The Impact of Segregation on the Mentally Ill

1. The Impact of Segregation on the Mentally Ill Tiffany Swift LCSW-C

2. Perpetuating cycle • Individuals suffering from a mental illness often struggle with the circumstances of incarceration. • As a result, they may act out with dangerous, annoying or bizarre behaviors. • These behaviors are often misunderstood and viewed by authorities as disobedient or disruptive. Thus, authorities punish them as they would any other inmate. • When these punishments do not deter the behaviors, authorities may resort to placing the individual in segregation which will continue to perpetuate their illness and behaviors.

3. What is segregation? • Setting in which an inmate is confined in his or her cell for up to 23 hours each day • Utilized as a management tool • Disruptive behavior • Dangerous behavior • Predatory behavior

4. A day in segregation • In cell 23 hours per day (may vary by institution) • No visitations • Solitary recreation • No work • Eat meals alone in their cell • Restricted shower schedule • Restricted commissary options • Limited/no access to television, radio, telephone • Movement from cell only when escorted in shackles • Limited/no groups or programs • No privacy when meeting with medical or mental health staff • No social contact with other inmates except verbal through cell door • Restricted list of personal items

5. The New Asylums

6. Disciplinary Diet With written request from administration, the disciplinary meat loaf recipe from Title 15 of the California Board of Corrections may be served. • 1 ¼ oz. dairy blend • 1 ¾ oz. raw grated potato • 1.5 oz. raw carrots, chopped • ¾ oz. tomato juice or puree • 2 ¼ oz. raw cabbage, chopped • 3.5 oz. ground turkey or re-hydrated Textured Vegetable Protein (TVP) • 1 ¼ fluid oz. oil • ¾ oz. wheat flour • 1/8 tsp. salt • ½ egg • 3 oz. dry red beans, precooked before baking (or 16 oz. canned or cooked red kidney beans) • 2 tsp. chili powder • 2 tsp. raw onion, chopped Shape into a loaf and bake at 350-375 degrees for 50-70 minutes (165 degrees internal temperature).

7. Disciplinary Diet (continued) • It is recommended that this diet be served twice in each 24 hour period, in place of the typical three meals per day. Each serving should consist of: one-half of the loaf, two slices of wheat bread, and at least one quart of drinking water. • This disciplinary diet should not be served to an inmate who’s receiving a prescribed medical diet without consulting a physician. • Disciplinary diet should not be used for more than a 72 hour period.

8. Who’s typically in segregation • Sexual predators • Gang affiliates • Drug dealers • Escapees • Aggressive individuals with mental illness • Anyone who poses a threat to the safety of staff and/or other inmates

9. Psychological effects of segregation • Anxiety • Depression • Anger • Cognitive disturbances • Perceptual distortions • Obsessive thoughts • Paranoia • Psychosis • Sleep disturbances • Impulse control • Impaired ability to think, concentrate or remember • Suicides occur disproportionately more often than in general population

10. Variations • Solitary confinement can lead to severe psychological trauma in individuals without a prior psychiatric disorder. • Some individuals tolerate segregation better than others, depending on personal traits, situational factors, and environmental conditions.

11. Mental health treatment in segregation • Psychiatric assessments • Routine follow ups • Medication management • Welfare checks (MSE) • Scheduled private sessions • Advocate for placement in special management units, more hours out, and a more stimulating environment • Multi-disciplinary team meetings • Prompt crisis intervention • Access to acute psychiatric hospitalization • Educate correctional staff members about the unique characteristics of this population • Implementation of Crisis Intervention Team

12. Resources • http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02p73&continuous=1 • Locking Down the Mentally Ill. (2010). Retrieved from http://www.thecrimereport.org/archive/locking-down-the-mentally-ill. • Mental Health Primary Care in Prison. http://www.prisonmentalhealth.org/page_view.asp?c=17&did=271&fc=012. • Metzner, J. L., & Fellner, J. (2010). Solitary confinement and mental illness in U.S. prisons: A challenge for medical ethics. The Journal of the American Academy of Psychiatry and the Law, 38(1). Retrieved from http://www.hrw.org/news/2010/03/22/solitary-confinement-and-mental-illness-us-prisons. • Scott, C. L., & Gerbasi, J. B. (2005). Handbook of correctional mental health. Arlington, VA: American Psychiatric Publishing, Inc.