North Carolina State Officials Admit the Obvious: People with a Mental Illness Need Special Care in Prisons

Few of us consider the long-term impact of a 6-by-8-foot room. That’s about large enough to fit a car, roughly the size of a parking space. Consider living in a parking space—sitting, lying down, eating your meals. Going to the toilet, of course. Maybe during the day you’d peek out a tiny, translucent window about the size of your hand. Imagine doing that existence for hours. Days, maybe even months. And, no, leaving is not an option. Not until your time is up.

That’s life in solitary confinement. For the emotionally well-balanced, it’s like being buried alive in an exaggerated coffin with lights. For those with mental illness, it’s frequently haunting and, inevitably, a “screamatorium.” And those with mental challenges keep finding themselves in solitary confinement, according to studies.

This, one might intuit, has a lot to do with how the U.S. refuses to act on the fact that people with untreated mental illnesses suffer precisely the kind of disruptive symptoms that land family members and loved ones into prison and inmates into solitary confinement. It may shock some to know many inmates in correctional facilities aren’t there for reform; they’re there because they do disruptive things. In fact, much of the U.S. prison population caught the callousness or agitation from a reactionary, biased judge because of co-occurring substance use disorders or clinical challenges, coupled with legal and poverty-related disadvantages. This is one of the many reasons those with mental illness are overrepresented among probation and parole populations. Their unsolved or untreated illnesses also frequently get their parole revoked, and corrections agencies have limited resources to handle people with mental illnesses because of huge caseload size and the specific needs of different clients.

One Mississippi sheriff recently expressed outrage that his deputies were having to pull double-time acting as therapists and doctors for incarcerated people with mental illnesses. Adams County’s sheriff, Travis Patten, told reporters people with mental illness should not be a county sheriff’s problem.

“When people without mental illness hear the cell doors behind them lock, it does something to their psyche,” Patten reported. For people suffering paranoid behavior, schizophrenia or hallucinations due to mental illness, that metallic-sounding CLANG qualifies as “torture.”

The fact of the matter is the nation’s incarcerated population suffers disproportionately high levels of mental illness, according to studies. This doesn’t bode well for a population of people prone to hearing non-stop voices while left alone with themselves. For them, solitary confinement can prove an even more hideous agony than the inhumane torture is intended to be.

Psychologists recognized solitary confinement to have harmful effects as far back as the 19th Century, while others have noticed the association between solitary confinement and formerly incarcerated people’s increased deathrate upon release. Organizations like the ACLU work particularly hard to spread awareness of how mentally-ill prison residents disproportionately die.

It’s too bad, then, that more people with mental illness in places like Mississippi find themselves in prisons and jails than hospitals, according to the Treatment Advocacy Center, and doubly bad that Mental Health America ranks Mississippi the 29th worst state for access to mental health care services in its 2020 annual report.

In September, the American Journal of Preventive Medicine suggested a better way, and states like Mississippi would be smart to consider it.

Using 2016−2019 data from incarceration records of North Carolina prisons, NC officials created Therapeutic Diversion Units (TDUs) as treatment programs created to decrease violent incidents and self-harm by “helping participants develop effective emotional regulation and self-management skills, understand their symptom presentation and patterns, and prepare for re-entry into a less restrictive environment within the prison and ultimately into the community.”

Unlike landing in solitary confinement, admission to a TDU requires an assessment by staff trained in behavioral health. Determiners include a grading scale on an incarcerated person’s level of mental illness. At that point, the “prisoner” appropriately becomes a “patient,” with officials designing an individual treatment plan and intervention according to the person’s “needs and response to treatment.”

Study results indicate offenders assigned a TDU rather than solitary confinement were three times less likely to commit a disciplinary infraction, five times less likely to commit a severe infraction involving violence or contraband, and three times less likely to require inpatient mental health treatment. They also discovered patients to be three times less likely to threaten or commit self-injury and four times less likely to commit self-injury.

For those wondering why people with degrees are treating this like some kind of novel approach, stop wondering: The problem was always convincing prison officials and the state of North Carolina to come off the money to implement this brand of bespoke treatment (not to agree it works). North Carolina organizations the North Carolina Psychological Association, the NC chapter of the National Alliance of Mental Illness, and Disability Rights North Carolina already offer full approval of the practice.

What’s even more inspiring about the study is that it arose as a collaboration among state NC government entities. This includes the N.C. Department of Public Safety and the N.C. Department of Health and Human Services’ Division of Public Health, along with the UNC-Chapel Hill’s Injury Prevention Research Center.

Even NC Commissioner of prisons Todd Ishee acknowledged in a statement the state’s correctional systems struggled with providing proper care to offenders with mental illness.

“You have to protect the safety of prison staff and the other offenders, so you must remove someone who represents a threat, at least temporarily, from the general population,” Ishee said. “But at the same time, you don’t want to put someone in restrictive housing for an action they’ve taken in a moment of crisis. It’s better to give them the help they need.”

Duh. Still, better late than never.

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