When a mentally ill young woman killed herself in 2002 in New York State’s Bedford Hills Corrections Facility, reports the New York Times, she died in a “special housing unit” known as the box. It is a small barren chamber set apart from the general population with a concrete floor, a steel door, and no clock to mark the time. The box is isolated — a gloved hand passes food through a slot in the door; a caseworker’s muffled voice filters through the holes in a small Plexiglas window. Inmates are allowed few personal possessions. Lights are never fully extinguished. It is four walls for 23 hours a day — a psychologically punishing experience by design.
Forty years ago, America’s seriously mentally ill were housed in psychiatric hospitals that kept them too long and often without good cause. As those hospitals closed, America’s prison capacity grew; it has quadrupled since 1980. People with untreated mental illness are often poor and homeless. Many commit petty crimes, creating arrest records that often lead to harsh sentences. Today some 250,000 Americans with mental illness live in prisons, the nation’s primary supplier of mental-health services. Mentally ill inmates do not do well in the tense and rulebound world of prison. They create scenes, lash out unpredictably, and cannot or will not obey orders. Special housing units are intended for the most violent inmates, but they also tend to collect those who are troublesome and mentally ill. More than 800 of the 4,300 inmates in New York’s special housing units suffer from mental illnesses like schizophrenia, major depression or personality or trauma disorders. About 6 percent of inmates in New York have been housed in the box since 1998. Yet 34 percent of suicides, 26 in all, have occurred there. Prison officials who have been sued over special housing units in at least 10 states. In California, a federal judge said that placing the seriously mentally ill in such confinement was “the mental equivalent of putting an asthmatic in a place with little air to breathe.”