By: Mary Gamble, MSW, LGSW

I recently resigned from my position as a behavioral health social worker at a local detention center due to the use of prolonged and indefinite solitary confinement. The use of solitary confinement is a mainstay in the facility for those with severe mental illness, often those who are in the process of being deemed incompetent to stand trial. In my two years at the facility (one as an intern, the other as a contractual employee), countless individuals were held in isolation with no plan for transition to general population or the appropriate mental health unit.

It occurred to me early on in my work there that something was wrong with the manner in which individuals were kept in isolation cells. I quickly dismissed it, however, and returned to my work in the Behavioral Health Unit (BHU). The BHU is a treatment-focused unit for those with mental health conditions who have not exhibited any disruptive or otherwise concerning behaviors, as determined by the inmate classification department. Access to the BHU is minimal; oftentimes the people most in need of treatment are deemed by security staff as manipulative, malingering or a risk to officer safety.

With each day that passed, my concern for the well-being of those in isolation grew, as did my own ethical conflict. I tried to problem-solve, advocate, and bargain with the security staff. I quickly learned that my clinical opinion regarding an inmate’s mental status was not deemed to be all that important.

It is important to note that I worked in a local detention center where many of the individuals are pre-trial detainees. In other words, they are waiting for their day in court and have not been convicted of a crime. This means an individual who is still considered innocent by our own criminal justice standards is held for months in tortuous and psychologically damaging conditions.

I started to advocate in the community. I spoke with the local Judiciary and the Office of the Public Defender. I had to walk a thin line as I spoke publically about the conditions of the facility, so I approached the matter in terms of getting the mentally ill out of jail through diversion strategies and by expediting competency proceedings. For a moment, I felt excited, hopeful that the system would change. Sadly, my excitement was short-lived. It seemed that no one was too concerned about the issues I was raising.

My breaking point came when I watched a 19-year-old male held in solitary confinement in extreme isolation for 100 days. His reprieve came only when he was transported to the forensic hospital due to being deemed mentally incompetent to stand trial. During his time in isolation,he went weeks at a time without clothes or a mattress due to “disruptive behavior.”

He was not permitted to have personal property, personal visits, outdoor recreation, and was
limited to a 3 time per week shower restriction, which was not always fulfilled. He received numerous infractions resulting in more lockdown time and loss of privileges. His infractions were often for disruptive behavior and being unsanitary. On one occasion he drew pictures on the wall with his own feces; on another he refused to give up his breakfast tray.

I started to feel lost and despondent. I became preoccupied with this issue in my personal time and started to experience insomnia. I decided I had no choice but to confront solitary confinement practices with the jail administration. I practically begged them to review their practices as I described the conditions in which this particular inmate was being held. I was appeased in the moment, but no actual follow-up was done.

I knew I could no longer practice social work in an environment that violated my code of ethics. I was not only a witness, but also an accessory to human torture. I had no recourse, no one to report the abuse to, and no protection. I was making waves there and was starting to fall out of favor. My presence and input were no longer wanted at meetings. My integrity was questioned.Some staff members even flat out called me a liar, that what I was reporting was simply not happening. Others stated that I was jeopardizing officer safety.

In a position statement by the National Commission on Correctional Health Care – “Correctional Health Professionals’ Response to Inmate Abuse,” several guiding principles are listed for reporting the mistreatment of inmates. According to these principles, it is the duty of health staff to report harm to appropriate authorities. The statement lists “unreasonable confinement” and “willful deprivation of services which are necessary to maintain a person’s physical or mental health” as forms of abuse. 1

The question is, without formal mandated reporting laws, who does a health professional report such abuse to? Who are the appropriate authorities? In order for social workers and other health professionals to practice ethically in the correctional environment, there must be a formal mechanism in place for reporting abuses.

Correctional Officers are hardworking and respectable people; however, many become desensitized to human suffering in order to work under the harsh conditions of the correctional environment. It is unlikely that segregation practices will improve unless change is imposed through legislative reform.

Social workers and other healthcare professionals must support legislation that requires greater transparency and accountability from correctional facilities in order to end solitary confinement. While it is vital to support our correctional system by offering safe alternatives, such alternatives are futile unless there is a change in the institutional attitude toward solitary confinement.

At first I felt guilty about leaving my position, that I was letting those who were suffering down. I realized that by continuing in my employment, I was continuing to be a necessary part of a system that holds humans in tortuous conditions. Correctional healthcare is important and necessary; however, it is time for social workers and other healthcare professionals to no longer participate in the practice of solitary confinement.


  1. National Commission on Correctional Health Care (2012). Correctional Health Professionals’Response to Inmate Abuse. Retrieved from’-response-to-inmate-abuse