Keep Mentally Ill out of Solitary Confinement

The nation used to lock its mentally ill in asylums. Now it stows them in prison.
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NEW YORK -- Twelve years ago a federal judge called the practice of
putting mentally ill prisoners in solitary confinement the equivalent
of putting an asthmatic in a room with no air. Since then, lawsuits
against corrections departments in at least 10 states have obtained
court orders or settlements designed to keep the mentally ill out of

For example, a settlement in April after five years of litigation
commits New York corrections officials to a number of concrete steps,
including creation of a new residential mental health unit, that
should dramatically decrease the number of prisoners with serious
mental illness locked round-the-clock in their cells. And
Massachusetts may be next: following the suicide of eleven prisoners
in solitary in the last two and a half years, seven of whom were
mentally ill, the Disability Law Center filed a lawsuit seeking an end
to the solitary confinement of mentally ill prisoners for more than a
week and the construction of a new secure treatment unit that would
provide them with extensive out-of-cell activities.

Life in solitary can be tough for anyone, but for the mentally ill it
can be torture. In solitary prisoners are locked in small,
claustrophobic cells 24 hours a day with no more than an hour of
exercise in a little barren cage outside the cell a few times a week.
Inmates can spend years with scant interaction with staff and nothing
to do, and both the isolation and idleness can exacerbate their
symptoms. The cruelty is compounded because mental health services for
segregated prisoners typically consist of little more than medication
and brief cell-front checks-ins by mental health staff.

Untreated or under-treated, the mentally ill may deteriorate. They may
rant and rave, babble incoherently or huddle silently. They may talk
to invisible friends and live in worlds constructed of hallucinations.
They may self-mutilate until their bodies are riddled with scars. Many
try suicide; some succeed.

Devastating as solitary may be for them, mentally ill prisoners are
disproportionately represented in segregation units, punished and
isolated for behavior that may be caused or heavily influenced by
their illness. Indeed, prisoners with mental illness are less able
than other prisoners to adjust to prison life. They are more likely
to break the rules through disruptive, belligerent, or aggressive
behavior. They are more likely to be victimized and more likely to
be injured in a fight. They may suddenly without warning refuse to
follow straightforward orders to come out of a cell, stand up for the
count or take a shower. They are more likely to behave in ways that
annoy, disgust and even enrage security staff who have scant training
in how to recognize, much less cope with, symptoms of mental illness.

Men and women with serious mental illness may be ill equipped for
prison, yet their numbers behind bars are soaring. Nationwide half of
all prison inmates have a mental health problem, according to a 2006
federal report. Thirty percent of prisoners are estimated to have
major depression and 15 percent may have a psychotic disorder. Prisons
house three times more people with serious mental illness -- such as
schizophrenia, and bipolar disorder -- than do mental health hospitals.

There is something painfully awry when institutions set up for
punishment and control are asked to take care of the mentally ill. The
nation used to lock its mentally ill in asylums. Now it stows them in

Corrections officials can and should keep mentally ill prisoners out
of segregation. But they cannot keep the mentally ill out of prison
in the first place. That is a challenge for elected officials,. They
must reform crippled community mental health systems that fail the
poor and homeless, and they must reform unduly harsh laws that send
low level nonviolent offenders to prison. The mentally ill do not
have to end up in prison, but they will until public officials show
far more common sense and compassion than they have to date.

Jamie Fellner is director of the US Program at Human Rights Watch and
co-author of the report "Ill-Equipped: US Prisons and Offenders with
Mental Illness"

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