Issue 1. Field Leaders: Safe Alternatives to Solitary Confinement
Pennsylvania Implements Humane Strategies for Treating People with Mental Illness in State Prisons
Featuring Lynn Patrone: Mental Health Advocate
The findings of the Department of Justice (DOJ) were grim. A federal civil rights investigation concluded that by keeping them in their cells 22 to 23 hours daily, the State Correctional Institution at Cresson, Pennsylvania, had violated constitutional rights of people who had mental illness or intellectual disabilities. The Civil Rights of Institutionalized Persons Act (CRIPA) prohibits a pattern or practice of deprivation of constitutional rights of individuals confined to state or local government-run correctional facilities, and in 2013 Pennsylvania had shown just such a pattern. The review found that the state’s misuse of solitary confinement had caused mental strain, depression, psychosis, self-mutilation, and suicide. Roy L. Austin Jr., deputy assistant secretary general for civil rights at DOJ, wrote:
We found that Cresson often permitted its prisoners with serious mental illness or intellectual disabilities to simply languish, decompensate, and harm themselves in solitary confinement for months or years on end under harsh conditions in violation of the Constitution.
Today, Lynn Patrone is proud to be on the team of John Wetzel, Secretary of the Department of Corrections (DOC), and she credits the profound changes the state has made in large part to his determination to improve mental health services in state prisons. Lynn was appointed in May 2015, as the Mental Health Advocate for DOC. Pennsylvania is very likely the only state that has created such a position within DOC. On her appointment, Secretary Wetzel said he expected her to help “ensure that offenders are getting the treatment they should while in prison” and that they are “connected with benefits upon their release from prison.”
Skills are Up and Infractions Are Down
Today, prisoners who have serious mental illnesses are housed in specialized units staffed by officers who have received 32 hours of Crisis Intervention Training (CIT). The curriculum was adapted from the Memphis model and adapted to Pennsylvania’s needs. Officers are skilled in recognizing symptoms that might be related to mental illness and using techniques to de-escalate a situation and prevent misconduct. They may observe that a person is struggling emotionally and intervene utilizing the skills they learned through CIT. Trainees also learn recovery-based intervention skills, such as asking questions to understand what led to an incident as opposed to issuing an immediate misconduct. Data show that empathy and crisis intervention skills go a long way toward prevention. Under the new system, infractions have steadily decreased.
When nonviolent misconduct occurs, the matter is referred for an informal hearing and, if needed, psychological services are provided. More serious infractions are reviewed by a psychiatric team that includes a psychiatrist and psychologist, who conduct a psychological evaluation and determine whether the misconduct was a result of mental illness. If necessary, the individual is consigned to diversionary treatment. Even if the person is segregated in these units, he will spend a minimum of 20 hours out of the cell engaging with program staff. Segregation never persists months on end. While the person loses some freedom, the focus is on addressing the cause of poor behavior choices and preventing future ones.
Certified Peer Specialists: Bringing an Evidence-Based Practice to Prisons
There’s another reason that infractions are down in the Pennsylvania system. Long considered an evidence-based practice in the mental health field, Pennsylvania is a pioneer in employing certified peer specialists throughout the state prison system. Over 500 certified peer specialists – people who are incarcerated and who themselves have a mental illness – have been trained to help others who are coping with the symptoms of mental illness. Lynn explains that these specialists receive a 75-hour training program to prepare them for one of the highest-paid jobs in the prison system. Candidates must be role model inmates with record free of conduct issues for a given period. Their impact, Lynn says, has been “phenomenal.” The peers visit people with mental illness on suicide watch, in the infirmary, on mental health units, or in the general population. They give others a chance to open up about their challenges and learn coping skills from someone who has “been there.” Most importantly, they offer hope.
Lynn has plans for taking the state’s innovative program one critical step further. Many people who are incarcerated – both men and women – have experienced trauma, and the symptoms of trauma can keep them cycling from community to prison. Lynn plans to introduce a curriculum on trauma-informed care to help peers upgrade their skills further and enable them to coach others on how to manage the troubling symptoms that often haunt people who have experienced trauma, such as child abuse. Many people who commit crimes have themselves been victims. By helping them heal, the system can also protect communities from future violence.
A Vital Link for People in Prison and Their Families
Lynn herself plays a key role in ensuring that people with mental illness leave prison better able to lead satisfying and productive lives than the day they entered. She travels to every prison in the state system and lets people know that she is there for them and can help ensure access to treatment. Her credibility is enhanced by her own experience with mental illness, and she doesn’t hesitate to share it. She participates in discussion groups, listens to needs, and follows up on the needs of individuals.
People will sometimes cry, Lynn says, because they are able to talk to someone. They see that something was created just for them. Someone will fight for them, if need be, and help them get through. They can share some of the intense challenges of coping with mental illness who “gets it.” For many, that is entirely new in their lives.
While some people with mental illness have no friends or family to support them, others have family members who worry about them. When someone is anxious about a loved one with mental illness, they can call Lynn or write a letter. She follows up, often visiting with the person and then letting the family know how they are doing. “You’re an angel!” said a thankful mother recently. “My son said he had a great visit. Now I know he’s okay.”
Addressing Mental Illness Benefits Individuals, Communities, Families – and Prisons
The impact of the changes Pennsylvania is making are still being measured. Already, the kind of incidents that often result in extended solitary confinement are declining. As the correctional system improves its ability to identify and help individuals struggling to live with mental illness, both individuals and the prison system will be safer. And because people with mental illness are no longer forced to endure prolonged confinement – which has been shown to exacerbate the symptoms of mental illness – they will leave prison better prepared to rejoin their communities, and recidivism is expected to go down. However significant the savings in financial terms, however, restoring the hope of a fulfilling life is beyond price.
Thank you, Pennsylvania, for being a pathfinder in safe alternatives to solitary confinement for persons with mental illness!
 U.S. Department of Justice. Justice Department Finds Pennsylvania State Prison’s Use of Solitary Confinement Violates Rights of Prisoners Under the Constitution and Americans with Disabilities Act (May 31, 2013). See: http://www.justice.gov/opa/pr/justice-department-finds-pennsylvania-state-prison-s-use-solitary-confinement-violates-rights
Editor’s Note: This is a bill that will be submitted to the Maryland Legislature within in the next two weeks. It is a draft of the bill. The final draft may differ in some small ways from what is below.
Corrections – Restrictive Housing Tracking
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, That:
In this section the following words have the meanings indicated
(1) “Correctional facility” means a facility operated by or under contract with the Maryland Department of Public Safety and Correctional Services;
(2) “Prisoner” means someone confined to a facility operated by or under contract with the Maryland Department of Public Safety and Correctional Services.
(3) “Restrictive Housing” means is the practice of housing an individual separately from the general population of a correctional facility and imposing restrictions on their movement, behavior, and privileges.
B. The Department of Public Safety and Correctional Services shall annually submit to the Governor’s office of Crime Control and Prevention and post publicly on its website a report documenting the use of restrictive housing in its facilities, disaggregated by facility. The report shall include:
(1) The total facility population;
(2) The number of individuals held in restrictive housing, by age, race, and ethnicity;
(3) The number of persons with serious mental illness held in restrictive housing;
(4) The definition of serious mental illness used by the Department of Public Safety and Correctional Services;
(5) The number of prisoners known to be pregnant who were held in restrictive housing;
(6) The average and median lengths of stay in restrictive housing;
(7) The reasons for which individuals were placed in restrictive housing;
(8) The number of incidents of death, self-harm, and attempts at self-harm by individuals held in restrictive housing;
(9) The number of individuals released from restrictive housing directly to the community;
(10) Any additional information that is important to understanding the facility’s use of restrictive housing; and
(11) Any changes to the Department of Public Safety and Correctional Service’s policies regarding the use of restrictive housing.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect October 1, 2016
Safe Alternatives to Solitary Confinement: U.S. Leaders Share Progress and Insights
On September 29, 2015, the Vera Institute of Justice convened a short meeting to explore what a few states are learning about how to end over-reliance on extended solitary confinement in correctional systems. Researcher Craig Haney reminded attendees why this is essential. He noted that a robust literature on mental and physical harms of the practice shows it can lead to despair and anger, destabilization of the sense of self, and a loss of ability to relate to others. It can also amplify symptoms of mental illness. Shaka Senhor, who spent a total of 7 years in solitary confinement, vividly evoked the experience and pointed out that the damaged people subjected to it may one day be “somebody’s neighbor.” He stressed that “we have every tool available to make the right decision” and challenged policy makers to move toward change.
What does Germany Do?
To help people think “outside the box,” Jorg Jesse, the Director General of Prison and Probation Administration in Mecklenburg, Germany, described how his country sees the experience of incarceration. In Germany, the maximum period for solitary confinement is 3 months, and the warden must have the consent of a higher authority to impose this extreme punishment. Instead, the country sees the aim of incarceration as resocialization. Only 5 percent of course cases result in prison sentences (in the U.S., it is 65 percent), and correctional officers must have years of training to become effective problem solvers who can further the country’s aim of reducing recidivism. Their aim is to help people who are incarcerated prepare to live a life without crime, a life with “no more victims.” To encourage positive behavior, the system emphasizes the use of incentives as well as deterrents. Sanctions in response to inappropriate behavior might include reducing leisure or work time, reducing the money a person can make, or removing something the person values, such as a radio or TV.
U.S. Leaders are on the Move!
Some states and communities are leading positive change in the U.S. We heard from executives in Colorado, Washington, and New Mexico, as well as the Hampden County Correctional Center, that it is possible to reduce over-reliance on solitary confinement, advance the interests of public safety, and make prison settings safer.
Policy Changes in Colorado Reduce Assaults and Advance Public Safety
Rick Raemisch, Executive Director of the Colorado Department of Corrections, was appointed to his position to fulfill the vision of the previous director, who was assassinated by a person who had spent years in solitary confinement. He has gained the cooperation of staff by emphasizing the public safety mission of correctional facilities: “When you send someone back to the community in worse shape than they came in, you have failed.” People in solitary confinement in Colorado represented 7 percent of the prison population in 2011, but less than 1 percent today. Assaults on inmates and staff are the lowest since 2006, a change the Director attributes to new policies that decrease the time people spend in solitary confinement. One year is now an absolute maximum and is imposed only in extreme cases such as assault and rape. Policies also emphasize the need to identify and treat mental illness when it is the underlying cause of a behavioral problem.
Staff Involvement Helps Guide Change in Maine
The Hampden County Correctional Center describes itself on its web site as a “a model of safe, secure, orderly, lawful, humane, and productive corrections, where inmates are challenged to pick up the tools and directions to build a law-abiding life in an atmosphere free from violence.” Assistant Superintendent Richard McCarthy explained that the Massachusetts facility took the path of reform in 2008, asking staff to identify alternatives to solitary confinement. Changes emphasized positive reinforcement for people on the right track who had previously been in solitary confinement. They could earn the right to time in an exercise cell and were eligible for good time. Many “stepped down” to the general population, and the facility now has 68 percent fewer people in segregation. There has been no increase in violence, and the changed climate of the facility has benefitted both staff and the people held there.
Cognitive-Behavioral Programs Work in Washington
Bernie Warner, Secretary of the Washington Department of Corrections, said the state is working to move to an evidence-based approach to corrections and has launched promising initiatives to end long-term segregation. The state began with a study of who was in segregation and why, learning that people with mental health issues and gang members were overrepresented. Washington is seeking to create programs that seek to help people in these populations change their behavior. Cognitive-behavioral programs seek to change the thinking and behavior of gang members, and an Intensive Transition Program to help people prepare to return to their communities has had an 80 percent success rate. Like Hampden County, Washington engaged corrections staff in creating its promising programs. The state also trained them to communicate more effectively with people experiencing serious mental illness. The Secretary noted that as the more costly units that rely on solitary confinement are closed (three times as many staff are needed to run these restrictive facilities), resources are freed to support more effective alternatives.
New Mexico Offers Gang Members a Way Out
Gregg Marcantel, the Secretary of the New Mexico Corrections Department, reported that the state “stole” Washington’s innovative approach to “managing offender change” and ran with it. They distinguished between predators in gangs and people who were simply gang members and might want out. The state created a special management unit for people who wanted to leave gangs and created a step-down program leading to transition and release. He noted that people tend to “fall or rise to expectations,” and creating an expectation of change has helped people change their behavior – and with those changes, altered the state’s reliance on solitary confinement.
Everyone Can Play a Role!
IAHR - along with more than 20 other organizations - seeks greater transparency about the use of solitary confinement as a first step to reducing its use. Why focus on this when there are so many other areas of reform? There are two reasons: estimates from other states tell us that solitary confinement costs three times as much as managing the general population in prison. Vast research tells us that the use of prolonged solitary confinement is destabilizing to the personality and that the effects can also be long term. It is a human rights issue as well as a cost savings issue.
- From 2012 to 2015 the use of solitary confinement grew to more than 9% of the Maryland prison population - more than double the national average.
- In Maryland people can be put into solitary for minor infractions
- The average length of stay is 130 days in solitary.
- The average length of stay for someone who is mentally ill is 228 days.
The UN Rapporteur on Torture, Juan Mendez (Professor of Law at American University in Washington, DC), states that more than 15 consecutive days in solitary can be tantamount to torture.
95% of those who are in prison will be released to the community. How they are treated in prison is an important component in their ability to re-enter society successfully.
IAHR will introduce legislation this year to track the use of solitary - called segregation in Maryland. With a new Secretary of Corrections, it is our hope that he will initiate change. What we have found is that Corrections will respond to the legislature, if not to the public. For that reason we need legislation that requires reporting and transparency as the Department tracks its reform efforts in the use of solitary confinement.
As an end game, we seek the re-allocation of funds saved from reducing solitary to train staff to deal with the mentally ill (estimates range from 15 - 30 %) and to treat addiction, provide education and meaningful job training.
There are alternatives to solitary that protect public safety, reduce prison violence and save money.