Mental Health Treatment in Prisons as an End to

Solitary Confinement Policy Brief

Jessica Holliday
Department of Criminal Justice, Seton Hill University
SCJ: 410 02: Program and Policy Analysis
Dr. Arthurs
December 01, 2021
 Mental Health Treatment in Prisons as an End to Solitary
Confinement Policy Brief

Who is this aimed at

● Corrections policy makers and planner in the prison system

Key messages
● Solitary Confinement is often used as a means to house mentally ill inmates leading to
the possibility of future mental illness
● Early screenings upon entry of prison can help identify mental illness
● Prisons are a critical place to address mental illness simply because of the amount of
mental ill inmates
● Prisons are not equipped to help mentally ill inmates
● Many inmates, with a mental illness, are put into solitary confinement or isolation,
more often,due to their inability to follow jail or prison rules, because of their mental
illness. In most cases, solitary confinement makes mental illness symptoms worse.

Executive Summary
“About 37 percent of people in prison have a history of mental health programs, according
to a 2017 report from the U.S. Department of Justice.”1 Most of these individuals are locked
in solitary confinement due to their inability to follow prison rules because of their mental
illness. Often, these individuals are left in solitary confinement for years with one hour of
sunlight a day. This is proven to only worsen their mental illnesses. By eliminating the use of
solitary confinement and implementing screenings for new prisoners as well as providing
treatment, not only can the lives of mentally ill inmates increase in prosperity, but also cause
a decrease in inmate population.

1
Stringer, H. (2019, March). Improving mental health for inmates. Monitor on Psychology. Retrieved November 28, 2021, from
https://www.apa.org/monitor/2019/03/mental-heath-inmates.

2
 Introduction

Prisons have become the “de facto” mental health institution. Those who commit a crime
with a mental illness whether that be due to the mental illness or not are subject to very
different treatment within the prison system. Often, they are victims of the practice of solitary
confinement. Solitary confinement is defined as the isolation of an individual from personal
interaction with others while being locked and confined in a cell for 23 hours a day. The use
of solitary confinement has even been compared to physical torture creating effects such as
perceptual distortions, paranoia, cognitive disturbances, anxiety, depression, and psychosis2
. Solitary confinement is proven to lead to worsening mental health conditions as well as
create new mental health conditions within individuals. The purpose of this brief is to
examine and identify the effect of solitary confinement on those with mental health
diagnoses. As well as suggest policies to combat solitary confinement for those with mental
illnesses as a form of treatment.

Approximately ⅓ of the 12 million people who pass through prison or jail annually have
identified a mental illness diagnosis before or during incarceration. Through research, on
prison inmates put into solitary confinement it has been discovered that after analysis of
these individuals more than one quarter of the population showed significantly higher levels
of psychological symptoms mainly anxiety and stress.3 Solitary confinement also leads to
higher risk of self harm for inmates. In an analysis of the New York City jail system in
2010-2013, studies showed that of the individuals admitted to the hospital for self harm
reasons 53% had been in solitary confinement. This policy brief includes not only the
consequences of solitary confinement usage, but also the effect it has on those with mental
illness. Solitary confinement is often used as a form of “control” for those with mental illness
often increasing symptoms within the individual. This brief gives both an overview on these

2
Ray, C. (2019, December 26). Solitary confinement and mental illness. International Bipolar Foundation. Retrieved November 28, 2021,
from https://ibpf.org/solitary-confinement-and-mental-illness/.

3 Reiter, Keramet,PhD., J.D., Ventura, J., PhD., Lovell, David,PhD., M.S.W., Augustine, D., M.A., Barragan, M., M.A., Blair, Thomas,M.D., M.S., .
. . Strong, J., M.A. (2020). Psychological distress in solitary confinement: Symptoms, severity, and prevalence in the united states, 2017–2018.
American Journal of Public Health, 110, S56-S62. doi:http://dx.doi.org/10.2105/AJPH.2019.305375

3
issues, but also possible alternatives to better treat those with mental illnesses and find
better practices than solitary confinement.

Approaches and Results

Throughout the past several decades the debate on if solitary confinement is humane or if
it is cruel and unusual punishment has been prevalent. Many believe that the lack of human
interaction while a prisoner is in a very small cell for twenty three hours a day can cause a
variety of different mental health problems. The rate of self harm by individuals in solitary
confinement has steadily increased over the years as well as the rise of worsening mental
illness for those put in solitary confinement due to these illnesses in the first place. When
isolated prisoners spend large amounts of time in solitary confinement they are at risk for a
variety of substantial health effects such as psychosis, paranoia, and perceptual distortions.
In addition to psychological effects individuals may also experience lethargy, and insomnia.
Self harm is also becoming increasingly prevalent in those in solitary confinement. Those in
solitary confinement are at an increased risk for both self harm and suicide. More than half
of suicides in federal prisons occur in solitary confinement.4 Most of these inmates had
serious mental health conditions before their entry into solitary confinement. These mental
and physical health effects are due to the lack of both social interaction and stimulation that
those in solitary confinement face as well as the lack of control over their daily routine within
the prison setting. Solitary confinement is also thought to change brain activity and effects
may even prolong after the offender is released back into the general prison population.
Some of these effects may be extremely long term particularly if the individual is young or
has a pre-diagnosed mental illness.

Long term effects of solitary confinement may include:

● Impaired Memory
● Confusion
● Depression/ Anxiety

4
Kelsall D. (2014). Cruel and usual punishment: solitary confinement in Canadian prisons. CMAJ : Canadian Medical Association journal =
journal de l'Association medicale canadienne, 186(18), 1345. https://doi.org/10.1503/cmaj.141419

4
 ● Phobias
● Personality Changes
The fundamental goal and purpose of the corrections and prison system is both
rehabilitation and preparing offenders for a smooth re-entry back into the community.
Since placing inmates in an extended residence in solitary confinement can lead to both
mental and physical health damage this is a counteract to the goal of safe reentry and
rehabilitation. In fact, solitary confinement can actually lead to worse mental health issues
than the offender had when entering the correctional system. Although, the use of solitary
confinement as a means of punishment and solitude for those with mental illness is
becoming more common.
Few states have decided to stop the use of solitary confinement for those who are
mentally ill. Colorado has created a law that when a prison is found to have psychological
problems they are immediately redirected to treatment rather than being put in solitary
confinement. Since the implementation of this new law Colorado has seen a drastic
decrease in the number of prisoners being treated in mental health facilities. Though, it is
too early to tell if this is based on the increase of mental illness for those in solitary
confinement for a long period of time. Colorado has also become the first state to ban the
use of solitary confinement for longer than 15 days.5 University of California psychologist
Craig Haney PhD has researched ways to reduce the number of people put into isolation
many of which have mental illnesses. Through interviews, Haney has shown that the
absence of interaction has led to a rise in a variety of mental health issues. He frequently
visits Norwegian prisons stating how prisoner routines mimic that of a normal daily life.
Through his visits he has stated that these prisons do not use solitary confinement as a
means of punishment as well as providing access to rehabilitation programs. The result of
this prison culture has led to a decrease in recidivism.6 Other alternatives have also been

5
Pilkington, E. (2018, October 10). More than 4,000 mentally ill inmates held in solitary in US – report. The Guardian. Retrieved November
28, 2021, from https://www.theguardian.com/us-news/2018/oct/10/mental-health-inmates-solitary-confinement-us-prisons.

6
Stringer, H. (2019, March). Improving mental health for inmates. Monitor on Psychology. Retrieved November 28, 2021, from
https://www.apa.org/monitor/2019/03/mental-heath-inmates.

5
 presented to reduce the use of solitary confinement. The Oregon Department of
Corrections created a restrictive housing reentry program the Step Up Program.7
The Step Up Program seeks to improve living conditions of those within the
correctional system while avoiding the psychological and physiological harm that is done
with solitary confinement by using rehabilitative programs. Prisoners assigned at random
to the housing program when interviewed stated that their daily lives had improved. They
stated that the Step Up Program has provided more time out of a cell as well as greater
access to other services and activities. The living situations within this program also
provided more opportunity for social interactions opposed to solitary confinement. The
research in this study found that it is in fact possible for correctional officials to create
restrictive housing environments that offer a less harmful alternative to the use of solitary
confinement.

Conclusions

In conclusion, research suggests that there are alternatives to solitary confinement. By

looking at other prison systems that do not use this method of punishment, but have better
environments within prison as well as different means of housing opposed to solitary
confinement have led me to believe that it is not the only option. Not only are there
alternative methods to solitary confinement, but there are a variety of possible health side
effects that can severely affect an inmate for the rest of their life. The implementation of
mental health treatment for those in prison can not only be beneficial for those suffering from
a mental illness, but also reduce the need for solitary confinement. Since, individuals with
mental illnesses are often put into solitary confinement for reasons they are not able to
control, the use of solitary confinement is going to decline when mental illness is treated.

By stopping the use of solitary confinement and implementing mental health treatments
within prisons, inmates can recieve the help they need and are more likely to be
rehabilitated than if they were in solitary confinement. As an alternative to solitary

7
Pilkington, E. (2018, October 10). More than 4,000 mentally ill inmates held in solitary in US – report. The Guardian. Retrieved November
28, 2021, from https://www.theguardian.com/us-news/2018/oct/10/mental-health-inmates-solitary-confinement-us-prisons.

6
confinement, mental health treatment should be implemented in prisons. In essence, the
best possible practice for treating individuals with mental illness within prisons should be
removing these individuals from facilities and transferring them to mental health hospitals,
but this is impossible at this very moment due to the lack of beds within these facilities.
Since this is not a viable option, two different options can be imposed including appropriate
treatment for those with mental illnesses, jail and creating intake screenings for inmates
entering the prison.

Implications and Recommendations

When inmates first enter the prison system they should be required to be seen by the
prison's psychologist. Each facility should be equipped with four psychologists who are
assigned a case load within the prison. One of these psychologists should be primarily
tasked with creating and performing these intake screenings. The intake screenings will
consist of a background into the prisoners mental health in the past as well as accessing
any records of prior diagnoses or any past treatment. The individual will also participate in
two therapy sessions within their first week of imprisonment so the psychologist can gain a
better understanding of their mental health as well as give any possible diagnoses. If an
inmate is cleared from any mental illnesses they are not required to meet with the
psychologist, but can request a session if they would like. If an individual is either diagnosed
or has a prior diagnosis they will have weekly sessions with their assigned therapist.
Correctional staff will also be trained by the psychologists on staff in how to handle situations
where mental health is causing an inmate to have a breakdown and how to address those
with mental illness in general. This training will also include a basic overview on the different
mental illnesses represented within the prison and the individuality of each of them. By
creating these training and hiring psychologists as staff this will lead to a decrease in the
need for solitary confinement. Since the staff will be trained in how to handle individuals
dealing with mental illness they will not find the need to put these individuals in solitary
confinement. This will soon lead to the end of solitary confinement as a whole.

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 Housing an inmate in solitary confinement costs $75,000 yearly per prisoner which is
around three times the average cost of solitary confinement.8 Caring for a mental ill inmate
in prison costs around $31,000 a year.9 This is less than half the cost of solitary
confinement. By implementing these policies, the corrections field could see a steady
decline in the use of solitary confinement as well as a decrease in disorderly conduct within
the prison. By giving mental ill inmates treatment they are far less inclined to act out.
Potential issues could include staff not following the training leading to a future rise in the
solitary confinement of mentally ill individuals though this will be combated by further training
or even possibly repremant for officers not abiding by training knowledge. As well as the
possibility of mental illness treatment not working for prisoners. In this case, the individuals
will be sent to the next available bed within a psychiatric facility to receive further in depth
treatment.

This process will be done in steps. The first step is hiring the psychologist staff. Once this
is complete psychologists will complete their training as well as being introduced to the
prison system as well as the individual prison they are in. Once complete, the psychology
staff will train corrections officers to understand mental illnesses as well as how to interact
with individuals who have them. This will be done in a class-like setting once a week for an
hour over the course of eight weeks. Staff will receive pay for this time and will be given a
final test at the end of the course testing them on their knowledge of mental illness as well
as knowledge of different mental illnesses within the prison system. Once this is complete
psychologists will begin having sessions with current inmates to address mental illnesses as
well as beginning the use of intake screenings. Overall, the policies recommended within
this brief can both help those with mental illnesses receive treatment and stop the use of
solitary confinement that causes both psychological and psychological harm on one's health
by implementing intake screenings and further mental health treatment within prisons.

8
Reiter, K., & 23. (2016, October 21). The social cost of solitary confinement. Time. Retrieved November 28, 2021, from
https://time.com/4540112/the-social-cost-of-solitary-confinement/.
9
Riley, R. (2019, August 26). The cost of caring for mentally ill inmates. Colorado Springs Gazette. Retrieved November 28, 2021, from
https://gazette.com/life/health/the-cost-of-caring-for-mentally-ill-inmates/article_86b44a74-7352-11e9-9170-b79662bf61ec.html.

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 References

Kelsall D. (2014). Cruel and usual punishment: solitary confinement in Canadian

prisons. CMAJ : Canadian Medical Association journal = journal de l'Association
medicale canadienne, 186(18), 1345. https://doi.org/10.1503/cmaj.141419

Pilkington, E. (2018, October 10). More than 4,000 mentally ill inmates held in solitary
in US – report. The Guardian. Retrieved November 28, 2021, from
https://www.theguardian.com/us-news/2018/oct/10/mental-health-inmates-solita
ry-confinement-us-prisons.

Ray, C. (2019, December 26). Solitary confinement and mental illness. International
Bipolar Foundation. Retrieved November 28, 2021, from
https://ibpf.org/solitary-confinement-and-mental-illness/.

Reiter, K., & 23. (2016, October 21). The social cost of solitary confinement. Time.
Retrieved November 28, 2021, from
https://time.com/4540112/the-social-cost-of-solitary-confinement/.

Reiter, Keramet, PhD., J.D., Ventura, J., PhD., Lovell, David,PhD., M.S.W., Augustine,
D., M.A., Barragan, M., M.A., Blair, Thomas,M.D., Strong, J., M.A. (2020)
Psychological distress in solitary confinement: symptoms, severity, and
prevalence in the United states, 2017-2018. American Journal of Public Health,
110, S56-S62.

Stringer, H. (2019, March). Improving mental health for inmates. Monitor on

Psychology. Retrieved November 28, 2021, from
https://www.apa.org/monitor/2019/03/mental-heath-inmates.

9
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