Editor's note: This story is part of a three-part series about Pennsylvania's use of solitary confinement and the effects it has on inmates who endure it. The focus on this topic is the result of the reporter's participation in the 2018 John Jay/Langeloth Foundation Fellowship on “Reinventing Solitary Confinement.”
Solitary confinement can affect brain activity within hours. People who experience the isolation can deteriorate and, especially for those with mental illness, the effects can be profound and even irreversible. Panic attacks, PTSD and depression are possible for years after a stint in solitary, where inmates are alone and confined to a cell for 22 to 24 hours a day.
“We know that within days certainly, the EEG changes in the direction of what we used to call stupor and delirium,” said Dr. Stuart Grassian, a psychiatrist who has interviewed hundreds of prisoners in solitary. “That happens even in people who are not high risk… I’ve seen people who have become delirious and psychotic within hours.”
In 2013, the U.S. Department of Justice [DOJ] opened an investigation into the use of solitary confinement on prisoners with serious mental illness or intellectual disability in Pennsylvania. A year later, the DOJ reported routine shoddy recordkeeping by the Pennsylvania Department of Corrections [PDOC]: “...health records reveals a disturbing tendency by many of PDOC's clinicians to describe almost all disruptive conduct as purely willful and behavioral, and to overlook the role of the prisoner's mental instability in causing the conduct.”
As part of a January 2015 settlement with Disability Rights Network of PA, the PDOC established a policy that prohibits inmates with serious mental illness [SMI] and intellectual disabilities from being confined to a cell for 22 hours a day. The state also redefined what it means for an inmate to have a SMI.
The department’s new definition of SMI is "a substantial disorder of thought or mood, which significantly impairs judgment, behavior, capacity to recognize reality or cope with the ordinary demands of life.” The change in definition was seen as a way to better capture which inmates have a SMI and would be particularly vulnerable to the effects of solitary confinement.
Concerns remain over if the change was enough. How is it decided if an inmate meets the criteria of having a SMI? How are jails and prisons addressing the mental health problems that solitary confinement itself causes? And are there alternatives?
The issue of solitary is one of the many civil rights issues presented by the penal system in America, which imprisons at a rate higher than any other country in the world.
As of fall 2017, Pennsylvania was imprisoning 46,920 people — the fifth highest number of all the states, according to a 2018 report by the Liman Center for Public Interest Law at Yale Law School. At that time, nearly 1,500 inmates in the state were spending time in solitary. The Liman Center report showed three states with fewer than 14 prisoners in solitary and 17 states where more than 5 percent of prisoners were in segregation.
While those in solitary make up only about 3 percent of the total prison population in Pennsylvania, when you consider the toll solitary could take on those 1,500 minds, experts and civil rights advocates feel more reforms must be made.
“Nothing in the Disability Rights Network settlement or the litigation or reforms really acknowledges how solitary confinement will generate adverse, pathological, mental health symptoms in people who did not previously exhibit them,” said Bret Grote, co-founder and legal director of the Abolitionist Law Center, a Pittsburgh-based public interest law firm.
Redefining serious mental illness
Grote said he is skeptical of how the PDOC diagnoses SMI. He said he believes the PDOC created its own A-D scale for levels of mental illness exhibited by an inmate. And the scale, he said, “is not anything recognized by a professional organization of mental health practitioners or psychiatrists.”
Prisoners ranked “D” benefit from the settlement agreement after the DOJ investigation, meaning they won’t be put in restrictive housing, Grote said.
But where the inmate lands on the scale is dependent on a diagnosis. According to the Substance Abuse and Mental Health Services Administration, nearly 60 percent of adults with a mental illness didn’t receive mental health services in the previous year. Therefore, in many cases, inmates may not have the medical history that the state prison system uses to make its decisions on who to keep out of solitary.
The Liman Center report states that 4,220 or 9 percent of Pennsylvania prisoners, as of fall 2017, were diagnosed with a SMI; none were in restrictive housing. The figure is based on how the PDOC defines serious mental illness.
The Pennsylvania Department of Corrections’ stability ratings regarding serious mental illness [SMI]:
"A" Roster - inmate has no identified psychiatric or intellectual disability needs or history of psychiatric treatment.
"B" Roster - inmate has identified history of psychiatric treatment, but no current need for psychiatric treatment; inmate is placed on inactive mental health roster.
"C" Roster - inmate is currently receiving psychiatric treatment, but is not currently diagnosed with a SMI or functional impairment, and does not have an intellectual disability or is not guilty but mentally ill.
"D" Roster - inmate is currently diagnosed with a serious mental illness, intellectual disability, credible functional impairment, or is guilty but mentally ill.
Grassian, said he couldn’t comment on Pennsylvania’s SMI definition specifically; however, he said he is skeptical of the PDOC’s evaluation of mental health.
“I’ve been dismayed often at the fact that when they define serious mental illness in whatever way...suddenly a lot of people are cured of their serious mental illness and end up being diagnosed with personality disorders,” he said. “...When a system doesn’t really want to change, they simply stop diagnosing people as having serious mental illness.”
Some states provided the researchers for the Liman Center report a sentence or two explaining their definitions of SMI while others gave more detailed descriptions. The report authors, however, stated that the definitions still left them unsure of who exactly would be considered to have a SMI.“Given this variation in scope and detail, a person could be classified as seriously mentally ill in one jurisdiction but not in another.”
Grassian said most people who end up in solitary have difficulty managing their emotions and behavior.
“The individuals who commit infractions are the people who are most vulnerable to the toxic effects of solitary,” he said.
Solitary confinement isn’t ‘toxic’ for only those with SMI. It is detrimental for prisoners across the mental health spectrum. It could change anyone’s brain within hours.
Grassian said “the degree to which people suffer from the lack of stimulation and the inability to maintain an adequate state of alertness [varies]. But, everyone suffers from it.”
And what does it accomplish? He said there’s evidence that solitary doesn’t decrease violence inside facilities and actually increases violence when prisoners formerly in solitary return home.
Other inmates who have experienced solitary return home and isolate themselves, Grote said. “They have a hard time coming out of their cell. It’s this nightmarish scenario where for so long there’s this yearning for freedom and to have more access and then winning that opportunity through struggle, through litigation and then the door’s opening and being too scared to come out or too adapted to that [confined] space, and it's very difficult."
Inmates in solitary can request a counselor. But sessions are cell-side.
That’s unacceptable to Jamelia Morgan, a civil rights litigator and associate professor of law at the University of Connecticut:
“You can just imagine how incredibly awkward that would be to talk about hearing voices, to talk about the traumas you experienced, when your cell buddy to your left and your right can hear you."
At the Allegheny County Jail [ACJ] in Pittsburgh, inmates in segregation receive daily check-ins from mental health professionals.
Laura Williams, chief deputy warden of healthcare services, said if a prisoner is “faring pretty well in their segregation status,” they will receive less attention than someone with “higher needs” or “a potentially known mental health history.” Williams said the county jail has one licensed full-time psychologist on staff.
PublicSource did not receive statistics on solitary confinement in the jail as of publication time. The jail was not included in the Liman Center report.
Amy Worden, press secretary for the PDOC, wrote in an email that prisoners with SMI who commit serious infractions — such as assaulting an officer — are sent to diversionary treatment units [DTUs], where they are allowed out of their cells 20 hours a week. They also receive “treatment tailored to their infraction,” Worden wrote.
“They are not simply shut away,” she wrote. “For instance, if one assaults an officer, he/she would receive violence prevention/anger management counseling.”
In 2014, prior to Disability Rights’ settlement, the number of prisoners housed in DTUs ranged from 129 to 156 in monthly data snapshots conducted by the PDOC. There was a dip in early 2015 and since then, the average number of prisoners staying in DTUs per year has risen. The number has not dropped below 200 prisoners since June 2017. In October 2018, the PDOC reported 240 prisoners in DTUs.
Warden Orlando Harper of the ACJ said his administration is dedicated to providing more recreation time for individuals in segregated housing.
“We know spending that much time in a cell will cause an inmate to decompensate,” Harper said. “We understand the seriousness of not having these inmates in the cell 24, 23 hours a day.”
Harper and county spokeswoman Amie Downs said televisions are expected to be added to the segregation unit at the ACJ in 2019.
Jack Pischke, an inmate program administrator at the jail, said solitary isn’t used like it used to be.
“Now, if you’re caught stealing, you may receive the infraction right there on your housing pod…” he said. “You may lose commissary for like 30 days. You may lose phone privileges. You may be locked in 48 hours. In the old days, you were locked in for six days until your hearing and then you’re locked in for 30 [more] days.”
People who have been in solitary confinement often experience hypersensitivity, agoraphobia (fear of crowds), panic attacks, social anxiety, depression and PTSD after returning to a facility’s general population or once they’re released. Advocates like Morgan and Grote would like to see solitary abolished completely, but, until then, they’re calling for more time out of cell, one-on-one sessions with counselors and education programming that stimulates the mind.
Pischke said there should be consequences for serious infractions like assault. But, he doesn’t think the system should be as harsh as it has been.
“Somebody caught stealing, should they be treated the same as somebody that murders their cellmate?” he said. “I think a lot of that has changed. Before, it used to be no matter what you did, you’re all treated the same.”
Brittany Hailer is a freelance journalist based in Pittsburgh. She can be reached at firstname.lastname@example.org. Brittany is a Justice Reporting Fellow for the 2018 John Jay/Langeloth Foundation Fellowship on “Reinventing Solitary Confinement.”
This story was fact-checked by Harinee Suthakar.