10.11.19

Christopher Kearns two essays

Christopher Kearns
 Two Essays on Prison Conditions and some reports on KMCI

Christopher Kearns 656571;
KMCI, PO Box 282; Plymouth, WI53073
Born in 1964,  54 y.o.

 Parents, Don't  Try This at Home

(It will result in a cage of your own.)

As if merely relieving someone of "certain unalienable Rights," namely, ". . . Life, Liberty, and Pursuit of Happiness" (family, friends, career, life savings, etc., etc.) isn't enough to cause severe psychological damage, the state can always rely on the cruel and unusual use of solitary  confinement to achieve their mission of total control.
Much of the civilized world has begun a conscious effort to curb the use of administrative segregation in their prison systems, except in extreme circumstances; yet, Wisconsin seems to find the draconian use of solitary confinement as the go to response to punish nearly any improper  behavior. You may notice that I have used the term "improper" as opposed to "violent," because administration liberally chooses segregation over many other punitive options, such as loss of certain privileges. "In many jails and prisons, incarcerated people are tossed into a dank, dungeon-like solitary confinement cell when they are determined to have 'misbehaved.' It's dubbed 'the Hole." (Schenwar, p. 3) Offenders are frequently sent to "the Hole" for a variety of reasons, including possession of contraband, disrespect, or failure to adhere to a direct order—sometimes simply for mental health issues that facility staff seems ill equipped to handle Many of these violations of the rules are not violent or threatening. In his book, Unethical, former Wisconsin Corrections Secretary, Ed Wall, points out, "'Segregation'  was one of the tools frequently used . . . . I found this tool had a propensity to be overused." (Wall, p. 108) Additionally, he questioned the effectiveness of such reprisals, stating, ". . . that in many cases we were actually making already dangerous people exponentially more dangerous." (Wall, p. 108) Wall's opinions are not just sour grapes from a disgruntled employee. Many qualified psychologists, psychiatrists, and sociologists, as well as current and former Corrections officials disagree with the use of this outdated form of retribution. In an editorial written by Yale Medical School Assistant Professor, Dr. Reena Kapoor, expounds on the "potential harms of solitary confinement," (Kapoor, p. 2) especially when concerning those suffering from mental illness. The adverse effects of such extreme punishment have been chronicled for years. "By the 1830s, evidence began to accumulate the extended solitude was leading to emotional disintegration.” and, "In 1890 the U S Supreme Court weighed m, deploring solitary confinement for the 'semi-fatuous condition' in which it left prisoners" (Kluger) University of Wisconsin, Madison, professor of history, Alfred W McCoy, explains in his 2006 book, A Question of Torture, "It sends prisoners in one of two directions: catatonia or rage." (Kiuger) In his 2018 exposé of the private prison industry, American Prison, Mother Jones author Shane Bauer recalls, "The four months I'd spent in solitary confinement in Iran was an eternity I will never erase from my psyche . . . ." (Bauer, p. 5) Is Wisconsin no better than Iran? Does this primeval form of retribution, really, help anyone? "The cells look like tombs; men lie in their bunks, wrapped in blankets, staring at the walls." (Bauer, pp. 62-63) Are there no other ways to achieve our goals of prisoner rehabilitation? (If, in fact, rehabilitation is a goal)—Is segregation the only answer? Many professionals think not. Again referencing Dr. Kapoor' s article, many states have, ". significantly reduced the use of solitary confinement, while saving money and experiencing no increase in rates of violence." (Kapoor, pp. 2-3) Professor Emeritus at Columbia University's Montefiore Medical Center/Albert Einstein College of Medicine, as well as, Senior Research Associate and Scholar in Residence at John Jay College of Criminal Justice of The City University of New York, Dr. -Ernest Drucker pointsout in 2011 A Plague of Prisons, “clearly the practice of locking away tens of thousands of prisoners in solitary confinement for long stretches of time has a profoundly deleterious effect on the long-term mental health of these inmates." (Drucker, p. 129)
 Don't even get me started on the belittlement and humiliation of those on suicide watch! Prisons should rehabilitate. Prisons should encourage people to behave better, not behave worse. "Aren't prisons supposed to be for correction?" (Dreisinger, p. 282)
How about it, Governor Evers? It's time to keep those campaign promises and get rid of administrative segregation, institute pragmatic alternatives to incarceration (community service & restorative justice), reduce the prison population (in half), and save the taxpayers millions of dollars by closing costly, outdated and no longer necessary facilities.
.. Bauer, Shane. American Prison, Penguin Books, 2018. --
. Dreisinger, Baz. Incarceration Nations. Other Press, New York. 2016
• Drucker, Ernest. A Plague of Prisons: The Epidemiology of Mass Incarceration in America. The New Press, New York, 2011.
• Kapoor, Reena, MD. "Taking the Solitary Confinement Debate Out of Isolation." The
Journal of the American Academy of Psychiatry and the Law, 42: 2-6. 2014
• Kiuger, Jeffrey. "Are Prisons Driving Prisoners Mad?" Time, January 26, 2007.
• Schenwar, Maya. Locked Down, Locked Out: Why Prison Doesn't Work—and How We Can Do Better. San Francisco: Berritt-Koehler Publishers, Inc., 2014.





Reform Prison Now!
Of course, there is a necessity for prisons. There are violent, wicked people in our world. I accept that fact. I do take issue with the bureaucracy that is the Prison Industrial Complex and the sugar-coating of the system by referring to, it as "corrections" as opposed to the more appropriate phrase of "human warehousing." There appears to be little "correcting" taking place. Moreover, rehabilitation and reformation are two words that are conspicuously absent from DOC lexicon. In fact, the system nowadays seems more akin to an extended period at camp - with Jerry Springer on TV!
Mass-incarceration-plagues today's criminal justice system.-Politicians like to spout their fear-mongering, "tough-on-crime" rhetoric to an already, paranoid public, thus, leading to over two-million Americans presently behind bars Repeatedly, studies have demonstrated that the harsh laws and long prison sentences, enacted by these legislators to "keep communities safe," are of little deterrent when it comes to reducing crime, nor do they provide much in the manner of safety or security at a community level. However, these laws may help those associated with these retributive regulations garner votes in the next election or to profit financially from their investments in the P.I.C. (e.g., stock in private prisons, prison vendors, etc. - more on this later). Contrary to tenuous political opinions, crime rates do not decrease in any significant degree due to the widespread use of prison as punishment. Therefore, the repeal of the following three major contributors to mass incarceration is immediately necessary: (1) discriminatory mandatory minimum sentences (which, virtually, eliminate judicial discretion in favor of the self-aggrandizement of power-hungry prosecutors and lawmakers); (2) "three-strikes" ("and you're out" - for life!) laws; and (3) truth-in-sentencing laws (essentially eradicating parole and early release programs - as well as any incentives for proper behavior) These punitive practices could easily be augmented or replaced by the more humane, practical, and beneficial approaches of restorative justice and/or community service. These types of programs have been shown to create a win-win-win situation for the offender, the victim, and the community; all at a fraction of the cost of imprisonment.
Another topic of major concern is that of mental health. The prison system's current lack of adequate resources available to treat mental health deficiencies should alarm us all. Due to the, all too common, DOC catchwords "over-crowding", and "under-staffing" (and, no doubt, "under-funding" and "under-prepared," as well), many of those within the criminal justice system in need of serious mental healthcare go largely untreated. DOC statistics affirm this fact. Presently, the use of addictive, psychotropic medications and administrative segregation are the primary, go-to responses as treatment for those most vulnerable. These methods of pacification are merely a short-term fix and do not affect any quality, long-term solutions. Modern psychological techniques, including face-to-face psychotherapy and/or group counseling, in combination with medication, are almost non-existent inside the facility fences. Not only does the criminal justice system's unhindered use of incarceration as a form of punishment exacerbate - while practically ignoring - preexisting mental health conditions, the retributive atmosphere has been known to result in additional adverse effects, such as PTSD, depression, and anxiety, to name a few. Most of these afflicted offenders will, one day, be released back into society and now would be an opportune time to address the root causes of their illicit behavior. Then again, at that point in time, they will no longer be the DOC's problem.
Another immediate concern, one of personal interest to all of those imprisoned, is the wanton, deliberate, and costly fleecing of inmates by way of DOC approved vendors. Perhaps, considered by some to be unnecessary luxuries, the DOC does offer select items - such as personal underwear and shoes, a limited number of electronics and books, and other, various sundries - for purchase through certain catalog retailers. There are also foodstuffs for sale through a contracted "canteen" distributor. That is all fine and good, except for the fact these products are often sold at the manufacturer's suggested retail price, even though inmate wages hover around 25cents per hour. Adjusting for the current $7.25 per hour minimum wage - at my current 5 cents per hour income - my puny, 13" television, at a cost of $180 (sans remote control and connecting cables) would cost nearly $26,000 in the real world. That's one expensive TV!  How about a $340 jar of peanut butter or $50 for one package of ramen noodles - what a bargain. The telephone service provider (ICSolutions) charges my family and friends anywhere between 6cents and 12cents per minute for a collect call to stay in touch. Apparently, "unlimited plans" have yet to be discovered by the DOC. The truth of the matter, so I've been told, is that the DOC receives. "kickbacks" from these various vendors, so it is in their best interest to contract with those whose return is the highest. What those who profit from this boodle do with this free money is anybody's guess. This complaint may sound trivial compared to the more humorless aspects of prison life; yet, it is simply another questionable characteristic adding to the high psychological and financial costs of this unfair, unjust, unacceptable experiment in social control.
       Both the federal and state (Wisconsin) prison systems are complex enigmas claiming "security" as an excuse for their lack of transparency, oversight, and accountability. The fact is, if taxpayers were actually aware of the utter ineffectiveness of their hard-earned tax-dollars at work ($1.2+ billion per year, in Wisconsin alone!), along with the total lack of return on their investment - as highlighted by the extraordinary rates of recidivism —heads would surely roll! It is abundantly clear that our current prison system is in serious need of a complete overhaul.
 Until a thorough and independent audit is implemented, alternatives to incarceration investigated, and meaningful reforms instituted, the unfortunate, expensive, and ineffectual conditions will continue as the status quo. Prisons merely treat the symptoms, not the disease.
The current state of mass incarceration in America is a sorry condition everyone ought to be embarrassed to showcase on the global stage. The manner and rate in which we imprison our citizens is way out of line with the rest of the rest of the Western World. The  rest of the world can see that- why can’t we?


https://casesprison.files.wordpress.com/2019/11/christopher-kearns-intro-essays-10-19.pdf
https://casesprison.files.wordpress.com/2019/11/christopher-kearns-report-10-3-19.pdf
 



3.2.12

Disability Rights Suit NY

April 25, 2007
New Rules for Confining the Mentally Ill
By SARAH KERSHAW
New York State would more closely scrutinize its use of solitary confinement for mentally ill prison inmates under the proposed terms of a legal agreement scheduled for review by a federal judge on Friday.
New York is one of several states that have faced lawsuits over the means used to punish mentally ill prisoners, and, under a settlement reached last week, it has agreed to consider changes in how it uses solitary confinement as a disciplinary measure with the mentally ill.
Many advocates hail the agreement as a watershed in prison reform because of the effects long sentences in isolation have had on the most vulnerable prisoners, including suicide and self-mutilation.
Some mentally ill inmates serve months to years in punitive segregation, locked up for 23 hours a day and sometimes restricted to a diet of cabbage and a pasty flour loaf three times daily for up to 30 days for misbehaving.
Disability Advocates Inc. and the Legal Aid Society of New York sued the state over the practices five years ago, and the resulting agreement goes before Judge Gerard E. Lynch of the Southern District of New York on Friday for final review.
If the agreement is approved, as expected, the state will not be barred from the use of solitary confinement, or punitive segregation, to discipline mentally ill prisoners, but it would have to provide far more assessment and services for mentally ill inmates in solitary. In addition, the state would be required to review the reasons for and the length of proposed segregation sentences.
Many mental health advocates believe that the New York settlement will create pressure on other states to review their policies of confining mentally ill prisoners.
Others, including state lawmakers and advocates, said the agreement was only a small step toward stopping inhumane treatment of these prisoners. Many of those advocates were particularly disheartened last fall when Gov. George E. Pataki vetoed a bill that would have banned the use of solitary confinement for the mentally ill in New York.
“We see the settlement as a step in the right direction because it provides additional resources and services for treating the mentally ill in prison,” said Robert Gangi, executive director of the Correctional Association of New York, an advocacy group that is now lobbying the new administration in Albany to stop sending mentally ill prisoners into isolation. “But it falls far short of the policy changes that are needed to ensure humane and appropriate treatment for all the mentally ill people in prison.”
In New York, with one of the largest prison populations in the country, mental illness has been diagnosed in about 8,400 of the 63,000 inmates, according to the State Office of Mental Health. The number of inmates has decreased significantly in the last few years, but Mr. Gangi said the number of mentally ill prisoners was rising, possibly because the condition is being more accurately diagnosed.
Under the agreement, mentally ill prisoners sent to solitary confinement would be entitled to leave their cells for therapy and treatment for two to four hours daily. Their placement in solitary confinement would have to be preceded by extensive reviews, all prisoners entering the system would be screened for mental illness, and the state would be required to provide some mentally ill prisoners with alternative residential housing.
State officials said that because of both the agreement and their own budgetary priorities, they had set aside an additional $9 million in the 2007-8 fiscal year for programs within existing prisons and new or renovated facilities to accommodate mentally ill inmates, a total of $57.5 million dedicated to mentally ill inmates.
The agreement also stipulates that New York prisons, which local and national advocates say are unique in using restricted diets to punish prisoners already in segregation, cannot use the cabbage-and-loaf punishment for more than seven days with mentally ill prisoners without “exceptional circumstances.”
Lawyers who brought the suit and national prisoner rights advocates said the New York settlement was unique in covering all mentally ill prisoners, from the time they enter the system until they leave, whereas some states have merely stopped sending prisoners with major mental illnesses to prisons with especially harsh conditions.
“The proof of the pudding is in the eating,” said David C. Fathi, senior staff counsel with the American Civil Liberties Union’s national prison project, who has handled several cases around the country regarding the treatment of mentally ill inmates. “We will have to see how this is implemented. But on paper, it is very significant, a victory and a step forward.”
He added, “Now we can point to New York and say, if New York can do it, why can’t you do it?”

Disability Rights Suit MA

3 articles on ongoing lawsuit to get mentally ill prisoners out of seg. Latest first

1)11-10-9
Treatment units for mentally ill inmates on hold
State cites budget crunch as talks to end suit fail

By Jonathan Saltzman, Globe Staff | November 10, 2009
The Patrick administration has shelved plans to build special treatment units for hundreds of seriously mentally ill inmates, two years after advocates for prisoners alleged in a federal lawsuit that the state’s practice of keeping such inmates in solitary confinement 23 hours a day was inhumane and causing suicides.
Citing the state budget crisis, lawyers for top state prison officials said negotiations to settle the civil rights suit by the Disability Law Center against the Department of Correction out of court have ended. The center has asked a federal judge in Boston to schedule a trial for January 2011, while the state wants it to start a year later.
The collapse of negotiations, made public in court filings Friday, marks a startling reversal from where things stood a year ago. Last November, Harold W. Clarke, the correction commissioner appointed by Governor Deval Patrick, and Leslie Walker, executive director of Massachusetts Correctional Legal Services, said they expected the suit would be resolved shortly with the announcement of plans to build maximum-security residential treatment units.
Inmates would be exposed to more types of therapy in such units, and advocates want the prisoners to have more time out of their cells.
“We’re hoping to be able to say, ‘We don’t have to go to court, we can avoid litigation,’ which I’m certain will serve all parties best,’’ Clarke said in a Globe report Nov. 16.
On Friday, however, lawyers for the prison system filed a document in US District Court that said, “Due to the fiscal crisis, the parties have discontinued formal settlement negotiations.’’ The state’s lawyers did not elaborate on the financial constraints.
The nonprofit Disability Law Center sued the state in March 2007, alleging that hundreds of mentally ill prisoners were kept in closet-size solitary confinement cells in response to unruly behavior. The conditions had led to self-mutilation, the swallowing of razor blades, and numerous suicides, said the center.
The suit, which resembled legal challenges that led to changes in other states, said Massachusetts ignored repeated calls from its mental health providers and consultants to provide high-security treatment units for violent, mentally disturbed inmates.
A Globe Spotlight Team series in December 2007 reported 15 suicides in the prisons from 2005 through 2007, most by those in solitary confinement with histories of mental illness or drug addiction. There had also been more than 3,200 suicide attempts and self-inflicted injuries in the prior decade, the Globe found.
Walker, of Massachusetts Correctional Legal Services, which helps represent the Disability Law Center in the suit, said yesterday that she was “deeply disappointed that we’re not going to be able to resolve this case short of trial.’’ She said she could not comment further because settlement talks were confidential.
In a brief statement, Diane Wiffin, a spokeswoman for the prison system, said correction officials plan to “continue providing appropriate levels of service to segregation inmates with serious mental illness.’’ She declined to elaborate, citing the litigation.
There is nothing appropriate about the segregation of inmates with mental illness, according to Laurie Martinelli, executive director of the National Alliance on Mental Illness of Massachusetts, an advocacy group that supports the lawsuit.
She said keeping such prisoners in their cells 23 hours a day violates the constitutional prohibition against cruel and unusual punishment and that the state’s fiscal crisis was irrelevant.
“You can’t get around a constitutional violation by saying, ‘We don’t have money,’ ’’ she said.
Fred Cohen, a retired criminal justice professor at the State University of New York at Albany and an expert on the treatment of the mentally ill in prisons, agreed, saying no federal court has ruled that finances trump an inmate’s constitutional rights. If the case goes to trial, however, plaintiffs would have to prove that the isolation of inmates violates their civil rights. In some states, Cohen said, politicians were glad for judges to order them to improve conditions for inmates; that way, judges, rather than the politicians, had to take the heat from the public for spending scarce tax dollars on convicted criminals.
“It’s not unheard of, and it’s especially popular during times of economic duress,’’ he said.
Several states, including Connecticut, New Mexico, Ohio, Texas, and Wisconsin have faced lawsuits in recent years that have been resolved by settlements or court orders requiring improvements in the treatment of mentally ill prisoners.
Kevin M. Burke, Patrick’s public safety secretary, was quoted as saying in 2007 that it would cost “several million’’ dollars to fully fund high-security treatment units. A spokesman for Burke, whose office oversees the prison system, said yesterday that the secretary would not comment on the litigation. Patrick also declined to comment through a spokeswoman.
Prisoner rights groups as well as specialists on the treatment of inmates have repeatedly criticized the Massachusetts prison system for failing to address the needs of inmates with mental illnesses.
An independent study of the state prison system released in February 2007 found that the number of mentally ill inmates increased by nearly 1,000 between 2000 and 2005 but that the state was not responding adequately to the challenges they presented. There are about 11,000 inmates in the state system.
Lindsay M. Hayes, a national specialist in prison suicide prevention who wrote the report, said suicidal inmates were being punished instead of being helped. The study, commissioned by the department after an increase in prisoner suicides in 2005 and 2006 left the state’s rate nearly double the national rate over the prior decade, made 29 recommendations. They ranged from improving the suicide-prevention training of correction officers to increasing the frequency of observation of at-risk inmates.
Although prison officials immediately said they embraced all of the recommendations, the department never endorsed a blanket ban on the segregation of mentally ill inmates. Inmates in segregation are typically allowed out of their cells for an hour only to shower or to get exercise in a small caged space.
In April 2008, the state prison system took a modest step to improve treatment of mentally ill inmates when it opened a unit for such prisoners at Souza Baranowski Correctional Center, a maximum-security prison in Shirley. The unit is called the Secure Treatment Program and it houses 14 prisoners, Wiffin said.



2) 8/12/12 Judge orders prison suicide records
Advocacy group sues over care of inmates
By Jonathan Saltzman, Globe Staff | August 12, 2010
A federal judge in Boston ordered a former contractor for the state prison system yesterday to provide him with the psychiatric treatment records of about 25 inmates who committed or attempted suicide while in solitary confinement from 2005 to 2007.
US Chief District Court Judge Mark L. Wolf gave the University of Massachusetts Correctional Health Program until Aug. 27 to turn over thousands of pages of mental health reviews written by therapists after the suicides and attempts. He wants to determine whether he can legally turn them over to a nonprofit advocacy group that has sued the state over the care of mentally ill inmates.
UMass Correctional Health, which is not a defendant in the suit and is a program of the University of Massachusetts Medical School, contends that federal law requires the records to remain confidential under a privilege between psychotherapists and patients. The only way the privilege can be waived, UMass said yesterday, is if the inmates, or their representatives, give permission to release them.
But lawyers for the Disability Law Center said the records are crucial to their case. The center filed a civil rights suit against the prison system in 2007 alleging that hundreds of mentally ill inmates are held in cells 23 hours a day in inhumane conditions.
“We’re seeking documents that analyze what happened,’’ Carol E. Head, a lawyer for the Disability Law Center, told Wolf during a two-hour hearing. The records, she said, might indicate whether inmates were improperly diagnosed or harmed themselves because of conditions in solitary confinement.
James A. Bello, a lawyer for UMass, called the plaintiffs’ request for the records a “fishing expedition’’ and said inmates might have committed suicide for reasons that had nothing to do with conditions in prison.
But Wolf countered that the records were relevant even if the plaintiffs have no idea what they say. It was possible, he said, the documents might contain damaging evidence, such as a comment by a mental health clinician that “if we don’t change the way we deal with prisoners in segregation with serious mental health needs, I predict the number of suicides will soar.’’
Lawyers for the Department of Correction have taken no position on the request for records and were mostly silent at the hearing.
Suicides in the state prison system have been a focus of concern for years.
In February 2007, following seven suicides the previous year, a nationally renowned suicide prevention specialist hired by the state issued a 63-page report that found serious shortcomings in the state’s handling of inmates at risk for suicide. The state immediately pledged to comply with all 29 recommendations in the report.
A Globe Spotlight Team series in December 2007 revealed deepening mental illness and misery behind the walls of the state’s prisons and identified numerous problems, including bungled background screenings of suicidal inmates, missing mental health records, and skipped security rounds by correction officers.
Although suicides fell after the state promised to comply with the 29 recommendations, they surged again this year. Eight inmates killed themselves in the first seven months of the year, a suicide rate more than four times the national average. In response, the Patrick administration announced it would rehire the suicide prevention specialist.
Few of the suicides this year occurred in solitary confinement, according to James Pingeon, director of litigation for Prisoners’ Legal Services and a member of the Disability Law Center’s legal team. But some of the inmates who killed themselves had spent considerable time in solitary confinement, including one with a history of mental illness who was mentioned in the center’s lawsuit.
The suit, which alleges that solitary confinement has caused inmates to mutilate themselves, swallow razor blades, and commit suicide, demands that the state build maximum-security residential treatment units. In late 2008, the Patrick administration signaled that it would build such units in the hopes of settling the suit out of court. But the administration shelved the plans a year later, saying the state’s finances made that impossible.
Wolf said yesterday that the state and Disability Law Center have tried to settle the dispute, and he hoped they could continue to talk, given the “high human stakes here.’’
He ordered UMass to provide complete mental health records pertaining to the 25 inmates as well as records redacting the information that the vendor says is privileged, so he can compare them.
UMass no longer provides mental health services at the state prisons, although it does provide inmates with medical services. State officials replaced UMass with another vendor for mental health services, Virginia-based MHM Services Inc.



2)March 2007March 9, 2007
Mentally Ill Inmates at Risk in Isolation, Lawsuit Says
By PAM BELLUCK




BOSTON, March 8 2007— Placed in solitary confinement in a Massachusetts prison, Mark Cunningham tried to kill himself last year, advocates for inmates say.

Mr. Cunningham cut his legs and arms. He tried to hang himself with a tube from a breathing machine he used for sleep apnea. He smashed the machine to get a sharp fragment to slice his neck and ate pieces of it, hoping to cause internal bleeding. Five weeks ago, after being placed in solitary confinement again, Mr. Cunningham, 37, hanged himself.
With that, Mr. Cunningham, who lawyers said had a long history of mental illness, including depression, became the 13th inmate to commit suicide in Massachusetts since November 2004.
Mr. Cunningham’s case is one of 18 suicides and suicide attempts by inmates in solitary confinement described in a federal lawsuit filed Thursday by advocates for inmates and the mentally ill. They are seeking to prevent Massachusetts from placing mentally ill inmates in such segregated cells.
“We aren’t saying these folks should go free; we aren’t saying they shouldn’t be under high security conditions,” said Stanley J. Eichner, executive director of the Disability Law Center. But Mr. Eichner said putting prisoners in solitary conditions and denying them adequate mental health services was “literally the fatal flaw in the system.”
“How many more men will have to die,” he asked, “how many more men will be driven to harm themselves before this problem is fixed?”
The lawsuit reflects an increasing concern nationally as the number of mentally ill inmates rises, experts on inmates and mental illness say.
Several states, including Connecticut, New Mexico, Ohio, Texas and Wisconsin, have faced lawsuits that have recently been resolved by settlements or court orders requiring improvements in the treatment of mentally ill prisoners. Those changes include more frequent monitoring, better training of corrections officers and removal of fixtures that could be used for hangings.
In January, Indiana agreed to stop putting some mentally ill inmates in isolation cells. While not all agreements in other states have resulted in excluding mentally ill prisoners from isolation, many have called for better screening or monitoring of isolated inmates.
In California, after a record number of prison suicides — 44 — in 2005, a special master appointed by a federal judge reported that inmates “in overcrowded and understaffed administration segregation units are killing themselves in unprecedented numbers.” The judge, Lawrence Karlton, ordered the administration of Gov. Arnold Schwarzenegger to spend more than $600 million to improve mental health services.
In New York, the Legislature passed a law last year to remove mentally ill inmates from solitary cells, but Gov. George E. Pataki vetoed it. A 2002 suit seeking to end the practice is close to a settlement, said Nina Loewenstein, a lawyer for Disability Advocates, which filed it.
“That’s what states around the country are struggling with — when they have inmates that are very violent and out of control and need to be segregated from other inmates, but they are also mentally ill,” said Lindsay M. Hayes, a national expert in prison suicide prevention who was hired last year by the Massachusetts Department of Correction to study why the suicide rate was so high.
A segregated inmate is typically locked up for 23 hours a day, allowed out only to shower or get outdoor exercise in a small caged space.
In a report Mr. Hayes issued last month, he found that of 10 prisoners who killed themselves in 2005 and 2006, 5 had recently been on suicide watches and 9 committed suicide in solitary or segregated conditions. A prisoner who tried to kill himself was left brain dead.
“Confining a suicidal inmate to their cell for 24 hours a day only enhances isolation and is antitherapeutic,” Mr. Hayes wrote.
When the report was released, the State Department of Corrections said it would adopt all 29 of Mr. Hayes’s recommendations, which included better assessment, supervision and monitoring of inmates, and better officer training, a recommendation Mr. Hayes also made in a 2000 report. He did not specifically recommend excluding mentally inmates from segregation units, saying it was not his area of expertise.
The Department of Corrections declined to comment on the suit or its position on segregated cells.
But in a statement, the department said: “We are well aware of the national trend of the increasing number of prisoners with mental illness” and added that it was “committed to the full implementation of the Hayes recommendations and improvement of prison mental health care.”
The statement said the department had already taken several steps, including briefing senior staff, revising the training curriculum and evaluating cells for design improvements. It said it also was soliciting bids for a residential treatment facility for mentally ill inmates.
Leslie Walker, executive director of Massachusetts Correctional Legal Services, said that advocates had been pressing for change for 17 years and that she was not confident the state would do enough on its own.
Frances Armstrong, whose nephew, Andrew Armstrong, 22, killed himself in a segregation unit in 2005, said in an interview that Mr. Armstrong had been put in isolation several times for cutting himself.
“Even in the Bible it says man is not meant to be alone,” Ms. Armstrong said. “He just lost his will to live. He thought if this is going to be the way it’s going to be, I better check out now.”
Correction: March 12, 2007
An article on Friday about a lawsuit filed in Massachusetts by advocates for inmates and the mentally ill misstated the number of prison suicides in 2005 in California, which has been ordered to spend $600 million to improve mental health services in prisons. There were 36, not 44.

Grassian:effects of solitary

Am J Psychiatry 140:11, November 1983
Psychopathological Effects of Solitary Confinement
Stuart Grassian, M.D.
Psychopathological reactions to solitary confinement were extensively described by nineteenth-century German clinicians. In the United States there have been several legal challenges to the use of solitary confinement, based on allegations that it may have serious psychiatric consequences. The recent medical literature on this subject has been scarce. The author describes psychiatric symptoms that appeared in 14 inmates exposed to periods of increased social isolation and sensory restriction in solitary confinement and asserts that these symptoms form a major, clinically distinguishable psychiatric syndrome. (Am J Psychiatry 140:1450-1454, 1983)

There have been several legal challenges to the use of solitary confinement in the United States penal system based on allegations that such confinement can cause serious psychopathological reactions (1—3). The present article describes clinical observations of 14 prisoner plaintiffs in a lawsuit alleging that the condi¬tions they were exposed to in solitary confinement were violations of Eighth Amendment protection against "cruel and unusual punishment."
REVIEW OF THE LITERATURE
. Despite the obvious legal and humanitarian impor¬tance of this issue, there has been a scarcity of recent medical literature on the subject beyond a flurry of theoretical interest generated by concerns about "brainwashing" of American prisoners of war in Korea and the experimentation on profound sensory deprivation precipitated by those concerns (4—8). In the recent literature, reports of clinical observations of prisoners in solitary confinement have been virtually nonexistent. However, with the exception of the only experimental study in the literature (9), these reports (10—12) have indicated psychopathological effects. One report noted "restlessness, yelling, banging and assaultiveness" in some prisoners and in others "a kind of regressed, dissociated, withdrawn hypnoid state" (10). Another report cited two cases of reactive psychosis marked by initial agitation and behavioral dyscontrol, leading to a hallucinatory, incoherent, confusional state (11).
There was, however, extensive interest in the problem of psychopathological syndromes among prisoners in late nineteenth- and.early twentieth-century Europe. During that period, solitary confinement was extensively used in both Europe (13) and the United States (14); in many prisons it was the exclusive mode of incarceration. Indeed, the American penitentiary be¬came world famous; important visitors journeyed to the United States specifically to observe this system and bring it back to Europe for emulation. Perhaps the best known of these visits, that of Alexis de Tocque-ville, gave rise to a classic study of American social institutions (15).
This enchantment with solitary confinement was relatively short-lived, however. As early as the 1830s statistical evidence began to indicate an increased incidence of physical morbidity and mortality, as well as of insanity, among prisoners exposed to especially rigid forms of solitary confinement (14, p. 87). The system's openness to public scrutiny brought forth vivid descriptions of the effects of such confinement. Charles Darwin, for example, observed inmates "dead to everything but torturing anxieties and horrible despair. . .. The first man . . . answered . . . with a strange kind of pause . . . [he] fell into a strange stare as if he had forgotten something. . . . [Of another] Why does he stare at his hands and pick the flesh open, . . . and raise his eyes for an instant ... to those bare walls? (8, p. 66). By 1890, the United States Supreme Court entered an opinion explicitly condemning solitary confinement on psychiatric grounds, indicating that "a considerable number of prisoners . . . fell into a semi-fatuous condition . . . and others became violently insane" (1).
In the United States, unfortunately, these experiences did not give rise to a body of clinical literature. However, in Germany, whose penal system had emulated the American model, major clinical concern developed about the incidence of psychotic disturbances among prisoners. Between 1854 and 1909, 37 articles on this subject appeared in German journals,collectively describing hundreds of cases of psychoses that were deemed to be reactive to the conditions of imprisonment. A review of this literature appeared in 1912 (13) and will be. Only summarized here.
The literature described'a hallucinatory, paranoid, confusional psychosis in which characteristic symptoms included 1) extremely vivid -hallucinations in multiple sensory modalities, including the visual, auditory, tactile, and olfactory; 2) dissociative features, including sudden recovery "as from a dream," with subsequent amnesia for the events of the psychosis; 3) agitation and "motor excitement" with aimless violence; and 4) delusions, usually described as persecutory. Onset was often described as sudden and, in some reports, as precipitating at night. In other cases, initial manifestations included "humming and buzzing, unpleasant noises and inarticulate sounds [leading to] hallucinations." Rarer, only occasionally noted symptoms included jrbereiden ("the symptom of approximate answers," usually associated with Ganser [16], although described as well by others) and hysterical conversion symptoms.
Of this large body of literature, only- Ganser's contribution (16) remains well-known, and Ganser failed to comment on the form of imprisonment to which his prisoner subjects were exposed. However, in more than half the total body of literature, solitary forms of confinement were specifically cited as responsible for precipitating the psychosis, and rapid recovery was often noted when the prisoner's solitary confinement was terminated.

CIRCUMSTANCES OF THE CLINICAL OBSERVATIONS
The present observations developed as a consequence of a court order mandating psychiatric evaluation of 15 inmates at the Massachusetts Correctional Institution at Walpole, all of whom were plaintiffs in a class action suit against the Department of Corrections that alleged violations of Eighth Amendment protection against "cruel and unusual punishment" because of the conditions to which the prisoners were exposed in solitary confinement.
The correctional institution at Walpole is the maxi¬mum security state prison for the Commonwealth of Massachusetts. It is divided into 13 cell blocks. Block 10 is reserved for solitary confinement and is divided into four tiers, each housing 15 cells approximately 1.8 m x 2.7 m in size, each cell containing an open toilet and sink, a steel bed, and a small, fixed steel table and stooh The cells in the lower tiers have double doors. The inner door is barred; the outer door is solid steel except for a small Plexiglas window. There are no other windows in the cells; each cell has one 60-watt light bulb to provide light.
While these structural features have remained con¬stant, administrative decisions have determined other features of the confinement. Until August 20, 1979, the outer steel doors were left open,' permitting natural
light and air to enter the cell and permitting inmates to speak with other inmates in adjoining cells; on August 20 the steel doors were closed on 'the cells of all inmates in isolation. At the same time, correctional officers removed personal belongings from these cells, including radios, television sets, and all reading materi¬als except a Bible.
Suit was brought not against the conditions in Block 10 generally but specifically against the conditions prevailing in the lower tiers since August 20, 1979. Of the 15 plaintiffs in the suit, 14 were interviewed, the 15th was no longer in Block 10 at the time of the interviews and was not available. All of the plaintiffs were men, and their mean age was 28 years (range, 22—38 years). Median duration of confinement in isolation was 2 months (range, 11 days to 10 months). Each prisoner was interviewed for approximately one-half hour by one of two psychiatrists, with the exception of one prisoner who, because of concern over his clinical state, was seen twice over a 3-week period. History was obtained of incarcerations, previous experience with solitary confinement, and previous and '• current psychiatric symptoms and treatment. Due to the pressure of time, we made no active attempt to cover other areas of a full clinical history, e.g., assessment of object relations, defenses, and family history.
In the interviews, conducted in an open-ended manner, careful attention was paid so that suggesting possible symptoms was avoided. The circumstances of the interviews, however, were clearly seen by the prisoners and guards as adversarial. Access to the prisoners for the interviews was obtained only through court order; all prisoners interviewed were informed of the purpose of the interviews and told that data from them might be used in court testimony. In addition, there were several guards stationed just outside the interview room, prompting several prisoners to resort to whispering as a means of avoiding being overheard.
FINDINGS
It might be expected that the adversarial circumstances of the interviews would have biased the prisoners' reports in the direction of exaggeration of whatever symptoms they might have experienced. Such was not the case. In fact, contrary to expectation, the prisoners appeared to mobilize multiple defensive operations—rationalization, avoidance, denial, distortion, and repression:—in an effort to minimize the quality of their reactions to isolation. The interviewer was required, therefore, actively to encourage disclosure of information, to provide reassurance, and persistently to confront and explore gaps in the reported accounts. Numerous interviews began with statements such as "Solitary doesn't bother me" or "Some of the guys can't take it—not me," or even with the mention of a symptom and simultaneous denial of its significance: "As soon as I got in, I started cutting my wrists. I figured it was the only way to get but of here." As the interviews progressed, these facile, superficial accounts gave way to descriptions of experiences that were troublesome. For example, one inmate was unable to describe the events of the several days surrounding his wrist slashing, nor could he describe his thoughts or feelings at the time. His overt anxiety increased mark¬edly upon questioning, and only after some time was he able to describe an apparent acute confusional state, panic, and subsequent partial amnesia for those events. Similarly, the prisoner who said he could "take it" eventually came to describe panic, fears of suffocation, and 'paranoid distortions while he had been in isolation. :
Indeed, the general pattern was for inmates initially to downplay reactions to the solitary confinement situation, then, after being carefully questioned, to become overtly anxious;and, frequently overtly reluctant to elaborate on significant details. Upon confrontation, several inmates acknowledged the reasons for their reluctance. The feared that the guards would discover their primitive fantasies of revenge or that the guards were waiting to see a weakness that they could exploit to make the inrmate "crack up." Furthermore, in several cases, the inmate's dread was that he was in fact going insane.
The specific psychiatric symptoms reported were strikingly consistent among the inmates.

Perceptual Changes
General hyperresponsivity to external stimuli:" This symptom was most commonly associated with dysesthetic responses to: certain stimuli (11 prisoners). Instances of this included "You get sensitive to noise— the plumbing system. Someone-in the tier above me pushes the button on the faucet, the water rushes through the pipes—it's too loud, gets on your nerves. I can't stand it-—I start to holler. Are they doing it on purpose?" "Everything gets exaggerated. After a while, you can't stand it. Meals—I used to eat everything they served. Now I can't stand the smells—the meat—the only thing I can stand to eat is the bread." "What really freaks me out is when a bee gets into the cell—such a small thing." "Difficult to breathe, stale, awful smell from the toilets—the stench starts to feel unbearable." All 11 inmates denied ever having experienced such symptoms except during'confinement in isolation.

Perceptual distortions, hallucinations, and derealization experiences. These symptoms were experienced by seven prisoners and are grouped together because under the peculiar circumstances of solitary confinement there were often inadequate means to distinguish them. Thus, experiences described by five of these seven prisoners included hearing voices—often in whispers, often saying frightening things to them—but usually the prisoners had no means by which to corroborate what they thought they heard; for exam¬ple, "I hear sounds—guards saying, 'They're going to cut it [his nerve-damaged leg] off/ I'm not sure. Did they say it, or is it my imagination?" If they did say it, the prisoner is suffering from derealization; if they said something else, or something not directed at him he is suffering a (paranoid) perceptual distortion; if they said nothing, he is having a hallucination. There is no independent corroboration. Another inmate described the dilemma poignantly: "I overhear the guards talk¬ing. Did they say that? Yes? No? It gets confusing. I tried to check it out with [the prisoner in the adjoining cell]; sometimes he hears something and I don't. I know one of us is crazy, but which one? Am I losing my mind?"
There were, in addition, two reports of noises taking on increasing meaning and frightening significance; for example, "I hear noises, can't identify them—starts to sound like sticks beating men. But I'm pretty sure no one is being beaten. . . . I'm not sure."
Perceptual illusions with loss of perceptual constancy were more readily identifiable in the visual sphere (three cases), and there were reports such as "The cell walls start wavering," and "Melting, everything in the cell starts moving; everything gets darker, you feel you are losing your vision."
In one of the prisoners the illusions became more complex and personalized: "They come by [for break¬fast with four trays- the first has big pancakes—1 think I'm going to get them. Then someone comes up and gives me tiny ones—they get real small, like silver dollars. I seem to see movements—real fast motions in front of me. Then seems like they're doing things behind your back—can't quite see them. Did someone just hit me? 1 dwell on it for hours." This prisoner also described overt, frightening, visual hallucinations: "There's a guard in my cell; he's holding a noose." He acknowledged having experienced perceptual distortion with psychedelic drug abuse. Otherwise, all seven inmates denied ever experiencing perceptual symptoms like those they described, except during confinement in isolation.

Affective Disturbances
Ten prisoners described massive free-floating anxiety during their incarceration in solitary, accompanied in eight cases by recurrent acute episodes of tachycardia, diaphoresis, shortness of breath, panic, tremulousness, and dread of impending death. One prisoner reported "shortness of breath a lot. My heart pumps real fast. I feel like I don't get enough oxygen. Get frantic." Another said, "I start to feel dizzy.- I can't breathe,” and another, "I start to dwell on things—too many roaches—get scared one might get into my ear. Start to feel hot—extreme heat—then I can barely breathe, start sweating, heart races, can't sit still, shaking, get a headache—real bad."
Of these 10 prisoners, three had experienced acute anxiety reactions prior to confinement in isolation, and they reported intensification of symptoms. The other seven denied any previous history of such symptoms.

Difficulties With Thinking, Concentration, and Memory '
Of the eight inmates who mentioned these symptoms, four reported acute confusional states with subsequent partial amnesia for events during the episode. There was, again, a problem with independent corroboration of these symptoms, especially important because the prisoners were only vaguely aware of what had happened to them. However, one prisoner slashed his wrists, during such a state, and thus his confusion and disorientation were noted in the prison medical record.
One prisoner's description particularly suggested dissociative features with mutism: "I went to a stand¬still psychologically once—lapse of memory. 1 didn't talk for 15 days. I couldn't hear clearly. You can't see—you're blind—block everything out—disoriented, awareness is very bad. Did someone say he's coming out of it? I think what I'm saying is true—not sure. I think I was drooling—a complete standstill."
Four others reported milder symptoms of difficulty in concentration and memory; for example, "I can't concentrate, can't read. . . . Your mind's narcotized . . . sometimes can't grasp words in my mind that I know. Get stuck, have to think of another word. Memory is going. You feel you are losing something you might not get back."
Several described attempts they made to focus their, concentration by self-discipline: "Got to try to concentrate. Remember list of the presidents. Memorize the states, capitals, five boroughs, seven continents, nine planets."

Disturbances of Thought Content
Emergence of primitive, ego-dystonic fantasies. Six prisoners reported the emergence of primitive aggressive fantasies of revenge, torture, and mutilation of the prison guards. In each case, the fantasies were described as ego-dystonic, frightening, and uncontrollable; for example, "I try to sleep 16 hours a day, block out my thoughts—muscles tense—think of torturing and killing the guards—lasts a couple of hours. I can't . stop-it. Bothers me. Have to keep control. This makes me think I'm slipping my mind. Lay in bed too much— scare yourself with thoughts in bed. I get panicky— thoughts come back—picture throwing a guard in lime—eats away at his skin, his flesh—torture him. Try to block it out, but I can't."
Ideas of reference, paranoia. Six prisoners reported ideas of reference associated with persecutory fears; e.g., "Sometimes get paranoid—think they meant something'else. Like a remark about Italians. Dwell on it for hours. Get frantic. Like when they push the buttons on the sink. Think they did it just to annoy me." The prisoner's reality testing in this instance was especially shaky: "Spaced out. Hear singing, people's voices—'Cut your wrists and go to Bridgewater and the Celtics are playing tonight.” I doubt myself—is it real? ... I suspected they're putting drugs in my cell, the reverend, the priest—even you—you're all in cahoots in the Sacred Straight program. Drive them crazy."

Problems With Impulse Control "
Five prisoners reported episodes of lack of impulse control with random violence. One prisoner said, "I snap off the handle over absolutely nothing. Have torn up mail and pictures, throw things around. Try to, control it. Know it only hurts myself." Three of these prisoners reported impulsive self-mutilation; for example, "I cut my wrists—cut myself many times when in isolation. Now, it seems crazy. But every time I did it, I wasn't thinking—lost control—cut myself without knowing what I was doing." :
Rapid Subsidence Qf Symptoms on Termination of Isolation
The legal statute in Massachusetts requires relief from isolation status with closed solid steel doors for at least 24 hours each 15 days. Certain prisoners had additional periods of relief for medical consultation and, in one case (peroneal nerve injury), hospitalization.
All prisoners interviewed reported a very rapid (usually within the first few hours) diminution of their 'symptoms during periods of relief. No correlation was apparent between severity of symptoms and the time required for them to subside.

DISCUSSION '
The observations reported here suggest that rigidly imposed solitary confinement may have substantial psychopathological effects and that these effects may form a clinically distinguishable syndrome. The full syndrome described here has not been previously reported in the recent medical literature, although there have been observations consistent with those that I have reported.
The present observations are, however, strikingly consistent with earlier German reports. The German literature reported only on prisoners who suffered gross psychotic symptoms, some of whom were ob¬served in hospitals or "insane departments" of prisons, The Walpole population, on the other hand, was not preselected by overt psychiatric status. Despite this, all of the major symptoms reported by the German clinicians, except Vorbereiden and hysterical conversion symptoms, were observed in the Waipole population. In addition,, less severe forms of this solitary confinement syndrome were observed in the Walpole population, including 1} sensory disturbances: perceptual distortions and loss of perceptual constancy, in some cases without hallucinations; 2) ideas of reference and paranoid ideation short of overt delusions; 3) emergence of primitive aggressive fantasies, which remained ego-dystonic and with reality-testing preserved; 4) disturbances of memory and attention short of overt disorientation and confusional state; and 5) derealization experiences without massive dissociative regression.
The observations at Walpole also suggest that solitary confinement cannot be viewed as a single entity. The effects of-solitary confinement situations vary substantially with the rigidity of the sensory and social isolation imposed
CONCLUSIONS
The present observations, coupled with those in the earlier German literature suggest strongly that the use of solitary confinement carries major psychiatric risks. I have not attempted in this paper to define or classify this psychopathological syndrome, but, as mentioned earlier, there have been speculations in the literature linking solitary confinement with the formal experiments on profound sensory deprivation. A review of this literature and an elaboration of the variables that may explain the particular pathogenicity of rigidly imposed solitary confinement will be presented in another paper.

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Received Oct. 24, I9X(); revised March 5 and Oct. 20, 1982; accepted Nov. 30, 19X2. From the Department of Psychiatry, New England Memorial Hospital,; Stoneham, Mass.; Tufts University School of Medicine, Boston, Mass.; and Harvard Medical School, Boston. Address reprint requests to Dr. Grassian, 401 Beacon St., Chestnut HiJI, MA 02167. \ '
The author thanks Dr. Dan Buie for his review of the manuscript. Dr. Frank Rundle conducted half of the psychiatric evaluations on which this report is based. :
Copyright *- 1983 American Psychiatric Association.
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