Last month, the Pennsylvania Department of Corrections announced that placing inmates with mental illness in solitary confinement will no longer be part of their management practices. It was a response, in part, to a civil rights investigation by the Department of Justice (DOJ) that found Pennsylvania inmates with mental illness were “in solitary confinement for months and sometimes years, with devastating consequences to their mental health.”
The 2014 DOJ report also indicated that inmates were “routinely confined to their cells for 23 hours a day; denied adequate mental health care; and subjected to punitive behavior modification plans, forced idleness and loneliness, unsettling noise and stench, harassment by correctional officers, and excessive use of full body restraints”.
An unforeseen consequence of the increasing use of solitary confinement is that large numbers of inmates with mental illness are placed in these units due to behavior stemming from psychiatric symptoms.
Assessed as significant security threats, many U.S. inmates are placed in “supermax” lockdown units for assaults on staff and inmates, gang affiliations, or drug smuggling. This is the solitary confinement that is usually discussed in the press, and the nature of these units is beyond the comprehension of most people who have not witnessed them first-hand.
More than simply “isolation;” it's a a profoundly disturbing environment for both staff and inmates.
The psychological consequences of solitary confinement for individuals with mental illness are well known: increased symptoms, increased risk for suicide, increased risks for assaults on staff, increased opportunities to be victimized by other inmates, and decreased opportunities for programming.
Why do so many inmates diagnosed with mental illness end up in these units, and what can be done to decrease their presence in these units?
These supermax/solitary units were never created specifically for individuals with mental illness.
In the state correctional system in which I provided mental health services, these housing units were created for inmates who were repeatedly assaultive or distributed drugs. Regular disciplinary segregation, according to correctional administrators, was not enough to curb these inmates' behaviors. Once placed for a six-month sentence in this unit, inmates would then have to complete cognitive programming, which would then designate their release dates.
Inmates with mental illness exhibited behavior that, based on correctional administrative rule, warranted their placement in such units. For example, some inmates with mental illness who did not receive appropriate medications would become assaultive, and would then be placed in supermax housing.
Psychotic, and unable to complete any offered programming, these inmates would then remain in supermax housing, sometimes for years.
There are effective ways to keep inmates with mental illness out of these supermax/solitary segregation units.
First, there must be effective treatment and monitoring of inmates with severe mental illness within the general prison population. This ensures individuals experiencing symptoms are not assaultive. Second, there must be mental health professionals assigned to supermax with the administrative authority to block inmates' long-term placement in these units.
This involves high levels of collaborative efforts between correctional administrators, correctional officers, mental health staff, and medical staff. Mental health staff, while maintaining confidentiality, must inform correctional administrators, officers, and medical staff of inmates with histories of assaultive behavior due to psychiatric symptoms such as paranoia or psychosis.
Medical staff must effectively communicate to mental health staff if severely mentally ill inmates stop prescribed medications or miss doses. Mental health staff must check medicine logs and monitor inmates with severe mental illness closely – as often as necessary – to ensure that treatments are working.
Institutional mental health treatment plans must include contingencies for rapid placement of symptomatic inmates with histories of assaults within secure psychiatric inpatient units for treatment.
Front line officers must be informed of these inmates' presence on their housing units, and be comfortable in identifying warning signs of symptoms, and have strong collaborative relationships with mental health staff to ensure these plans are executed safely, effectively, and humanely.
If inmates with mental illness enter supermax/solitary confinement, they should be assessed by a mental health professional immediately upon admission. If their admission to a supermax unit is the result of psychiatric symptoms, admission to an inpatient unit is warranted to provide treatment to decrease symptoms.
This includes collaboration with correctional administrators to ensure appropriate placement out of the unit. In many instances, this may include a process of negotiation, as correctional administrators may only see an inmate with a history of staff assaults, for example, and not an inmate experiencing delusions, paranoia, or psychosis.
If returned to the supermax unit to serve their sentence, close monitoring and continued treatment must be part of the inmates' stay in this housing unit. If unable to complete programming to exit these units, mental health and correctional administrators must identify pathways out of these segregation units for these inmates. Long-term confinement is not a solution to experiencing psychiatric symptoms, treatment is.
These are just initial steps to ensure that individuals with mental illness do not end up in these horrendous and toxic environments. As outlined, these are not issues solely relegated to mental health staff, officers, administrators, hearings officers, or medical staff. All prison staff must be on board with a mission of safe institutions.
A mental health administrator I worked with indicated as much when he stated to me during my research:
Anybody in this kind of environment, if you try to fly solo, you're going to crash. You have to rely on your own network – relationships with your co-workers, security, health services, administration. Every piece has a direct bearing on not just the safety and security and well-being of mentally ill inmates, but also the safety and security of the entire institution.
Rule violations may occur due to psychiatric symptoms, and treatment providers must be involved in decisions about where, how, and when to house inmates with mental illness.
Without this collaborative action, inmates with mental illness may be inappropriately placed in segregation units. This by no means excuses assaultive or disruptive behaviors.
However, it does indicate that in order to decrease incidences of such behavior, and increase institutional safety and security, all staff must share an understanding of mental illness, mental health treatment, and the most effective way to address the needs of our most vulnerable prisoners.
Joseph Galanek, PhD, MPH, is a Research Associate at the Begun Center for Violence Prevention Research & Education at Case Western Reserve University's Jack, Joseph, and Morton Mandel School of Applied Social Sciences. Dr. Galanek's research and evaluation activities have been funded by the National Science Foundation, the National Institute of Mental Health and the Ohio Department of Mental Health. He welcomes comments from readers.