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

I need my medicine, she demanded.

I have to get out of here! she screamed.

Fillmore was in the Duchesne County Jail on a charge of violating probation in a drug case; she had reportedly failed to report a change of address. At 25, she’d struggled with mental illness for years, but Xanax and hyperactivity medication had stabilized her. Now, she told her mother, the jail’s nurse was denying her those pills — and she couldn’t take it any longer.

That November day, she phoned her mother, Melany Zoumadakis, three times over an hour. In their final conversation, Fillmore’s voice was raw with rage. She blamed her mom, a nurse herself, for not doing more. She threatened to kill herself, warning that if she did: “‘You’re going to be the worst mother in the world.’” Then she hung up.

Zoumadakis called her daughter’s probation officer and told him she feared her daughter would die in jail, but he assured her Fillmore was being monitored.

The next day, Thanksgiving 2016, Fillmore’s sister, Calley Clark, received a Facebook message. “I’m so sorry,” a friend wrote. Then another note arrived: “Please tell me it isn’t true.” In Texas for the holiday, Clark had an uneasy feeling and asked her boyfriend to call the jail. He returned with the news.

Clark dialed her mother, gasping so hard she could barely speak, and asked if she’d talked with Tanna that day. She hadn’t.

“Mom,” she cried, “she’s dead!”

On her ninth day in the Duchesne County Jail, Tanna Jo Fillmore hanged herself in her cell. She never did get her meds.

Read the headlines on any given day across America and you’ll find evidence of a crisis roiling the criminal justice system: “Suicide leading cause of death in Utah jails.” ‘’San Diego County inmate suicide rate ‘staggeringly’ high.” ‘’Attempted suicides at Cuyahoga County Jail tripled over three-year span.”

Stories like Fillmore’s have been told time and again, and yet the deaths continue in jails large and small.

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 year for which the government has released data. That’s 2½ times the rate of suicides in state prisons and about 3½ times that of the general population.

It’s a problem commonly blamed on the mere fact that more mentally ill people are landing behind bars, a trend that started after state psychiatric hospitals began closing in the 1970s and promised alternatives failed to emerge. More recently, jails have been overwhelmed with those addicted to opioids or meth, many of whom wrestle with depression and withdrawal.

Increasingly, troubling questions are being raised about the treatment of inmates in many jails, possible patterns of neglect — and whether better care could have stopped suicides.

A joint investigation by The Associated Press and the University of Maryland’s Capital News Service finds that scores of jails have been sued or investigated in recent years for allegedly refusing inmates medication, ignoring their cries for help, failing to monitor them despite warnings they might harm themselves, or imposing such harsh conditions that the sick got sicker.

Reporters spent months examining hundreds of cases in local news reports, reviewing investigations of specific jails, and compiling a database of more than 400 lawsuits filed in the last five years over alleged mistreatment of inmates, most of whom were mentally ill. Some 40 percent of those lawsuits involved suicides in local jails — 135 deaths and 30 attempts.