Born in the Caribbean nation of Antigua and Barbuda in 1978, Tiombe Kimana Carlos was 4 when her family moved to New York City as legal permanent residents of the United States.
She was 34 and awaiting deportation back to her homeland when she killed herself last month in custody in York, Pa.
U.S. Immigration and Customs Enforcement, the agency that supervised her detention, said it was investigating Carlos' death and reviewing its policies, but declined to elaborate.
How the woman called "Kim" was diagnosed with schizophrenia as a teen, stripped of her green card, and died in a prison cell is a tale of chronic psychosis, long litigation, and a dark corner of the immigration system that critics say lacks the ability to safely detain the mentally ill.
An inmate at the prison said Carlos tried in August to kill herself the same way - using prison bedsheets as a noose. Carlos' parents and sister, who live in the Philadelphia suburbs, said they knew she was depressed but were never notified of an earlier suicide attempt.
Thomas Griffin, a Philadelphia lawyer, who spent 2 1/2 years trying to persuade ICE to move Carlos to a group home or other treatment center, maintains that the agency lacked the "skills, competence, or resources" to care for her.
An advocate for her and other detainees says Carlos' story is not surprising.
"What happened to Tiombe is mad, mad tragic, OK? But it is endemic in the system," said Donald Anthonyson, who worked on her case through Families for Freedom, the New York support group. "She was successful on her second attempt - and ICE says they can handle it? Now the girl is dead."
Of about 34,000 immigrants in detention on any given day, as many 1,700 - 5 percent - have "a serious mental illness," according to one estimate by the health services arm of ICE.
It's unclear how prevalent suicide is among detainees. The agency's website reports the cause of detainee deaths and, until three years ago, included "hanging" as a category - listing seven between 2003 and 2010. Those deaths have since been reclassified as "asphyxiations."
Between 2003 and December, ICE reported 120 deaths for which a cause was determined, including 17 asphyxiations. The cause in 11 other deaths is pending, its data show.
ICE, the largest wing of the Department of Homeland Security, says it meets the needs of detainees using hundreds of contracted medical professionals. They do intake screenings and urgent-care visits, and last year performed 54,969 unspecified procedures listed as mental health interventions.
The York County prison, a 2,522-bed facility for immigration detainees and convicts on short sentences, typically holds 500 to 1,000 detainees, mostly men.
After years in and out of hospitals and prisons, Carlos arrived there in 2011.
Her parents and sister said her childhood had been mostly happy, until adolescence, when she began having auditory hallucinations and bouts of manic talking. She heard voices "and could talk you to death," said her oldest sister, Renee Benjamin.
In 1994, her mother, Angela Carlos, took her to a psychiatric hospital in the Bronx, where she spent four months and was signed out by her parents, against medical advice, with the diagnosis "paranoid schizophrenia, chronic."
After another hospitalization a few months later, Carlos was diagnosed with bipolar disorder - "manic, with psychotic features" - and discharged with medications, according to records reviewed by The Inquirer.
At 14, debilitated by manic mood swings, she dropped out of high school. A few years later, while living with her sister in a North Philadelphia apartment, Carlos went off her medications, disappeared for days, and spent a month in the psychiatric ward of Episcopal Hospital.
Until 2003, Carlos had lived with her parents in the Bronx, supported by them and mental-health disability benefits.
She was often in and out of hospitals and had convictions for trespass, shoplifting, and assaults, mostly fighting with police when they arrested her and, once, with another woman over a man, according to court filings and case documents.
In 2004, when Carlos was 26, an argument over a beer in a Connecticut bar got her arrested for disturbing the peace, resisting arrest, and biting an officer, the records show.
For those crimes, and the multiple violations of probation and parole, Carlos was sentenced to eight years in prison, with all but 2½ years suspended. In January 2010, when her sentence ended, she was delivered to ICE, which had begun deportation proceedings because of her criminal convictions.
In the years since, her sister moved from New York to Philadelphia to Sicklerville; her parents, Angela and Hueth Carlos, settled in Langhorne.
In September 2011, after six months of ICE detention in Boston, Carlos was granted a transfer to York to be closer to them and her lawyer.
That same year, Ronald Noble, a University of Pennsylvania-trained clinical psychologist affiliated with Physicians for Human Rights, a nonprofit volunteer advocacy group for prisoners, was retained by Griffin to interview Carlos at York and review her hospital records.
Noble's report became part of a Sept. 21, 2011, letter to ICE asking for "prosecutorial discretion" to suspend deportation proceedings because of her mental illness.
The letter said Carlos was being maintained "on a heavy dose of Haldol," an antipsychotic drug administered by injection.
"Regardless of which diagnosis is ultimately correct," Noble wrote, "Ms. Carlos suffers from a severe, chronic mental illness." He suggested "a group home setting" with regular medication.
Using Noble's report, Griffin asked a court to release Carlos to a mental health setting and to overturn her deportation.
Immigration Judge Andrew Arthur, sitting in the York prison, rejected the arguments.
In September 2011, Griffin again wrote to ICE prosecutors asking to halt the deportation, citing: Carlos' arrival in the United States as a young child; long-term permanent residency; lack of immigration-specific violations; lack of ties to Antigua; close family bonds in America; and a U.S. citizen daughter, born in 1999 during one of Carlos' hospitalizations. The child, now 14, lives with her grandparents.
Another defense argument was that Carlos sometimes fought when police or guards restrained her, but was not a threat to the public.
Griffin wrote that Noble's report, and Carlos' psychiatric history, were reviewed by a supervisor at the Criminal Justice Unit of the Philadelphia Department of Behavioral Health, who said Carlos was qualified to be considered for residential treatment.
On Sept. 23, 2011, a senior ICE lawyer replied.
"Despite the kind attention of her family and doctors," he wrote, "your client's condition has led her to situations that have put her and others at risk of physical injury, and the safety of the U.S. community is of paramount concern."
For those reasons, he wrote, she would remain locked up.
On Jan. 21, 2012, Arthur ordered Carlos sent back to Antigua. It was up to ICE to set a date.
But the agency also needed the assent of Antigua, which had to issue travel documents for Carlos to return there.
Omayma David, deputy consul general at Antigua and Barbuda's consulate in New York, said she had sent Carlos' file to Antigua to verify her nationality and became concerned when she learned from Carlos' parents about her chronic mental illness.
"What am I sending her to?" David said in a recent interview. "If she has a diagnosis of schizophrenia and her family is here, who am I sending her home to? It's like sending her home to die."
In December 2012, Carlos was still in the York prison, awaiting deportation. Griffin sought her release on the ground that holding her beyond 180 days after the order of removal was unconstitutional.
In a reply, ICE's Philadelphia director, Thomas Decker, said her criminal history and mental health made Carlos "a danger to the community" and cited that as a reason the agency was continuing to detain her. He also wrote: "Your client has been under the . . . regimented care of the medical staff at York County Prison, with access to both physical and psychiatric care. . . . [She] appears to be stable in her current environment."
By the summer, Carlos was clearly depressed, her relatives and lawyer said. But none knew that she tried to hang herself in August.
Angela Dempster, a detainee born in Jamaica, said she was in an adjacent cell the day Carlos strung up her bedsheets. In an interview last week, Dempster said she witnessed the prison's emergency-response team dash to Carlos' cell, holler for a knife to cut her down, and rush the 198-pound woman from the six-cell pod on a stretcher.
According to Dempster, Carlos received medical treatment and was put on a suicide watch for several days.
By October, Carlos had been returned to another unit - and was quite unhappy. On Oct. 21, a Monday, she called her father.
"She said, 'Daddy, I am so tired. I want to come out,' " Hueth Carlos said. "I told her: I pray for you day and night."
Around the same time, Dempster recalled a similar conversation with her fellow detainee:
"She was complaining, telling me she was tired [of] living in York County Prison. ... Just tired. Of everything. Of being locked up 23 hours a day."
Carlos hung herself in her cell on Oct. 23.
In a written response to questions submitted by The Inquirer, ICE spokeswoman Gillian Christensen declined to discuss details of Carlos' detention or death. She said the agency was "sending a team of specialists to review [York's] compliance" with "suicide prevention and intervention" standards.
Christensen also wrote that ICE was reviewing policies and procedures for the detention and removal "of individuals with a history of mental health issues."
It is not clear if or when Carlos would have been sent back to her homeland.
David, the Antiguan consular official, said she remained troubled by the case. "I am not trying to sabotage the process. I understand that some of our nationals come here, don't keep to U.S. law, and have to be removed," she said.
"But cases like Tiombe's . . . ," Davis said, her voice trailing off. "Somebody needs to provide an explanation here."
On Friday, following a 10 a.m. memorial service at Francis Funeral Home in West Philadelphia, Carlos will be laid to rest.