Running head: CONFINEMENT AND MENTAL ILLNESS IN U.

S PRISONERS 1

Confinement and Mental Illness in U.S Prisoners

Name

Institution Affiliation
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 2

Abstract

Over recent years, prison officials have gradually turned to solitary confinement as a method

of handling inmates that are troublesome or violent. Many of the segregated prisoners, which

can last for years, have severe mental illness, and solitary confinement conditions can worsen

their symptoms and cause recurrence[ CITATION Jer19 \l 2057 ]. Mental health problems

are another hall mark of prison population in the United States and elsewhere – and another

source of the mounting toll of lifelong disabilities that incarceration imposes. In United

States, 400, 000 to 600, 000 prisons in mates (15-20 per cent of all prisoners) have a major

acute or chronic psychiatric mental disorder, and serious psychiatric cases are now recurrent

in the prison systems[ CITATION Rog17 \l 2057 ]. Prison rules for segregated inmates,

however, greatly limit the type and amount of mental health services they will obtain.

Key words: Confinement, illness, mental illness, health, inmates, solitary.

CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 3

Introduction

The criminal justice system faces multiple mental illness issues that result from

solitary confinement affecting prisoners. This topic is very detailed, with a lot of issues to be

addressed and corrected. According to Metzner and Fellner Esq., (2010), isolation can be

psychologically harmful to any prisoner with the extent and severity of the impact depending

on the individual, period, and specific conditions, Anxiety, depression, frustration, mental

disorders, perceptual distortions, intrusive thinking, hysteria, and schizophrenia can include

psychological effects.

Significance of the Problem

In the U.S. jail and prison systems, mentally ill people are overrepresented compared

to the general population. Within jails and prisons, there are three times more seriously

mentally ill people than in U.S. hospitals. Scholars debate the exact cause of this over-

representation; the possible reasons include the mid-twentieth-century deinstitutionalization

of mentally ill people; insufficient funding for community mental health treatment; and the

criminalization of mental illness itself. Most U.S. prisons work with a psychiatrist and a

psychologist (Johnston, 2013). While many research claims that mentally ill criminals have

similar rates of recidivism to non-mentally offenders who are not mentally ill, many research

claims that mentally ill offenders have higher rates of recidivism. In disproportionate rates,

mentally ill people undergo solitary confinement and are more vulnerable to its negative

psychological effects. Twenty-five states have laws dealing with the emergency treatment of

the mentally ill in jail, and the U.S. Supreme Court affirmed the right of inmates to seek

mental health (.A Doc Sued On Behalf Of Prisoners with Serious Mental Illness, 2013)

Human Right Watch (HRW) is an international human rights organization. After the

following viewpoint, HRW argues that the mental ill generally do not receive adequate

treatment in U.S prisons. HRW points especially to the widespread use of solitary
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 4

confinement in U.S prisons. HRW says that solitary confinement can be exacerbate mental

illness; in otherwise healthy patients. The organization recommends eliminating the

widespread use of confinement and also suggests significantly reducing the U.S prison

population by discontinuing the imprisonment of people for nonviolent offenses. Without

such changes, the U.S is violating the human rights of mentally ill individuals in

prison[ CITATION Noa13 \l 2057 ] .

Physicians working in U.S. prison facilities face ethically difficult and challenges

arising from poor working conditions, dual loyalty to patients and employers, and the tension

between reasonable medical practices and prison rules and culture. In recent years, physicians

have steadily faced a new challenge: the extended solitary confinement of inmates with

serious mental illness, a method of punishment that has become widespread given the

psychological harm it may cause (Cloyes, 2007). There has been little professional or

academic exposure to doctors and other medical professionals' particular ethical dilemma

when prisons separate mentally ill inmates.

The topic chosen for study is inmates who spend time in solitary confinement with a

higher risk of mental illness than inmates in the general population. In 1992, the National

Mental Health Alliance (NAM) and the Public Health Research Group identified high

numbers of people with severe mental illness imprisoned across the country (Erickson &

Erickson, 2008). The 2005 Bureau of Justice Statistics estimated that most inmates have

mental health problems, including 705,600 in state prisons, 78,800 in federal prisons and

479,900 in local prisons (James & Glaze, 2006). To get to the root cause of linking prisoners

with mental illness and solitary confinement, the quasi-experimental models need to conduct

research on available data, facts and studies.

A new survey undertaken by Yale law researchers and the Association of State

Correctional Administrators (ASCA) reported that more than 4,000 prisoners in solitary
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 5

confinement suffers from severe mental illness in the U.S. Prisoners are held in solitary

confinement every day for 22 hours, for 15 days or more, despite the fact that long-term

isolation can both cause mental health problems and exacerbate existing mental illness. The

Yale and ASCA survey also found that approximately 2,000 prisoners have been held in

solitary confinement for more than six years, described by the Guardian as a "crisis point."

According to Fettig, the risks associated with long-term solitary confinement of prisoners

with severe mental illness are "so well-known and well-established that it is a violation of the

8th amendment," protecting people from cruel mental illness (Freier, Singer, David, 2005).

He added that the number listed to the survey (4,000) is probably low due to "notoriously

bad" mental health care and jail diagnosis.

Confinement is particularly damaging to individuals with mental illness. The extreme

conditions of confinement can exacerbate pre-existing mental illness or provoke a

reoccurrence of mental illness. Individuals with mental illness are disproportionately

represented in supermax facilities (Fuller, 2018). Prison administrations respond to

uncooperative behaviour caused by mental illness with punishment such as withdrawal of

privileges and lengthening their term in isolation, perpetuating their illness and delaying

recovery.

Purpose of the review

In this area of study, solitary confinement is critical as the nucleus to the issue of

mental illness within prisoners. In a small area, prisoners are enclosed and locked behind a

solid steel wall. The inmates spend 23 hours per day in one location, constrained by personal

property and reading material. While the interaction with the inmates is confined in isolation,

treatment and educational programs are also provided. Prisoners encounter mental torture,

sensual deprivation, and forced insomnia. Side effects that are potentially life-threatening to

isolated inmates of the general population become problematic. Reports also confirmed that
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 6

some prisoners who are subject to solitary confinement will potentially have mental illness.

According to Haney (2006), the rigid conditions of solitary confinement offer no opportunity

for individuals to engage in social reality testing. To test and validate their perceptions of the

environment, people rely on social contact. In the end, a total lack of social interaction makes

it difficult to differentiate reality from what is outside and what is not. The adverse effects of

solitary confinement seem to be mainly associated with internment length and circumstances

(Haney, 2003).

Background to the Research Problem

Over the last four decades, jail and prison policies have had an impact on nations to

the point where 25 per cent of the U.S population is behind bars. There are many people

behind bars who are poor, uneducated, some suffering from mental health issues. Mental

health problems impact half of U.S inmates, with mental illness being diagnosed at 10 to 25

percent. (Nation of Incarceration, October 2014). Prisoners are reluctant to open up to their

environment; most do not feel sufficiently comfortable physically or psychologically to

encourage the clinicians to provide the necessary medical treatment.

The Research Questions

i. What are the psychological impacts on prisoners for prolonged solitary confinement?

ii. Is it possible to regulate the use of solitary confinement and keep prisons safe?

iii. How does the re-entry of inmates into society have an effect on mental illness while

in solitary confinement?

iv. What's the difference between the general population and solitary confinement?

v. What are the reasons for inmates being held in solitary confinement?

The Hypothesis

The hypothesis includes the assumption that those in solitary confinement are at

higher risk of mental illness compared to those in the general population. This is because
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 7

there is minimal contact with others. If the hypothesis is confirmed, the study should show

increased contact with those in solitary boredom reduces, inmates will have a lower risk of

mental illness than those with nothing to do in solitary confinement. The figures will

correspond with the population as a whole. If the assumption is not established, prisoners

without would still be higher than the general population, the likelihood of mental illness

would be the same with those with intent.

Literature Review

Recidivism; is defined in this paper as the rates of recidism or re-entry into prison.

Research shows that rates of recurrence and return to jail for mentally ill prisoners are not

significantly higher (Hamaludin, 2018). A 2004 study found that while 77 per cent of surveyed

mentally ill prisoners were arrested or charged with a new crime within the follow-up period of

27-55 months, compared to the general population, "our mentally ill inmates were neither more

likely, nor more severe, than general population inmates. In comparison, a 2009 report analyzing

the criminal record of those in Texas Department of Criminal Justice facilities found that "Texas

inmates with significant psychiatric disorders were far more likely to have had prior

incarcerations than those without serious mental illness." Researchers noted in the analysis that

the findings of their study varied from most researches.

Social Isolation; one of the main purposes of solitary confinement is not to

communicate with other prisoners (Immarigeon & Civil Research Institute, 2006). Prisoners

remain in their cell for 23 hours a day on average, and the only time they undergo any human

interaction is when they are escorted by prison guards to and from their one-hour workout.

The contact, even then, is meaningless. More than 80,000 inmates are in solitary

confinement, ranging from 2 weeks to years; one man has been in solitary confinement for 40

years. As social isolation is one of the key factors in solitary confinement, attention must be

given to how this type of isolation leads to the mental health harm of an individual.
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 8

Brodsky and Scogin (1988) also point to social isolation as the cause of solitary

confinement's negative mental health effects. They took 69 male in solitary confinement and

asked them to complete an Isolation Sentence-Completion Assessment that determines the

mental status of the inmates. The test results indicate that some form of psychiatric disorder

had formed by about two-thirds of the inmates: 45 percent were diagnosed with anxiety and

36 percent had chronic depression (Brodsky and Scogin 1988, p. 279). Such findings,

however, do not describe the prevalence of mental illnesses before the inmates entered

solitary confinement. Brodsky and Scogin carried out the same experiment on a non-solitary

prison in a follow-up report, where group activities and spacious 2-man cells occurred (p.

279). The researchers found that these prisoners had no major mental disorders, which

suggests that the disparity in social activity has a major impact on prisoners ' mental well-

being.

Mark Leary (1995) reaffirms that a biological human necessity is this idea of social

activity. He developed the need-to-belong theory: at least a minimum amount of

interpersonal relationships must be established and sustained by humans. Leary explains that

his hypothesis is validated by existing evidence and how a major human motive is the need to

belong. He has developed a meta-analysis of past research and ties a lack of social

connections to a health decline. The need-to-belong theory of Leary offers solitary

confinement a new perspective, and his findings suggest that some, if not all, negative effects

of solitary confinement are triggered by social isolation.

Sensory Deprivation; another important aspect of solitary confinement is that

prisoners are absolutely deprived of external stimuli while being locked in their cells for 23

hours a day. They lack physical contact, which only happens when they are placed in

restraints by prison guards, and their cells are unchanging and monotonous from the

environment (Miller & Teresa, 2010). There are no windows, and the lights are always on in
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 9

most solitary confinement facilities; inmates are deprived of new stimuli visually. There are

usually no external distractions for the inmates. Research suggests that higher levels of

deprivation in prisons contribute to more psychological problems.

Donald O. Hebb (1951) decided to explore how human beings, particularly in solitary

confinement, were influenced by a lack of sensory input. He proposed that a continuous

stream of sensory input was needed by humans. Hebb took volunteer male graduate students

and placed them with a little more than a bed in small rooms individually. Participants wore

sunglasses, headphones around their arms playing white noise, gloves, and cardboard tubes to

restrict the senses. Participants, like inmates in solitary confinement, would also be escorted

and given food. Hebb was basically trying to simulate a situation similar to solitary

confinement in which one's senses are completely blocked. Hebb, initially wanted to study

his subjects for six weeks but none of the participants took more than a week to complete.

The majority did not last longer than a couple of days. When interviewed earlier, participants

said they were planning to think about work or school, but subsequently they reported that for

any length of time it was extremely difficult to focus or think clearly. Throughout the study,

Hebb used cognitive tests and the tests showed that the subjects were mentally impaired

temporarily. They had childish emotional responses and poorly performed on basic

associations of arithmetic, pattern recognition, and word.

Criticisms; while there is plenty of evidence that solitary confinement causes mental

health degradation for prisoners, some research questions this argument. One research by

Zinger and Wichmann took prisoners who were released from solitary confinement and after

their release monitored their lives. No significant health effects of free prisoners were found

by the researchers (Zinger, Wichmann & Andrew, 2001). Key aspects of solitary confinement

are already detrimental to the mental health of an individual, so how can it be that mental

health is not compromised by the combination of social isolation and sensory deprivation?
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 10

Studies of physical contact show that humans need this, and it has been shown in social

psychology that humans are social creatures and anxious to be accepted into a group. If

solitary confinement does not have a negative impact on mental health, it would not make

sense, even if there is not enough evidence to support this claim. The contrary evidence,

however, should not be ignored. Their finding was that there are no long-term effects of

solitary confinement.

Non-Solitary Confinement and Solitary confinement Prisons; if the threat of solitary

confinement entails serious health risks, are these risks different from the effect of regular

prison? Several studies have contrasted the consequences of daily incarceration with solitary

imprisonment, and generally there seems to be a strong correlation between increasing mental

illness and increasing prison restrictions. Zinger, Wichmann, and Andrews (2001) studied

inmates in solitary confinement as well as non-solitary confinement; however, their findings

showed that there was no difference in the inmates' mental deterioration, whether in regular

prison or solitary confinement. Their study supports the idea that mental illness is not caused

by solitary confinement. However, the inconsistency of research results comparing regular

prisoners with solitary prisoners suggests that prisons, both solitary and regular, are not the

same. Research has been done around the world and each institution has its own system;

results cannot be drawn from a single study performed in just two prisons (Ginsberg & Betsy,

2009).

Justify the Proposed Study

It may be accurate that inmates in solitary confinement are more likely to develop

mental illness than inmates in the general population. The primary use of solitary confines is

to help people commit suicide or injure others, but solitary confines can have a negative

impact on the inmate. Prisoners are cut off from any contact with other individuals while in

solitary confinement. When needed, they receive meals and medical attention. Solitary
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 11

confinement is believed to be able to make a person mad because they are often alone. If a

person has a psychological problem, it can make it worse, or the reason for developing

mental illness.

Methods

To get best of the information for the research, I will involve three conflicts who have

been in United States jail for at least a year. I will then pay a visit to at least four cells that are

well known to use the confinement as a form of restricting inmates. I will involve enquiring

and interrogating directors and head of cell blocks to get clarity of issues relating to solitary

confinement. I will persistently focus on how inmates are treated inside cell blocks, how they

interact with the outside world, their time limits, their freedoms and right being a prisoner. I

will also get to gather more data of how the government of United States influences the

accomplishment of solitary confinement and the kind of measures it is taking to address the

issue affecting prisoners. I will also figure out on how the concerns of prisons states and

prisoners affect the general people and population in United States, and also clarify on how

measures the general population is taking to reach to a peaceful conclusion against solitary

confinement.

Procedure and Analysis

Most reports provide information about prisoners' lives spending time alone, but still

there remain unanswered questions. Questions that need answers are what if the time frame in

which the solitary person starts to place the inmate at risk of mental illness. Are there ways of

measuring the on-set results? (Petersilia, Petersilia, et. al., 2012). At what point is the inmate

going to be psychologically impaired by the provided treatment? If a time table was created,

using this method as a type of punishment with a lower risk of mental damage would be more

humane? Finally, is the reward worth the risk? If this strategy works to keep prisoners in line
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 12

and order inside the jail, perhaps it should be something that is held and used, but done so as

not to risk the lives of the prisoner.

The procedure is to determine whether or not inmate’s solitary confinement has

mental illness or induces it. The techniques would look at issues from both sides of the

spectrum to see whether it is the actual act of isolation, time spent in isolated environments,

or lack of contact with others. Surveys between prison guards and inmates will be

administered. By doing these researchers get a comprehension of what the prison guards see

when the inmates are placed in solitary confinement, one can also get testimonies of the

emotions and mental state that the inmates are placed in solitary confinement. The next move

is to examine solitary prisoners. Seeing how the prisoners behave in this setting, researchers

get clear pictures of the actions of the prisoners. Researchers can see when the prisoner has a

break in a time consisting of hours and days. Another procedure that I will want to investigate

is to compare and contract facilities. The researcher should have a clear understanding that

isolation causes mental illness; the researcher should examine certain facilities for similarities

and differences between them in order to do this. Comparing and comparing services can be

used to assess how and why mental illness happens with solitary inmates. Investigating

whether the solitary cell or environment of each prison is the same could shed light on how

this disease could occur; could it be the small space, the fact that a person is alone in a room

for hours or days.

I will then analyze the context of individuals spending time alone to see if there were

problems with mental illness before they were placed in solitary. Taking a review of medical

evidence to see if it supports the fact that mental illness is caused by solitary confinement,

deploy the prison health records to assess when and how the mental breakdown of the

inmates started. A correlation can be seen in evaluating the results to give the inmates a time

frame after being in isolation before and after health conditions. Analyze the surveys as well
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 13

as the inmates' conduct records while in solitary to see if what the inmates think about the

study fits what researchers remember the inmate doing while in solitary confinement.

Obtaining data from these sources can provide a basis for solitary confinement as a result of

mental illness. This research will help to demonstrate one way or another through these

proposed methods that solitary confinement induces mental illness.

Suggestions for Further Research

Additional research on the levels of violence and financial health of institutions that

implemented revised solitary strategies could be completed in order to centivize the changes

as discussed above. Hitherto, research suggests that rates are declining and overall levels of

violence are decreasing as fewer prisoners are housed in solitary units. In addition, more

work could be carried out to explore the impact of solitary confinement directly on mentally

ill people, as many studies have difficulty in distinguishing between those who have

undergone mental illness from those who have acquired mental illness due to solitary

confinement (Harrington, 1997). Finally, future research into the long-term effects of solitary

confinement on both general population and mentally ill inmates would be useful.

Solitary confinement is an ancient punishment that had fallen out of favor by the end

of the nineteenth century and was deemed by the U.S. Supreme Court to be "an additional

punishment of the most significant and painful sort." However, it was again adopted in 1983,

after the murders of two prison guards in an Illinois state prison influenced the new supermax

prison.

Limitation of the Study

It is hard to study prisoners in solitary confinement because the responses they give

may increase their stay due to partial confidentiality. One alternative is to study prisoners

externally using medical records and cameras, but without an interview or questionnaire, it is

difficult to conclude what their mental state are. Some studies are conducting interviews;
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 14

however, prison officers often select these prisoners. This choice automatically makes the

research unrepresentative of the entire prison population, and this selection is,

unfortunately, a protocol to protect researchers from violent or disturbed prisoners. Some

other methodological concern is that, before incarceration, most studies do not monitor

inmates. This longitudinal method is crucial to compare the mental health of prisoners and to

determine whether solitary confinement is the only factor that contributes to mental illness.

Most studies on solitary confinement deal with percentages of mental illness inmates, but

their findings do not recognize that mental illness outside solitary confinement could be

obtained by prisoners.

Overall, evidence on solitary confinement is largely inconsistent with methodological

flaws; however, research results still provide insight into the consequences of confinement.

Significance and Conclusion

Studies have demonstrated that people with severe mental illness after solitary

confinement are comparable to aggravating symptoms such as anxiety, depression,

frustration, cognitive disorders, perceptual distortions, intrusive thinking, and psychosis.

(Haney, 1993). Education for correctional officers should be introduced on how to respond to

ways that do not exacerbate such situations for people suffering from psychological

disorders. Solitary prisoners were found to mutilate themselves at rates higher than the

general population. Other research found that street-released conflicts had higher rates of

recidivism compared to those who spent time in the general population after solitary

confinement (Haney 1993).

To conclude, most problems are caused by mental illness induced by inmates in

solitary confinement. It is of importance to know whether incarceration contributes to mental

illness if so why. Although prisoners in the general population may be affected in some way

by metal problems, finding a metal-disease catalyst among solitary confinement offenders is

CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 15

much more prevalent, which makes research important. It is felt that prisoners suffering from

mental illness are susceptible to increased mental abuse, physical abuse and emotional abuse.
CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 16

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CONFINEMENT AND MENTAL ILLNESS IN U.S PRISONERS 19

Appendices

Most problems stem from mental illness brought about by prisoners placed in solitary

confinement. The effects felt after a period of confinement is particularly vulnerable and

magnified to two populations; prisoners with mental health issues and juveniles, whose brains

are still developing. When a person entering an isolation unit is not mentally ill, their mental

health has been severely compromised by the time they are released. Since, after spending

time in confinement, most inmates are released directly into the streets. Long-term solitary

confinement therefore goes beyond a problem of prison conditions, posing a formidable

public safety and community health issue. Therefore, long-term solitary confinement goes

beyond a problem of prison conditions, posing a formidable problem of public safety and

community health.

Prison confinement fits the definition of torture. The isolation thus constitutes an

abuse and violation of human rights law. Although inmates in the general population may be

affected by mental problems in some way, finding the mental infection catalyst in solitary

confinement prisoners is much more prevalent. It is believed that more psychological

violence, physical abuse, and emotional abuse were endured by mentally ill inmates.

Research results may show how many inmates are suffering from mental illness while in

solitary confinement and why they are doing so.

Prison isolation must come to an end — for the security of families, to uphold duties,

to abide by international human rights law, to stand up against violence wherever it takes

place, and for the sake of our common humanity.