I am Mariposa McCall, a psychiatrist in Northern California who is hoping our colleagues and professional organizations recognize publically and use their influence to bring an end to prolonged solitary confinement in American jails, prisons, and detention centers.

Not only is there is a great need for solidarity among individuals and organizations to uphold human rights and ethical principles but also to reduce reprisals against any whistleblower.   I worked in California Department of Corrections and rehabilitation as a staff psychiatrist from 2020-11 at San Quentin State Prison and again from 2014-2016 at Pelican Bay State Prison. There are things one witnesses and learns that need to be shared, when silence is not an option. Considering that 95% of those incarcerated will be released back to the community, bringing with them the negative health consequences of their confinement, the conditions and traumas they face while incarcerated should concern us all.

According to the Bureau of Justice Statistics,  one in five U.S. prisoners are housed in solitary confinement at some point during their incarceration. Human Rights Watch found that  in the USA at least 30% of those in solitary confinement have mental illness. Additionally, not only are Latinos and Blacks disproportionately represented in the criminal system but they too are placed in solitary confinement at much higher rates.

According to a report issued in 2013 by the Government Accountability Office, there is no evidence that the use of segregation actually makes prisons safer. On the other hand, by using solitary confinement in the duration and frequency there is greater public safety concern as the lasting damage from this type of housing follows inmates released to the communities.  Regardless of the reasons for placement in solitary confinement let’s consider the costs.
1)In the USA, studies show that those who do time in solitary have an increase risk of recidivism. About 60 to 90 % of prisoners released directly from solitary reoffend within 5 yrs and those who have been in solitary are more often to reoffend.
2) Housing a prisoner in solitary confinement can cost 3 times more than would cost to have them
in general population.
3) Such extreme isolation often strains and breaks connections families and friends, weakening one of the most important protective factors we know against suicide and one of the most vital ingredients for health.
4) The human suffering at an individual level is unmeasurable. Solitary confinement is seen and experienced as a deliberate attempt and tool to break you.   Every person I have spoken with who has been in solitary confinement has spoken of the intense fear of losing  their sanity and of the tremendous energies it takes to not deteriorate into “madness”.  It is a painful existence.

These statistics are very relevant to helping providers.  It is a problem we cannot dismiss to someone else. Whether we want to or not, it is all our problem and we need to seriously face this. Solitary Confinement assaults our human need to connection, damaging the self. Solitary Confinement is an imposed environment on others that unnecessarily challenges people’s coping skills to maintain spiritual, physical, and psyche integrity. Solitary Confinement thus violates basic human rights. Human rights are based on a principle of respect for a person, to be treated with dignity, and to have freedom from cruel or degrading treatment or punishment. So why have the courts not found solitary confinement unconstitutional?  The challenge according to lawyers I have spoken to has been difficult to prove that solitary confinement deprives someone of a “basic human need” and that prison officials acted with deliberate indifference despite knowing the harm or risk of harm  To support our colleagues in the courts and those confined in solitary confinement, we as providers and organizations could take a firmer stand publicly and educate on the harms of solitary confinement and argue that meaningful social interaction is an essential human need, as essential as adequate food, clothing, and shelter, and that solitary confinement deprives people of this. It could thus be argued that being aware of these harms and not doing anything about it is considered deliberate indifference.

ALTERNATIVES to solitary confinement EXIST… Over t he past few years changes have happened across the country   that suggest that prisons can function without the need for such harmful confinements and alternative exists that actually improve institutional safety and offer more rehabilitation. Federal courts in Wisconsin, California, and Ohio have found that imprisoning seriously mentally ill prisoners in super-maximum security prisons is a violation of 8th Amendment. Beginning in June 2016, North Carolina no longer places those under 18 in solitary. On September 2016 California Governor Brown signed legislation restricting the practice for juveniles.  New York, Maine, and New Jersey have also made changes. In September 2017, head of Colorado Corrections, Rick Raemisch, ended the practice of solitary confinement beyond 15 days and any direct release to community from solitary confinement.

Another ray of hope from another country supported humanistic treatment of those confined. On January 17, 2018, Canada provided even further hope. British Columbia Supreme Court  Judge Peter Leask  ruled that Canada’s use of solitary confinement in federal prisons is unconstitutional. In his ruling Judge Leask wrote: “I find as a fact that administrative segregation…is a form of solitary confinement that places all Canadian inmates subject to it as a significant risk of serious psychological arm, including mental pain and suffering, and increased incidence of self harm and suicide…I am satisfied the law…fails to respond to the actual capacities and needs of mentally ill inmates and instead imposes burdens in a manner that has the effect of reinforcing, perpetuating or exacerbating their disadvantage…Even inmates who are more psychologically resilient inevitably suffer severe psychological pain as a result of solitary confinement, especially when the confinement is prolonged and/or the individual experiences this confinement as being the product of an arbitrary exercise of power and intimidation… The 15-day maximum prescribed by the Mandela Rules is a generous standard given the overwhelming evidence that even within that space of time an individual can suffer severe psychological harm… Not only that, prolonged segregation undermines the very security and safety the provisions are meant to promote. Based on the evidence, I find that segregation breaks down inmates’ ability to interact with other human beings; deprives them of rehabilitative and educational group programming; risks mentally healthy inmates descending into mental illness; and exacerbates symptoms for those with pre-existing mental illness.”

In the spirit of contributing to a trauma informed system, advancing the bio-psycho-social approach to diagnosis and treatment, promoting a public health framework for prevention and urging for a human rights perspective, I asked to present on how solitary confinement is traumatic and an often neglected social-ecological-environmental risk factor that worsens and causes illness. On February 8, 2018, I along with three other presenters (Dr Everett Allen, an internist who worked for several years at California Pelican Bay State Prison’s solitary confinement, a UCSF Public Health and Criminal Justice researcher Cyrus Ahalt, and Steven Czifra who was confined in solitary confinement for 8 years and is now is a U.C. Berkeley MSW intern) presented on the relevance of solitary confinement to community psychiatry to my colleagues at the California Contra Costa County Psychiatry and Psychology monthly meeting. We discussed the ethical dilemmas correctional health professionals encounter with this housing designation and how we individually and collectively might address this.  Another psychiatrist present suggested I write a petition.