City. More than two years after her daughter’s suicide, her mother says she still grieves and thinks about her constantly. Fillmore told her mother she desperately needed her prescription medicines, but a jail nurse wouldn’t provide them. Her mother has filed sued. (AP Photo/Rick Bowmer)

A review of 165 lawsuits that specifically involved suicides or attempts in local jails found:

— In about a third of the cases, staff allegedly failed to provide prescription medicines.

— Many inmates weren’t checked regularly — usually every 15-30 minutes — because of staffing shortages or inadequate training.

An arrangement of photos, flowers and Easter eggs surrounds the grave of Tanna Jo Fillmore on Friday, April 26, 2019, in Salt Lake City. Fillmore, who had a history of mental problems, killed herself in Duchesne County jail in 2016 while locked up on a probation violation. She told her mother she was being denied her prescription medicines that had stabilized her. (AP Photo/Rick Bowmer)
An arrangement of photos, flowers and Easter eggs surrounds the grave of Tanna Jo Fillmore on Friday, April 26, 2019, in Salt Lake City. Fillmore, who had a history of mental problems, killed herself in Duchesne County jail in 2016 while locked up on a probation violation. She told her mother she was being denied her prescription medicines that had stabilized her. (AP Photo/Rick Bowmer)

— More than half the suicides or attempts occurred during the first week, a stressful time for those coping with sudden confinement, and about 80 percent of the inmates were awaiting trial.

— Clothing, bedsheets or shower curtains were frequently used; some inmates were given razors, despite warnings to staff that they might harm themselves.

These lawsuits represent a tiny fraction of the problem. Suicide, long the leading cause of death in U.S. jails, hit a high of 50 deaths for every 100,000 inmates in 2014, the latest government data available. That’s 2½ times the rate of suicides in state prisons and about 3½ times that of the general population.

This undated photo provided by the family in 2019 shows Tanna Jo Fillmore as a girl. Jo-Jo or TJ, as her family called her, competed in rodeo barrel races while growing up in Utah. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail. Her mother, who has filed suit, says her daughter was denied her prescription medications and had threatened to harm herself when they spoke the day before her death. (Courtesy Melany Zoumadakis via AP)
This undated photo provided by the family in 2019 shows Tanna Jo Fillmore as a girl. Jo-Jo or TJ, as her family called her, competed in rodeo barrel races while growing up in Utah. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail. Her mother, who has filed suit, says her daughter was denied her prescription medications and had threatened to harm herself when they spoke the day before her death. (Courtesy Melany Zoumadakis via AP)

The total number of suicides in 2014 was 372, according to federal statistics.

An exclusive 50-state reporting effort to collect recent statistics found more than 300 suicides in local jails from 2015 to 2017 — in just nine states. The others did not provide numbers or offered incomplete data, an issue prompting some legislatures to consider bills that would require jails to provide better information about those dying behind bars.

It’s a problem commonly blamed on the fact more mentally ill people are being jailed, a trend that started after state psychiatric hospitals began closing in the 1970s. More recently, jails have been overwhelmed with opioid or meth users, many of whom also wrestle with depression.

Melany Zoumadakis holds a crucifix while talking about her daughter, Tanna Jo Fillmore, at her home on Wednesday, April 24, 2019, in Salt Lake City. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail in Utah. Her mother, who has filed a lawsuit, says her daughter was denied her prescription medications and had threatened to harm herself when they spoke the day before her death. (AP Photo/Rick Bowmer)
Melany Zoumadakis holds a crucifix while talking about her daughter, Tanna Jo Fillmore, at her home on Wednesday, April 24, 2019, in Salt Lake City. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail in Utah. Her mother, who has filed a lawsuit, says her daughter was denied her prescription medications and had threatened to harm herself when they spoke the day before her death. (AP Photo/Rick Bowmer)

Lori Rifkin, a California prisoners’ rights attorney, argues the vast majority of these suicides “are foreseeable and preventable.”

“I think there is a cultural dismissiveness toward both the signs that help us predict suicide — and toward the steps necessary to prevent them,” she adds.

Jonathan Thompson, head of the National Sheriffs’ Association, calls that absurd and says while jail officials must safeguard inmates, “we’re not the nation’s psychologists. We have decided that as a society let’s just warehouse the mentally ill in a jail … which is neither equipped for, trained to handle or able to be most efficient and effective at solving the problem.”

Melany Zoumadakis stands in her home Wednesday, April 24, 2019, in Salt Lake City, talking about the grief she has endured since the 2016 death of her daughter, Tanna Jo Fillmore. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail in Utah. Her mother, who has filed a lawsuit, says her daughter was denied her prescription medications and had threatened to harm herself. (AP Photo/Rick Bowmer)
Melany Zoumadakis stands in her home Wednesday, April 24, 2019, in Salt Lake City, talking about the grief she has endured since the 2016 death of her daughter, Tanna Jo Fillmore. Fillmore, who had a history of mental problems, killed herself in 2016 at the Duchesne County Jail in Utah. Her mother, who has filed a lawsuit, says her daughter was denied her prescription medications and had threatened to harm herself. (AP Photo/Rick Bowmer)

Some cases have resulted in substantial settlements over faulty policies or neglect.

In Lake County, California, Elizabeth Gaunt, a 56-year-old former social worker with a psychiatric history, was jailed after acting erratically but never charged. Over 25 hours, she begged for a doctor, repeatedly screamed “help me,” tore a blanket into strips and then killed herself. A guard didn’t enter her cell during a check but noted in an observation log all was OK. The county settled a wrongful death lawsuit for $2 million.

Dane Shikman, Gaunt’s son, says his mother belonged in a mental health center, not jail, and believes guards were negligent. “When they see someone who looks like they’re struggling,” he says, “they don’t say, ‘Let me step in. This is someone’s mom.’… They think this is a woman on drugs doing whatever she’s going to do, she’ll shut up.”

An inmate is shown covered in a tear-resistant blanket sleeps at the Lake County Jail in Lakeport , Calif., on Tuesday, April 16, 2019. These blankets were one of the many changes and reforms made at the norther California jail after a 2015 suicide there resulted in a $2 million wrongful death settlement. (AP Photo/Eric Risberg)
An inmate is shown covered in a tear-resistant blanket sleeps at the Lake County Jail in Lakeport , Calif., on Tuesday, April 16, 2019. These blankets were one of the many changes and reforms made at the norther California jail after a 2015 suicide there resulted in a $2 million wrongful death settlement. (AP Photo/Eric Risberg)

Sheriff Brian Martin implemented reforms that included installing a larger surveillance monitor, replacing blankets with tear-resistant ones and giving staff more suicide-prevention training.

In Fillmore’s case, a lawsuit is pending against Duchesne County, the former sheriff and others, including the jail nurse.

Fillmore had been diagnosed years earlier with post-traumatic stress, anxiety, panic disorder and depression. She also had a history of drug use, but attorney Tyler Ayres says she wasn’t suicidal and just needed her medication. “They have an obligation to provide adequate medical care,” he says.

Sheriff Brian Martin looks at a video monitor in a control area of the Lake County Jail in Lakeport, Calif., on Tuesday, April 16, 2019. The sheriff instituted many reforms and changes, including a larger video surveillance monitor, following the 2015 suicide of a woman who had repeatedly cried for help. Her son's wrongful death suit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Sheriff Brian Martin looks at a video monitor in a control area of the Lake County Jail in Lakeport, Calif., on Tuesday, April 16, 2019. The sheriff instituted many reforms and changes, including a larger video surveillance monitor, following the 2015 suicide of a woman who had repeatedly cried for help. Her son’s wrongful death suit resulted in a $2 million settlement. (AP Photo/Eric Risberg)

Fillmore was jailed, Ayres adds, for failing to provide a change of address to a probation officer.

Sheriff Travis Tucker, who took office in January, declined comment on the case but noted a jail wing is being built to serve mentally ill and addicted inmates.

When she died, Fillmore was waiting to enter a residential drug program. Five days later, on what would have been check-in day, her mother got a call asking why Fillmore hadn’t shown up.

This Tuesday, April 16, 2019 photo shows an exterior view of the Lake County Jail in Lakeport, Calif. After a 2015 suicide at the jail resulted in a $2 million settlement in a wrongful death lawsuit, several changes were made, including adding a larger surveillance monitor, to prevent further tragedies. (AP Photo/Eric Risberg)
This Tuesday, April 16, 2019 photo shows an exterior view of the Lake County Jail in Lakeport, Calif. After a 2015 suicide at the jail resulted in a $2 million settlement in a wrongful death lawsuit, several changes were made, including adding a larger surveillance monitor, to prevent further tragedies. (AP Photo/Eric Risberg)

She relayed the news. Then she prepared to bury her daughter.

___

In this Tuesday, April 16, 2019, photo, Emma Elwood, a nurse at the Lake County Jail in Lakeport, Calif., checks the vitals of a woman in the booking area. A series of changes, including adding a registered nurse, were made at the jail following the 2015 suicide of Elizabeth Gaunt, a former social worker who had repeatedly cried for help while locked in a cell. A wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
In this Tuesday, April 16, 2019, photo, Emma Elwood, a nurse at the Lake County Jail in Lakeport, Calif., checks the vitals of a woman in the booking area. A series of changes, including adding a registered nurse, were made at the jail following the 2015 suicide of Elizabeth Gaunt, a former social worker who had repeatedly cried for help while locked in a cell. A wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Corrections officer William Tinkler prepares to hand out tear-resistant security blankets at the Lake County Jail in Lakeport , Calif., on Tuesday, April 16, 2019. The blankets were part of a series of changes and reforms made at the jail following the 2015 suicide of Elizabeth Gaunt, who had repeatedly cried for help while locked in a cell. A wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Corrections officer William Tinkler prepares to hand out tear-resistant security blankets at the Lake County Jail in Lakeport , Calif., on Tuesday, April 16, 2019. The blankets were part of a series of changes and reforms made at the jail following the 2015 suicide of Elizabeth Gaunt, who had repeatedly cried for help while locked in a cell. A wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Surveillance cameras show holding cells seen on monitors in the booking area of the Lake County Jail in Lakeport, Calif., on Tuesday, April 16, 2019. At center is the holding area where a woman killed herself in 2015, leading to a $2 million settlement and a series of reforms at the jail. (AP Photo/Eric Risberg)
Surveillance cameras show holding cells seen on monitors in the booking area of the Lake County Jail in Lakeport, Calif., on Tuesday, April 16, 2019. At center is the holding area where a woman killed herself in 2015, leading to a $2 million settlement and a series of reforms at the jail. (AP Photo/Eric Risberg)
Dane Shikman sits by a photograph showing him with mother, Elizabeth Gaunt, at his home in San Francisco on Friday, April 19, 2019. Shikman's mother killed herself in 2015 at the Lake County, Calif., jail, after she was picked up for acting erratically. Gaunt, who had a history of mental health and substance abuse problems, had repeatedly screamed for help and pleaded to see a doctor. Her son’s wrongful death lawsuit resulted in a $2 million county settlement. (AP Photo/Eric Risberg)
Dane Shikman sits by a photograph showing him with mother, Elizabeth Gaunt, at his home in San Francisco on Friday, April 19, 2019. Shikman’s mother killed herself in 2015 at the Lake County, Calif., jail, after she was picked up for acting erratically. Gaunt, who had a history of mental health and substance abuse problems, had repeatedly screamed for help and pleaded to see a doctor. Her son’s wrongful death lawsuit resulted in a $2 million county settlement. (AP Photo/Eric Risberg)
Dane Shikman stands by a photo showing where the ashes of his mother, Elizabeth Gaunt, were scattered in Ireland, while at his home in San Francisco on April 19, 2019. Shikman's mother, a former social worker with mental health and substance abuse problems, killed herself in 2015 at the Lake County, Calif, jail, after pleading to see a doctor and repeatedly begging for help.  Her son's wrongful death t resulted in a $2 million county settlement. (AP Photo/Eric Risberg)
Dane Shikman stands by a photo showing where the ashes of his mother, Elizabeth Gaunt, were scattered in Ireland, while at his home in San Francisco on April 19, 2019. Shikman’s mother, a former social worker with mental health and substance abuse problems, killed herself in 2015 at the Lake County, Calif, jail, after pleading to see a doctor and repeatedly begging for help. Her son’s wrongful death t resulted in a $2 million county settlement. (AP Photo/Eric Risberg)
Dane Shikman holds a rock from the beach where the ashes of his mother, Elizabeth Gaunt, were scattered in Ireland along with a pair of cufflinks she had made for him as he sits at his home in San Francisco on Friday, April 19, 2019. His mother, who had a history of mental health and substance abuse problems, killed herself at the Lake County, Calif, jail in 2015, after she repeatedly cried for help. Her son's wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Dane Shikman holds a rock from the beach where the ashes of his mother, Elizabeth Gaunt, were scattered in Ireland along with a pair of cufflinks she had made for him as he sits at his home in San Francisco on Friday, April 19, 2019. His mother, who had a history of mental health and substance abuse problems, killed herself at the Lake County, Calif, jail in 2015, after she repeatedly cried for help. Her son’s wrongful death lawsuit resulted in a $2 million settlement. (AP Photo/Eric Risberg)
Dane Shikman holds a photograph showing him with his mother, Elizabeth Gaunt, at his home in San Francisco on Friday, April 19, 2019. Gaunt, a former social worker with a history of mental health and substance abuse problems,  killed herself in 2015 in the Lake County Jail in northern California. Her son's wrongful death lawsuit resulted in a $2 million settlement. Changes also were made at the jail. (AP Photo/Eric Risberg)
Dane Shikman holds a photograph showing him with his mother, Elizabeth Gaunt, at his home in San Francisco on Friday, April 19, 2019. Gaunt, a former social worker with a history of mental health and substance abuse problems, killed herself in 2015 in the Lake County Jail in northern California. Her son’s wrongful death lawsuit resulted in a $2 million settlement. Changes also were made at the jail. (AP Photo/Eric Risberg)
This undated photo provided by the family in May 2019 shows Janene Wallace, who killed herself in 2015 in a Delaware County, Pa., jail. The 35-year-old Wallace, who suffered from mental illness and paranoia, was in solitary 51 of 52 days for a probation violation. When she threatened to choke herself, a guard told her to go ahead. The family won a $7 million settlement. (Courtesy Susanne Wallace via AP)
This undated photo provided by the family in May 2019 shows Janene Wallace, who killed herself in 2015 in a Delaware County, Pa., jail. The 35-year-old Wallace, who suffered from mental illness and paranoia, was in solitary 51 of 52 days for a probation violation. When she threatened to choke herself, a guard told her to go ahead. The family won a $7 million settlement. (Courtesy Susanne Wallace via AP)
FILE - In this July 10, 2015 image made from dashcam video provided by the Texas Department of Public Safety, trooper Brian Encinia arrests Sandra Bland after she became combative during a routine traffic stop in Waller County, Texas. Bland was taken to the Waller County Jail that day and was found dead in her cell on July 13. (Texas Department of Public Safety via AP)
FILE – In this July 10, 2015 image made from dashcam video provided by the Texas Department of Public Safety, trooper Brian Encinia arrests Sandra Bland after she became combative during a routine traffic stop in Waller County, Texas. Bland was taken to the Waller County Jail that day and was found dead in her cell on July 13. (Texas Department of Public Safety via AP)
FILE - In this Sunday, July 26, 2015 file photo, Margaret Hilaire bows her head in prayer during a demonstration calling for the firing and indictment of Texas State Trooper Brian Encinia in Katy, Texas. Sandra Bland was found dead in her cell on July 13 in the Waller County Jail, just days after being arrested by Encinia during a traffic stop. Authorities determined through an autopsy that Bland hanged herself with a plastic bag. (Brett Coomer/Houston Chronicle via AP)
FILE – In this Sunday, July 26, 2015 file photo, Margaret Hilaire bows her head in prayer during a demonstration calling for the firing and indictment of Texas State Trooper Brian Encinia in Katy, Texas. Sandra Bland was found dead in her cell on July 13 in the Waller County Jail, just days after being arrested by Encinia during a traffic stop. Authorities determined through an autopsy that Bland hanged herself with a plastic bag. (Brett Coomer/Houston Chronicle via AP)
FILE - This July 22, 2015 file photo shows the Waller County jail cell in Hempstead, Texas, where Sandra Bland was found dead. In Texas, the Sandra Bland Act became law in 2017, mandating mental health training for law enforcement and making it easier for those arrested to receive a personal bond if they have a mental illness or substance abuse problem. Bland killed herself after being jailed for a minor traffic violation. (AP Photo/Pat Sullivan, File)
FILE – This July 22, 2015 file photo shows the Waller County jail cell in Hempstead, Texas, where Sandra Bland was found dead. In Texas, the Sandra Bland Act became law in 2017, mandating mental health training for law enforcement and making it easier for those arrested to receive a personal bond if they have a mental illness or substance abuse problem. Bland killed herself after being jailed for a minor traffic violation. (AP Photo/Pat Sullivan, File)
Dane County, Wis., Sheriff David Mahoney stands in a solitary confinement cell at the county jail. An advocate for the mentally ill, Mahoney says he sometimes has to lock certain inmates in these cells even though he calls the conditions
Dane County, Wis., Sheriff David Mahoney stands in a solitary confinement cell at the county jail. An advocate for the mentally ill, Mahoney says he sometimes has to lock certain inmates in these cells even though he calls the conditions “inhumane.” Mahoney hopes to secure funding to replace the jail with one that will have a hospital-like wing. (AP Photo/Morry Gash)
Dane County, Wis., Sheriff David Mahoney looks through a small window in a solitary confinement cell at the county jail in Madison. Mahoney says he has no separate housing for inmates with certain behavioral, medical or mental health problems, so he has to put them in these cells even though he says it's
Dane County, Wis., Sheriff David Mahoney looks through a small window in a solitary confinement cell at the county jail in Madison. Mahoney says he has no separate housing for inmates with certain behavioral, medical or mental health problems, so he has to put them in these cells even though he says it’s “inhumane. But we’re forced into a situation to keep these people alive.” (AP Photo/Morry Gash)
Medication withheld, cries for help ignored, routine checks neglected: With suicides a problem in many jails across the U.S., an AP/Capital News Service examination raises troubling questions about whether deaths could have been avoided. (June 18)
Medication withheld, cries for help ignored, routine checks neglected: With suicides a problem in many jails across the U.S., an AP/Capital News Service examination raises troubling questions about whether deaths could have been avoided. (June 18)

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