Solitary confinement worsens mental health crisis in NC prisons

Imagine being locked in a 6-foot by 8-foot closet for 22 to 24 hours a day with no access to natural light, only glaring florescent light or complete darkness. In that cramped space add a single bed, an uncovered toilet with a sink attached, and a small desk, all bolted to the concrete floor. Imagine the door to this closet is solid steel with a narrow rectangular slot, locked from the outside, through which food is provided to you.   

If you are allowed out, you are shackled and only out for very brief periods of time to shower or “recreate” in a cage even smaller than the closet. Imagine no phone calls and few, if any, visitors.  

Imagine you don’t know how long you will be there, or what you have to do to get out.  

On any given day in North Carolina, this reality, known as solitary confinement, is how nearly 3,000 people live in our state’s prisons, many for weeks, months, even years, accounting for 10% of the state’s overall prison population of approximately 30,000. Some are as young as 18; nearly 100 are over 61.

Many of these 3,000 people have mental health disabilities that are grossly exacerbated in solitary confinement; others develop mental health disabilities because of the solitary confinement conditions. At Disability Rights NC, we get letters from people in solitary nearly every day, begging us to help them access mental health treatment, which is not available due to staffing and programming shortages. More than half of the people in our prisons who died by suicide in the past two years did so in solitary confinement.   

There is undisputed evidence and research about the significant harm that solitary confinement causes. Scientific and international communities have determined that prolonged exposure to solitary, defined as more than 15 days, is considered torture as set forth in the Mandela Rules, named for Nelson Mandela, who spent many years in solitary confinement in apartheid South Africa. The Mandela Rules forbid the use of solitary confinement for people with mental health disabilities, juveniles, and other at-risk groups. Notably, a North Carolina task force on justice has recommended that NC adopt the Mandela Rules. 

Because 95% of incarcerated people will return to their communities, some straight from solitary confinement (also called “restrictive housing”), the NC Department of Adult Correction (DAC) policies allowing long-term solitary confinement directly affect public safety. Studies show that people who spend any time in solitary confinement have higher recidivism rates than those who do not. They are also more likely to die within the first year of release, from suicide, homicide, or opioid overdose. The overuse of solitary confinement is a life-or-death issue that North Carolina must address. 

Limiting the use of solitary confinement makes prisons safer for corrections staff, incarcerated people, and communities. Recognizing this, past and present prison officials in several states, as well as the American Correctional Association (ACA), are leading efforts to reconsider and reshape how solitary confinement is used.

The ACA has called the prolonged use of solitary “a grave problem in the United States.” Gary Mohr, prior director of the ACA and former director of the Ohio Department of Rehabilitation and Correction, said solitary should be restricted to people “we’re afraid of, not mad at.” Under Mohr’s direction in Ohio, they reduced the population of people in solitary confinement to less than 3 percent of the overall prison population. Reforms are underway in each of NC’s neighboring states: South Carolina, Tennessee, Georgia, and Virginia.  

NC’s secretary of DAC, Todd Ishee, worked for Mohr in Ohio and had planned to leave NC to become director of the ACA until Gov. Cooper tapped him to lead the DAC. He is well-recognized as a leader. At his confirmation hearing earlier this year, Ishee told legislators that he is revising NC’s policies about solitary confinement. He did not provide details, except to say that he would not limit the use of long-term solitary, citing concerns about safety.

We hope Secretary Ishee will work swiftly on the revisions and reconsider adopting the Mandela Rules. Currently in NC, people can be sent to long-term solitary confinement for infractions that would be considered misdemeanors or non-criminalized behavior outside of prison, such as using profane language, delaying work while on assignment, losing state property, or possessing a significant amount of tobacco.

States and prison administrators across the country have adopted many successful solitary confinement reforms. North Carolina has one such promising program, called Therapeutic Diversion Units (TDUs), that have been proven to be effective diversions from solitary confinement for people with mental health disabilities.

“There’s a body of research that indicates just how adverse restrictive housing can be for people who suffer from a mental health disorder — depression, anxiety, psychiatric distress, even feelings of dehumanization and loss of identity,” said Dr. Gary Junker, a study co-author and deputy secretary for DAC’s Division of Comprehensive Health Services. “We now have data, which came from our own offender populations, to guide us as we determine best practices.”  

TDUs support people with mental illness by offering group and individual therapy, as well as by providing programming for substance use issues and anger management. TDUs also involve more out-of-cell time and social opportunities than solitary confinement.  

Though TDUs began operating in 2016, they are limited. Five TDUs are currently operating with only 80 or so treatment beds for the entire state. Some TDUs are not operating at capacity due to staffing issues, with more than half of treatment beds vacant at some facilities. 

Even at capacity, TDU beds are insufficient to meet the mental health needs of the prison population. DAC classifies approximately 7,400 people (24% of the prison population) as needing mental health services. More than 6,300 of these individuals are classified as having a serious mental illness and, according to the TDU study, are up to 60% more likely to be placed in solitary confinement. The limited TDU services are not available for the many people with disabilities put into solitary confinement.  

Public safety and humane treatment of people who are disabled and decompensating require immediate focus. We urgently need reforms to reduce the misuse of solitary confinement and more funding to expand the use of TDUs so people can receive treatment for their mental health needs. Prisons and communities will be stronger and safer for these changes.  

Until that happens, we will continue to hear the pleas from people in solitary confinement, who want to be better and do better. In the words of people directly affected by this crisis:   

“I just don’t know what to do and it just drives me to a point of thinking crazy and doing crazy things at times. I need help please.”  

 “I don’t know how much of this I can take. This is my cry for help please call down here to see why I haven’t received the right care and see for yourselves the injustice that’s going on.”

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