The pictures of Artrina De Lima present a puzzle. One is a glamorous-looking image of her with her daughter Kamalei, the two of them beaming into the camera in 2018. But her daughter recalls that as a joyful moment at the precipice, a snapshot from the time before Artrina’s family began to fall apart.

And then there is Artrina’s official mug shot from the Maui jail, where she gives a seemingly relaxed, convincing smile. That picture was taken not long before she died.

De Lima, known to her family as Trina, apparently hanged herself with a shirt in the Maui Community Correctional Center on May 13. She died six days later after she was removed from life support at Maui Memorial Medical Center, becoming the sixth known suicide at the jail in the past four years.

De Lima’s family said she was diagnosed with post-traumatic stress disorder, and had been homeless in the Paia area for some time before her death.

She had been detained at the jail since April 18 on a petty misdemeanor trespassing charge along with contempt of court and a probation violation, according to the state Department of Corrections and Rehabilitation.

Her death revives troubling questions about mental health services at MCCC that have been raised by employees there before. Death reports on previous suicides at the jail stressed the urgent need to hire staff and upgrade those services, and two years ago the state paid hundreds of thousands of dollars to settle a lawsuit over the suicide of yet another inmate who killed herself there in 2017.

Artrina’s mother Jo Ann Manintin worked for 16 years as a corrections officer at MCCC, and she is angry that she cannot get more information from corrections officials about her daughter’s death.

She said she whispered into Artrina’s ear at the Maui hospital, telling her: “This is not over for me. I’m going to find out what happened to you.” Manintin said a tear left her daughter’s eye at that moment, and she thought, “She’s hearing me. She’s hearing me. That’s all that matters.”

“It’s a promise I made to her,” said Manintin, 73. “I want people to know what is happening here. I mean, something is wrong.”

A Series Of Suicides

De Lima’s death and the five other known suicides at MCCC in recent years are particularly alarming because data compiled by Honolulu Civil Beat suggests there were a total of only 10 suicides in all of Hawaii’s in-state correctional facilities during that time.

Yet MCCC houses just a small fraction of Hawaii’s prisoners. Hawaii’s in-state prisons and jails held a total of 2,800 inmates as of last week while MCCC was housing just 210 prisoners, or less than 8% of the total.

Wookie Kim, legal director of the ACLU of Hawaii, said the De Lima case and suicide statistics compiled by Civil Beat for MCCC are “shocking.” Hawaii continues to rely on its crowded jails and prisons to provide mental health services to a population that urgently needs better care, he said.

“Obviously it’s underfunded, under-resourced, understaffed, and that’s a huge problem,” Kim said.

The system is particularly short-handed at the moment, with the department reporting at the end of last year that about one-third of its corrections officer positions were vacant. Staff shortages can result in less supervision of prisoners, fewer services and less recreation time, which can worsen the symptoms of mental illness, Kim said.

He said the suicides are “maybe not surprising in the sense that people are put into really awful situations, and the prison and jail system isn’t the most conducive environment to people who are already on the brink.”

Cara Compani, interim oversight coordinator of the Hawaii Correctional System Oversight Commission, said vacancy rates are quite high for the civilian staffs of Hawaii’s jails and prisons, including medical and mental health team members.

“There just aren’t enough people in those positions,” she said. “This is also an opportunity to look at how we can get some of these acute mentally ill folks out of jails.”

That is a major issue on the neighbor islands where there are not enough community beds for mentally ill people, who then often end up in the jail, she said. “On the neighbor islands, including Maui, they just don’t have what they need to safely divert the population that really shouldn’t be in jail,” Compani said.

There is also too little programming and too much idle or “dead time” in Hawaii jails, a situation that is also aggravated by short staffing, she said.

Commission Chairman Mark Patterson, who formerly worked as a corrections captain at the Oahu Community Correctional Center, said a prisoner who wants to die can commit suicide in just two to three minutes. That can make it extremely difficult for the security staff to intervene in time.

Much depends on providing adequate training for the staff, and also on the size of the inmate population, he said. “If you’re watching 40 or 50 individuals every day, it can be taxing,” he said, especially if a significant fraction of those inmates have mental health issues.

It also is important for staff to know the inmate population and their day-to-day behavior, Patterson said.

The layout in MCCC can help with that because staff offices are on the floor with the prisoners. Staff there is “in the mix, and they can look at an individual and say, ‘How come you’re so quiet today?’ And then you question,” he said. “The question is whether or not they do that.”

‘She Wanted To Be A Mom’

De Lima’s family members describe her as a woman who deeply identified with being a mother to her children, and never seemed to recover after she lost them.

Artrina shouldered a great deal of responsibility growing up, helping to raise her two younger sisters on Maui while her mother worked three jobs to keep the family afloat. But she was also a loner, an independent kind of person who didn’t want to be controlled by others, Manintin said.

As soon as she was old enough, Artrina left. She had a relationship with an older man, got into drugs at a young age, Manintin said, and later lost custody of Kamalei, who was raised by her father. But she regained her footing and changed her life after she had a second daughter in 2008, Kamalei said.

“Her pride and joy was being a mom, that was her whole focus, was she wanted to be a mom to her kids,” said Kamalei, 24.

By 2019, Artrina was working in health care as a nursing assistant, and was raising a daughter and a son. But her family said she was caught in an abusive relationship during the pandemic, and was accused of choking one of her children. Child Welfare Services took custody of both children in 2020.

Artrina, 45, was mostly homeless after that, and the family would see her walking the streets of Paia, her daughter said. “She had mental instability, and she just didn’t get the help,” Kamalei De Lima said. “She didn’t trust anyone.

“She definitely did feel alone, like her kids were the only thing she had in her life. Then when they did get taken away, that fricking broke her heart.”

Manintin does not believe her daughter could have killed herself. “I know my daughter wouldn’t take her life, because her children were important to her,” she said. “She always wanted to be near her children.”

Artrina had been in jail before, but Manintin did not know Artrina had been stuck in MCCC for so long in April. Had she known, Manintin said she would have posted her bail to get her out, as she has done before. But Artrina never called her family to ask, they said.

Previous Warnings

Death notices filed with the governor’s office by the Department of Public Safety show officials at the Maui jail have known for years about shortcomings in the mental health services that facility has provided to its prisoners.

One report filed in connection with the suicide of Lewellyn Foster Jr. on Dec. 9, 2020 explained that a clinical mortality review done on Foster’s death “shows lack of mental health staffing at MCCC as (a) critical issue, (and) identifying need for additional funding as key to addressing the problem.”

The report continued: “PSD to redouble efforts to secure the necessary funds for Health Care Office to be able to offer competitive salaries to qualified applicants.”

A similar report filed after the suicide of William Robert Morrison, 52, at MCCC on July 8, 2021 explained that “corrective action” was planned to help provide additional mental health services to inmates. That included coordination with human resources staff to speed recruitment for mental health positions, according to the report.

That report, dated July 27, 2021, explained that a mental health section administrator position was “on orientation status” at the time, and the facility was trying to fill at least five other related positions including at least two that specifically involve mental health services.

The report also said federal funds had been requested to replace MCCC funding for mental health positions that was cut by the Legislature.

It is unclear today how many of those tasks have actually been accomplished to date. Tommy Johnson, director of the Department of Corrections and Rehabilitation, was traveling last week and unavailable for comment.

The issue of suicide at MCCC has also surfaced at the Legislature in recent years.

State lawmakers in 2022 approved a $550,000 settlement of a lawsuit filed in connection with yet another suicide at MCCC involving Daisy Kasitati, 26, who hanged herself in her cell on the afternoon of Oct. 12, 2017.

Kasitati had suggested to a corrections officer hours before her death that she be placed on suicide watch, but no effort was made to get medical help for her or to place her on watch status, according to testimony submitted to lawmakers by the state Attorney General’s Office.

The known Maui jail suicides for the past four years include Foster, 36, on Dec. 9, 2020; Morrison, 52, on July 8, 2021; Brandon Tapec, 28, on Dec. 27, 2021; and Jonathan Pico, 29, on June 8, 2022.

The other deaths by suicide during the last four years at MCCC were Destiny Brown, 44, on Oct. 17, 2022; and De Lima on May 19 of this year.

‘I Just Want Them To Be Held Accountable’

Kamalei last saw her mother in early April before she was arrested. Then on May 13 jail officials got word to her that her mother was in intensive care at Maui Memorial, and she was instructed to go there.

Corrections officers were assigned to watch over Artrina at the hospital, but the MCCC staff and the police told her nothing, she said.

It was a a nurse at the hospital who finally explained that Artrina had hung herself. But Kamalei said virtually no other official information has been provided, and the family does not even know if Artrina was ever identified as a suicide risk.

When asked about De Lima’s suicide, the Department of Corrections and Rehabilitation said in a written statement that jail staff found an MCCC inmate unresponsive in a cell shortly before 2 p.m. on May 13.

Staff called 911 and administered cardiopulmonary resuscitation on the inmate until Emergency Medical Services arrived and took over. The Maui Police Department also responded, and the unidentified inmate was taken in critical condition to a hospital, according to the statement.

The inmate was then released from MCCC custody on May 15, 2024, according to the statement, which does not identify De Lima by name. As of June 14, the department still had not received any official update on that prisoner’s condition, according to the statement.

That terse report has left De Lima’s family to seek answers on their own. They want to know if the jail did the mental health assessment that was supposed to be completed when De Lima was admitted, and if so, what it said.

They also want to know if she was on suicide watch when she died, and where she was being held. Manintin said she was told by jail staff that De Lima was by herself in a room adjoining the jail’s medical unit before she hung herself, and Manintin wants to know who was responsible for checking on her.

The family now has a lawyer to pursue those issues. “I just want them to be held accountable,” Kamalei said. “I don’t want this to happen to any other inmates.”

An Opaque Process

Suicides in Hawaii correctional facilities are difficult to track, in part because the Department of Corrections and Rehabilitation does not publicly announce them when they occur. In fact, the former Department of Public Safety rarely announced any deaths in custody at all until 2022.

Honolulu Civil Beat sued the department in 2021 in an effort to require the department to release the names of prisoners who died in custody, and Honolulu Circuit Court Judge John Tonaki ruled in the fall of 2022 the department must do so.

State lawmakers then passed a measure in 2023 that required the department to publicly post the names of inmates who died in custody on a website, which the department has done from 2020 to the present.

Autopsies of inmates who die in custody are usually considered public records, which means some suicides can be identified that way. But that still does not provide a full picture of deaths in Hawaii’s prisons and jails.

In some cases — including one suicide in 2023 and also in De Lima’s death this year — prisoners who are gravely injured end up hospitalized on life support, and are then “released” from state custody before they die.

Those “released” prisoners, including De Lima and an Oahu jail inmate named Jimuel Gatioan who hanged himself last year, do not appear among the deaths that are publicly reported by the department.

The only way the public is likely to learn what happened in those cases is if the prisoners’ families or jail staff raise concerns about the deaths.

Civil Beat’s coverage of Maui County is supported in part by a grant from the Nuestro Futuro Foundation.

Civil Beat’s community health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and Papa Ola Lokahi.