Solitary confinement has long been an area of controversy within the context of criminal justice and corrections. Those against the practice have questioned whether it is ethical due to the potential psychological impact it can have on incarcerated individuals. For incarcerated persons with mental illness (IPMI), this impact can be even greater; particularly if IPMI are more likely to receive solitary confinement. This article summarizes a recent study, originally published in Justice Quarterly, conducted by researchers at Florida State University that examines the relationship between solitary confinement and mental illness to determine if IPMI have an increased likelihood of being sent to solitary confinement.
Mental Illness and Justice System Involvement
Past research has confirmed that individuals with mental illness are overrepresented among incarcerated individuals. There are two primary hypotheses for why this may be:
- Criminalization: Due to deinstitutionalization efforts, people with mental illness have become more apt to be “supervised” by the criminal justice system than the mental healthcare system.
- Criminal risk: Individuals with a mental illness possess higher levels of criminal risk factors, making them more likely to become involved in the criminal justice system.
According to the study’s authors, “There is evidence for both hypotheses.” However, they noted that individuals with mental illness are often supervised differently within the criminal justice system—specifically that they are apt to be dealt with “more punitively” than incarcerated individuals without mental illness. In addition, they stated “mental illness is only a weak predictor of offending behavior when other risk factors are controlled.”
Use of Solitary Confinement
Solitary confinement, wherein an incarcerated person is isolated in a cell from 22-24 hours per day, has been studied extensively to determine whether it causes mental health issues. The authors of this study noted that prior research has shown “solitary confinement has not been found to reliably cause mental illness.”
Yet, research also has shown that of those placed in solitary confinement, 25% to 50% have existing mental health issues, which can range from “psychological distress to diagnosable mental illness.”
Prior researchers have tried to determine why IPMI are placed in solitary confinement at higher rates. Primary explanations include:
- IPMI are more likely to be written up for misconduct, and their official record may lead to greater likelihood of “disciplinary segregation” being used;
- IPMI may be more likely to be victimized by others, leading to solitary confinement being used “for protective purposes;”
- Possessing more risk-factors for behavioral problems means a greater likelihood of being in trouble while incarcerated and therefore placed in solitary confinement.
Yet the prior studies upon which these explanations are based have yielded mixed results and often lacked a systematic or methodological approach. Small sample sizes, facility variability, weak design, and the absence of mediators have limited the ability of scholars to draw conclusive predictions with regard to the relationship between solitary confinement and mental illness.
Hypothesis and Study Design
Based on the limitations noted above, Florida State University researchers chose to use propensity score matching to determine “whether IPMI are more likely to be placed in extended solitary confinement than similar [incarcerated persons] without mental illness.” Further, they stated:
“It predicts these placements from both global indicators of mental illness and from specific diagnoses. It also examines why IPMI receive these placements, and whether misconduct and victimization mediate any mental illness-solitary confinement association. To our knowledge, this is only the second study to test why any association exists. It is also one of the only studies to examine mental illness as a predictor of prolonged stays in solitary confinement, to use a large, system-wide sample that enables the examination of rare diagnoses and the detection of modest effects, and to account for both individual and facility characteristics.”
The study used an analytical sample size of 155,018 male incarcerated individuals, all of whom entered facilities on or following July 1, 2007 and were released by December 31, 2015. All of the correctional facilities were located in a large state in the southern region of the United States.
The study included two primary measures:
- Extended solitary confinement as an independent variable, including total days assigned and reasons for placement.
- Mental illness as a dependent variable, within which three sets were created:
- Any mental illness;
- Serious mental illness; and
- Eight specific disorders.
For the independent variable (extended solitary confinement), placements had to differ from disciplinary actions in that the restrictions were in place for months, rather than weeks (i.e., of an extended duration). For the dependent variable (mental illness), data was only used for IPMI who had received a diagnosis within the first two months of their stay.
Mediating variables were defined as: victimization, fearing for one’s life, and disciplinary infractions (both violent and non-violent). Confounding variables included “15 indicators of criminal risk” and 25 additional individual variables measured within the first two months of admission (e.g., age, custody level, assigned programming, etc.)
Thorough statistical analysis yielded the following results:
- There was a positive mental illness to solitary confinement association that is larger than what past studies have demonstrated.
- Mental illness increased the odds of placement in solitary confinement for IPMI by 170%, depending on the specific mental health diagnosis. This is significantly higher than past findings, which indicated an increase of only 30-80%.
- IPMI were shown to be sent to solitary confinement for a wide variety of reasons (in other words, not just for violent behavior). This may indicate that IPMI “have more difficulty adjusting to prison and following a variety of prison rules, which in turn can trigger solitary confinement.”
- Of the nine mental health diagnoses examined for the study, six were shown to be significantly associated with solitary confinement:
- Major depression;
- “Other psychotic disorder;” and
- Two personality disorders.
- In contrast to past findings, anxiety and PTSD did not predict placement in extended solitary confinement.
The authors were left with the critical question: Are IPMI behaving in a different way during incarceration or are correctional officers and staff perceiving them differently than incarcerated individuals without mental illness?
They also identified seven potential areas for future research to determine if the findings could be replicated, which included:
- Variability in length of stay, looking at both shorter and longer durations.
- Utilizing a more complete list of potential criminal risk factors, including two of the “Central Eight” they left out: antisocial attitudes and leisure activities.
- Examining both state prisons and jails as settings.
- Determining severity of the mental illnesses most commonly associated with longer solitary confinement stays.
- Applying the diagnostic criteria detailed in the DSM-5, which was published mid-way through the study.
- Using self-reported and independent measures of mediators to determine actual differences versus reported differences.
- Examining factors that might influence IPMI behavior during incarceration, such as correctional officer training or mental health interventions and treatment.
Experience of IACFP Members
For the next issue of the IACFP Bulletin, we’d like to focus on practice in this area, including a feature on our members’ experiences with solitary confinement and mental health.
For those interested in participating, please review the questions below and send your responses to IACFP Executive Director, Cherie Townsend, at firstname.lastname@example.org.
- Have you changed your policy on placing incarcerated persons in isolation cells over the last five years?
- Are you aware of criminal justice systems that have either not allowed mentally ill persons to be placed in isolation cells or to place an upper limit on their time in this type of confinement?
- As a practitioner, how do you assess an incarcerated person’s functional impairment? How do you communicate that to security staff?
- What interventions do you utilize to reduce behaviors associated with mental illness as an alternative to past utilization of isolation cells?
* References available upon request
To read the full article summarized here, visit: https://www.tandfonline.com/doi/abs/10.1080/07418825.2020.1871501?journalCode=rjqy20