More than two million people with serious mental illness are booked into jails around the U.S. every year, most of them for non-violent crimes.
This is a sobering statistic. But perhaps even more alarming is the fact that persons with serious mental illness have been over-represented among detainees placed in restrictive housing, or what is also known as solitary confinement.
Restrictive housing is defined as separating inmates from the general population for an average of 22 hours or more per day for 15 continuous days or more. There are three primary reasons for such confinement: punishment, the person’s own protection, or preventive measures.
But too often, persons with serious mental illness are placed in restrictive housing due to symptoms of their mental illness that impair thinking and make it difficult to adapt to a facility’s rules.
Correctional facilities have the difficult task of enforcing rules and security for the general population of inmates; they have used restricted housing as one tool to manage the population. However, solitary confinement is associated with anxiety, depression, posttraumatic stress disorder, cognitive changes, psychosis, and self-harm behaviors, including suicide.
Although some people with serious mental illness benefit from being separated from other inmates for therapeutic reasons, solitary confinement can aggravate symptoms of serious mental illness and have grave mental health consequences.
There are increasing number of evidence-based practices that can be used as alternatives.
As other countries and some U.S. states have taken decisive measures to reduce the extreme isolation of restrictive housing, it seems fitting, in the wake of World Mental Health Day (October 10), that we consider the mental health consequences of our social arrangements and conditions of confinement.
A Yale Law School study estimated there are more than 61,000 people in restrictive housing across the country, including more than 4,000 people with serious mental illness.
In Washington state for example, more than 4 percent of people in custody in Washington are in restrictive housing. A 2016 Disability Rights Washington report referenced the case of Josh Stuller, a former inmate with mental illness who spent more than a year in restrictive housing at Chelan County Jail.
Earlier this year, Mr. Stuller settled a lawsuit against the county for damages associated with his confinement.
Several legal and health organizations, including the American Bar Association, the American Medical Association, the American Psychiatric Association, and the World Medical Association oppose conditions of isolation that occur with restrictive housing, especially for persons with mental illness.
Six states have laws that limit or prohibit its use for persons with mental illness. Although Washington has taken measures to limit its use in the past decade and recently passed a law to limit youth solitary confinement, it is not one of the six states with laws limiting its use for persons with mental illness.
Given the well-known negative psychological effects of the practices, it’s time to extend protections to persons with serious mental illness and all inmates in segregated settings, regardless of the state where they are located.
Failure to do so leaves vulnerable people at risk for serious—and enduring—psychological harm.
Jennifer Piel, M.D., J.D. is a clinical and forensic psychiatrist, and the director of the University of Washington Center for Mental Health, Policy, and the Law. The opinions here are her own.