If North Carolina prisons reduce their use of solitary confinement, what’s next?

Zachariah Bacote says he still doesn’t know why he was stabbed at Bertie Correctional Institution in January.

He also can’t figure out why correctional officers put him, the victim of an attack, in solitary confinement after the assault.

One day alone in a concrete cell the size of a parking space scarred him as much as the metal shank that slashed his face and chest, Bacote said.

“It was horrible,” he told The Charlotte Observer from a prison phone. “I was feeling like I could have really died. I was thinking about that. I was thinking about my family, thinking about my son. I was in pieces at the moment.”

Officers found Bacote lying on a prison floor after the assault Jan. 29, said Brad Deen, a state Department of Adult Correction spokesperson.

Following a brief hospital stay, Bacote was placed in solitary confinement “for safety and protection, which is standard procedure following a violent incident that requires investigation,” Deen told The Observer in an email.

That’s not where Rick Raemisch, former head of Colorado’s prison system, would have placed Bacote.

“Absolutely not. You’re re-victimizing a victim,” said Raemisch, who helped eliminate long-term solitary confinement in Colorado.

North Carolina prison leaders say they are working on sending fewer people to solitary confinement, too.

Leslie Cooley Dismukes, the new leader of the North Carolina Department of Adult Correction, wants North Carolina to get closer to the Mandela Rules, named after the late South African president Nelson Mandela.

The rules say solitary confinement should only be used as a last resort and inmates should stay there no more than 15 days in a row. They equate too much time in isolation with torture.

Since 2022, at least seven state inmates with known mental health problems committed suicide while in solitary confinement in North Carolina prisons, a Charlotte Observer investigation has found.

But if inmates like Bacote or those living with mental illness aren’t put in solitary confinement, where will they go? What treatment will they receive?

How will prison leaders make sure they’re safe in general population — and general population inmates are safe around them?

Harms of solitary confinement

Multiple studies and North Carolina’s own experiences underscore the need to reduce the use of solitary confinement in the state, experts in behavioral health and corrections say.

The number of incarcerated men and women put in solitary fluctuates. About 5% of North Carolina’s 31,767 inmates were in solitary on May 20, the state said.

Yet those who have spent time confined to single cells for more than 22 hours a day account for about half of the suicides in state prison since 2020, prison data show. Last year, a record-tying 13 inmates in state prisons committed suicide. Eight, or about 62%, were in isolation, an Observer analysis found.

Research in the American Journal of Preventive Medicine found that North Carolina inmates in solitary confinement — compared to inmates in therapeutic division units — were more likely to commit infractions, need mental health treatment or injure themselves.

“These findings indicate that TDUs have considerable promise to lead to better outcomes than restrictive housing while incarcerated, particularly in terms of behavioral infractions, mental health, and self-harm.” the study states.

So what are TDUs, or therapeutic diversion units, and the other options North Carolina could deploy to reduce its use of solitary confinement? And how might they help?

Therapeutic diversion units

North Carolina’s first therapeutic diversion units opened in 2016. Last year, at least 67 inmates were treated in the program at three prisons — Foothills Correctional Institution in Burke County; Alexander Correctional Institution in Alexander County and Central Prison in Wake County, said Keith Acree, spokesperson for the Department of Adult Correction.

Chronic staffing shortages prevent the prison system from operating more diversion units, Acree said. As of December, the state had 3,000 correctional officer jobs unfilled, for an officer vacancy rate of 37%.

People in TDUs are restrained and escorted out of their solitary confinement cells to group therapy sessions with behavioral health staff, Acree said.

As their treatment progresses, they get more freedom and fewer restraints. Those who quit or are kicked out, return to solitary confinement, Acree said.

In addition to diversion units, the prison system operates outpatient treatment units. These are held in regular population units — not solitary confinement units — and call for participants to meet for therapy in small groups.

The goal of both programs is to provide enough support for the inmates to live in general population and eventually society without conflicts, said John Schwade, a retired prison psychologist at Granville Correctional Institution in Butner.

“These guys carry a lot of secrets with them, from the most obvious to the absurd,” Schwade said. “They’re terrified a lot of times that people will find out what their life was really like. Therapy defuses the belief that ‘I’m alone.’”

Step-down units

Some U.S. prison systems have step-down units for inmates leaving solitary confinement. These units help reacclimate inmates to being around people — first in general population, then in society.

Like therapeutic diversion units, step-down units provide people with services to treat mental health problems and develop skills, from social interaction skills to job and educational skills, Schwade said.

But inmates’ time in group settings is limited. Inmates on the first step could be out of isolation and in a group setting for four hours a day, said Raemisch, the former head of the Colorado prison system. Then it could be eight or 12 hours.

Sometimes they remain in shackles.

The idea is to slowly reintroduce inmates who were in isolation to being around people while providing them counseling, Raemisch said.

“These are violent, disruptive people,” he said. “They would push back. They would be loud. But after a short period of time, they stopped being loud and they started to listen. Then after that, they started to participate.”

Colorado did away with long-term solitary confinement in 2017 under Raemisch.

The North Carolina prison system has one Rehabilitation Diversion Unit, located at Marion Correctional Institution in McDowell County, Acree said. It’s a three-phase step-down program helping people in long-term solitary confinement work their way back to general housing.

Southern Correctional Institution in Troy will pilot another step-down program, likely beginning in July, according to Acree. If the pilot is successful, the department could add step-down units to other prisons, he said.

Special management units

As the use of solitary confinement has decreased in North Carolina’s state prisons, from about 70,000 trips in 2020 to about 63,000 last year, assignments to the department’s special management housing units have increased.

But what are they?

Special management units confine inmates for less than 22 hours a day, just a hair under what’s allowed under solitary confinement.

They can be used as a “cooling off period” for inmates, according to state prisons policy. They also can be used to isolate people who “threaten the secure and orderly operation of the facility, posing a threat to others, or a danger to themselves,” policy states.

Special management units have fewer restrictions and more out-of-cell time for those incarcerated, Acree said. But when asked, he offered few details about how they work in North Carolina prisons.

The key to the quality of special management units is how long people are out of isolation and what they’re doing during that time, said Jean Casella, director of Solitary Watch, an anti-solitary watchdog group.

If they spend nearly every minute of the day in a cell and do not receive counseling, such as anger management, then it’s no better than solitary confinement, Casella said.

“That’s solitary by another name,” she said.

There are reasons to reduce solitary confinement that extend beyond what occurs inside locked prisons, stressed Duke University researcher Lauren Brinkley-Rubinstein.

She co-led a study that looked at what happened to some 229,000 people released from North Carolina prisons from 2000 to 2015. About a third had spent time in isolation.

Cause and effect are difficult to prove. But the study did find an important association. Those who had been locked in solitary confinement were more likely to be re-incarcerated or die of suicide, homicide or a drug overdose, results published in the Journal of American Medical Association in 2019 show.

“There is good evidence, especially in North Carolina, that solitary confinement creates excessive harm and leads to death,” Brinkley-Rubinstein concluded.

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