Editorial note
The following is the second half of a report by Human Rights Watch was published in 1997 as part of a growing concern amongst human rights agencies and advocates over the legal, moral, and ethical issues involved with the increasing number of super-maximum-security prisons. It focuses on two Indiana prisons: Westville Correctional Facility and Wabash Valley Correctional Facility. Former and current political and social prisoners contributed to the findings.You can read the first half of the report here.
VII. Security, force, harassment, and abuse
As facilities that house the most disruptive and dangerous prisoners within the Indiana prison system, the MCF and the SHU exercise extraordinary control over prisoner’s lives. In the limited time prisoners are allowed out of their cells, the practice has been to restrain and escort them. Situations arise in which the use of physical force-including cell extractions, the use of chemical sprays and restraints-is necessary. But the history of the MCF and the SHU also reveal the unnecessary and excessive use of physical force. The class action lawsuit filed against the MCF described chronic physical abuse, including the use of physical restraints as punishment, while a SHU prisoner’s recent court papers alleged the unconstitutional use of “physical force, chemical agents, cell extractions, four-point restraints, and tranquilizer injections.” Prisoners also described some guards as verbally abusive, indifferent to prisoners’ needs, and extremely slow in responding to their legitimate requests.
Staff-Prisoner Relations
Conditions in super-maximum-security prisons tend to foster unusually bad relations between prisoners and guards, and are, in the absence of particular vigilance, conducive to custodial abuse [81]. The simple fact that prisoners in such facilities have been labeled the “worst of the worst” encourages correctional officers to view them in a dehumanizing way and to treat them more harshly than is necessary. Contributing to this tendency are the elaborate security precautions taken every time inmates and guards are in contact with each other. When guards escort a prisoner during his out-of-cell movements, the prisoner is placed in physical restraints, including handcuffs, a lead chain, and, often, leg shackles. As one inmate explained it, “When guards only see you in a cage or at the end of a chain, they just can’t relate to you as a person.”
In contrast with the normal prison setting, where prisoners and guards are physically intermingled and have limited social contact, the two groups are isolated from each other at the MCF and SHU. Guards inside the control rooms have little contact with inmates beyond controlling prisoner movements via electronically controlled doors. Other guards intermittently enter the housing sections to deliver prisoners’ food, respond to problems, and escort prisoners to recreation, showers, or visits, but they do not routinely patrol the sections to check in on prisoners. Human Rights Watch noted that guards tended to remain by the control rooms, away from prisoners, when not engaged in specific tasks. Cells do not have intercoms by which prisoners in need of assistance can call guards; instead, to get attention, prisoners must shout and bang on their cell doors. Much of the time, they say, their calls are ignored.
Being protected from physical assault encourages a tendency that both guards and prisoners referred to as “steel door courage.” The facilities’ high level of security means that guards have little practical incentive to cultivate friendly relations with prisoners or to attempt to defuse hostile encounters with them. (As described above, this tendency is equally true with regard to inter-prisoner relations.) Instead, verbal confrontations are more apt to escalate into physical confrontations, and hostilities become personalized.
Undoubtedly, guards at both facilities have reason to feel provoked, particularly when prisoners throw urine or feces on them. Nonetheless, professional discipline requires that they respond appropriately. Whether in response to prisoner harassment, or, as some prisoners alleged, out of sheer animosity, some officers engage in unprofessional behavior. Human Rights Watch received numerous complaints, mostly from prisoners at the SHU, that guards are vindictive, petty, spiteful, and disrespectful toward prisoners; that they engage in various forms of harassment; and that they try to goad prisoners into confrontations that they then quell using excessive force. Prisoners acknowledged, however, that only a minority of guards-“a select few”-engage in such practices.
Security and Control of Prisoners
Correctional staff inside the MCF and the SHU do not carry firearms or laser gun, a practice consistent with international standards [82]. Sergeants are authorized to use stun devices in emergencies (and at the MCF, a stun shield), but to our knowledge such devices have not been used. Instead, batons and chemical sprays (mace and pepper spray) are relied upon in subduing inmates, and restraints such as handcuffs, leg shackles and four-point restraints are used to keep inmates under control. Neither facility employs restraining chairs or other such devices.
Movement of prisoners outside their cells raises the greatest possibility of threats to the safe and orderly operation of the facilities. Both the MCF and the SHU closely control prisoners whenever they are outside their cells. Prison administrators have decided, however, that the patterns of restraint and control used when the facilities opened can be relaxed somewhat without jeopardizing security. At the MCF, whenever a level 5 prisoner is taken from his cell, he is handcuffed before the cell door is opened (by means of a cuff-port in the door) and is escorted by two guards, one of whom holds a lead strap attached to the inmate, and the other of whom carries a baton. Until recently, level 5 inmates also had to wear leg shackles anytime they left their cells. At present, the MCF permits inmates with twelve vested months to move within the confines of their housing unit without leg shackles, unless they have a history of kicking. MCF level 4 inmates are accompanied by one guard, without a baton, instead of two guards.
At the SHU, a prisoner is placed in handcuffs before leaving his cell for a shower or recreation, and is escorted by two guards, one of whom maintains control of the prisoner by means of the lead strap, the other of whom carries a baton. This rule has been relaxed for inmates in the A-side, who are no longer escorted to the showers or recreation but simply released from their cells by guards in the control room who open the automatic cell doors.
At both facilities, the kind and number of security devices employed increases whenever prisoners leave their housing sections, and increases another degree when they leave their pods (for example, for visits or for court appearances). Leg shackles, which restrict the size of inmates’ steps, are required whenever prisoners leave their housing sections. Out-of-pod movements require the use of leg shackles, a waist chain, and handcuffs attached to a “black box” that prevents arm movement (this combination of restraints is called “full trip gear”) [83].
Describing them as “leashes” or “dog chains,” prisoners at both facilities felt that the use of lead chains was humiliating. They also complained that guards sometimes deliberately jerked the lead chains to provoke them, occasionally making them fall.
Use of Force
When a dangerous situation erupts, correctional officers are justified in using proportionate and reasonable force to subdue inmates; indeed, the use of force may at times be required to protect the safety and security of inmates and staff. Indiana DOC policy permits the use of physical force by staff for self-defense, the protection of others, the prevention of self-inflicted injury, the protection of property, the prevention of escape, and for “the enforcement of direct orders for cooperation relating to violations of the disciplinary code” [84]. It limits the extent of force that may be used to ” the least amount of force necessary to ensure compliance” [85] and expressly prohibits the use of physical force “as a means of reprisal against or punishment of an offender [86]. International standards also mandate that “officers who have recourse to force must use no more than is strictly necessary” [87]. These standards for the use of force rule has not always been observed in Indiana’s super-maximum-security facilities. Indeed, our research indicates that the misuse of force was rampant in the early years of both facilities, but especially so at the MCF.
Our research suggests that the first superintendent of the MCF, Charles Wright, encouraged and condoned the unnecessary and excessive use of physical force. Wright’s operating philosophy was one of total control-a zero-tolerance approach to disciplinary infractions or even prisoner attitudes that he or his staff
found offensive. Particularly in the first year or so of his tenure, Wright pursued his vision of total control with a single-minded and lawless intensity: beating prisoners into submission on the slightest pretext or provocation. The abuses that took place during the initial years of the MCF under Wright were far more serious and systematic than any that have since occurred at either the MCF or the SHU. For example, in July 1991, one prisoner was reportedly beaten by ten guards as Superintendent Wright looked on [88]. Prisoners confined at the MCF facility during both the tenure of Wright, and that of Herbert Newkirk, the current superintendent who took over in mid-1995, acknowledge a striking change in their treatment by guards. As one prisoner said, “It’s not a living nightmare anymore . . . . Newkirk is a professional” [89].
Although not so extreme, elements of the total control regime have been evident at the SHU as well, particularly in its first year. Current SHU administrators acknowledge that when the unit opened, staff took a much harder line with prisoners and guards were quick to use force-a practice condoned by their superiors. In an incident in September 1994 that is not atypical, a prisoner complained to guards that they had mistreated another prisoner, rousing the guards to come to his cell and spray him with tear gas (called OC). After they handcuffed him and took him to the shower to remove the chemicals, the prisoner asked why they had sprayed him-he has asthma and is particularly sensitive to OC. The guards’ response was to hit him [90]. In April 1995, a verbal confrontation between one prisoner and a guard escalated when the guard, violating SHU rules, removed the prisoner’s handcuffs and scuffled with him. The prisoner reported that the guard said to him, while taking off the handcuffs, “You think you’re tough? Let’s see how tough you are!” After the prisoner’s handcuffs were off, two other officers jumped into the fight, beating the prisoner. The inmate was later found guilty of battery in a disciplinary hearing at which the hearing officer found “mitigating but not exonerating circumstances” [91].
Assistant Superintendent Ron Batchelor told Human Rights Watch that in the year-and-a-half since he took over responsibility for the SHU, he has transferred approximately thirty guards out of the unit “for being cowboys,” that is, for being too eager to employ physical force and violence [92]. In contrast, prisoners at the SHU continue to voice complaints about excessively brutal cell extractions and other incidents of violence. Although many long-term SHU inmates state that the level of violence has declined since the facility’s first years, they assert, nonetheless, that incidents of abuse by guards continues. They assert, for example, that cell extractions, mace, and pepper spray are still used unnecessarily, often in retaliation for minor infractions such as swearing at the staff, rattling or kicking cell doors, or refusing to shower. One prisoner reported that the was “goon squadded” in May, 1997 while he was in the shower: guards hit him, leaving him “bruised from head to toe” and then took him to a cell that had excrement on the mattress. He was strapped down on it for four hours, and then given a conduct report for refusing to give up his underwear and socks.
Cell Extractions
At the MCF and the SHU, as at every super-maximum-security prison, there are times when it is necessary to forcibly remove a prisoner from his cell in a process referred to as a “cell extraction.” Both the MCF and the SHU employ “quick response teams” to conduct cell extractions. The core of these teams is made up of at least five correctional officers wearing body armor, helmets with visors, neck supports, and heavy leather gloves. Accompanying them are other correctional staff, including a supervising sergeant, an officer with a video camera who records the extraction, and a medical assistant. Before conducting the extraction, the team holds a briefing in which each member of the five-person core group is assigned a part of the prisoner’s body that he or she is responsible for immobilizing: one person is to hold the right arm, another the left, etc. The actual extraction is usually quick: the cell door opens, the team rushes in and gains control of the inmate, and each member of the team secures the specified body part and places it in restraints [93].
An expert in the use of force in correctional systems as described the dangers of the process as follows:
“Because officers in a cell extraction are required to remove the inmate against his will, a cell extraction typically constitutes a major application of force, as staff gain control of a prisoner’s arms and legs for the purpose of applying handcuffs (and sometimes leg irons). Moreover, because a cell extraction typically requires officers to gain this control in a small, confined space, a cell extraction poses the risk of injury (including potentially serious injury) to both staff and inmates. Given the level of force inherent in the cell extraction process, and the potential risk of injury that is entailed, cell extractions are highly susceptible to potential abuse, including the use of assaultive behavior by staff” [94].
Under DOC policy, cell extractions are appropriate “when harm to staff appears likely to result if other means of force are used or when an offender is violent or uncontrollable and consistently or flagrantly refuses to obey instructions from staff or barricades himself in a cell or other enclosure” [95].
Under former Superintendent Wright’s tenure, cell extractions were frequent. Human Rights Watch was told that, by the official count, 579 cell extractions were conducted under the authority of Superintendent Wright [96]. The MCF’s cell extraction records show that two or three cell extractions a day were not uncommon; there were also days when as many as eight cell extractions took place [97]. Cell extraction records for the SHU also indicate that in the early years of the SHU’s operation, there were at least several extractions a week [98]. In both facilities, it appears that mentally ill prisoners were extracted the most frequently.
Staff at the MCF and the SHU confirmed to Human Rights Watch that in the past cell extractions were regularly undertaken when no force was required or when non-force alternatives had not been exhausted. If a prisoner refused to return his food tray or would not cuff up immediately, even if he was unarmed and not posing an immediate risk of harm to himself or the facility, a cell extraction would be ordered [99]. There was often little proportionality between the circumstances faced by the staff and the amount of force actually employed. Moreover, the cell extractions would be undertaken immediately, without waiting to see if the prisoner would change his mind. Indeed, they would be carried out even if the prisoner finally agreed to comply. As one MCF administrator stated, “The mentality was that once guards `suited up’ for an extraction, it was too late to stop it” [100].
Numerous reports by prisoners have convinced us that cell extractions at the MCF under Superintendent Wright became an end in themselves. They were not undertaken as a judicious use of force calculated as necessary to protect an important security interest. Rather, they were imposed as punishment on inmates simply for refusing to obey an order, regardless of what the order might have been.
Instead of being conducted using the least possible force, cell extractions and other confrontations were often unnecessarily brutal. We have received numerous complaints by prisoners that guards used the occasion of cell extractions to deliberately hit, kick and even beat them under cover of trying to “secure” the prisoner.Moreover, anyone who was extracted was automatically placed in full restraints, even if the person posed no risk to himself or others. The MCF’s use of force records indicate that prisoners who were cell extracted were frequently kept in restraints for a minimum of four hours. Prisoners also reported to us that many were placed in strip cells as additional punishment following an extraction.
In the past two years, the number of cell extractions at the MCF has dropped markedly. A review of the MCF’s use of force records indicates that weeks have gone by during this period without cell extractions. The reduced number of cell extractions does not reflect a change in the behavior of prisoners confined at the facility. Rather, it reflects policy changes by the facility’s administrators. The MCF was forced to institute those changes by the Agreed Entry ending the class action lawsuit against the MCC. Under its terms, cell extractions can only be undertaken after the prisoner had been given several opportunities to submit to being handcuffed. More important than the settlement terms, however, was a change of prison administration. When Herbert Newkirk replaced Charles Wright as superintendent, he brought with him a more reasonable approach to cell extractions.
Newkirk goes to considerable lengths to avoid cell extractions, conducting them only when unavoidable [101]. Under Newkirk, guards and supervisory personnel are instructed to try to talk the prisoner into compliance and to give him time (assuming there is no imminent security threat) to calm down. Until the last minute, even when the extraction team is standing at the cell door, the prisoner is given the opportunity to comply [102].
Cell extractions at the SHU, while they are more frequent than at the MCF, are not nearly at the levels of the early MCC. Many of the inmates we interviewed at the SHU explained that they have never been extracted because they are careful to avoid getting into such a situation. They said it is the “hotheads”-younger prisoners-and the mentally ill who are extracted most frequently. The facility’s use of force records indicates the cell extractions in 1996 and 1997 occur less frequently than in prior years. But they also indicate that the overwhelming preponderance of cell extractions involve individuals who are severely mentally ill. Indeed, the mentally ill prisoners noted above in this report appear with extraordinary frequency among the names of those subjected to cell extractions.
Some prisoners at the SHU complained to Human Rights Watch that guards are unnecessarily violent during cell extractions. SHU officials denied the misuse of force during cell extractions. They pointed out that extractions are videotaped from the moment the team is called together, through the removal of the prisoner from his cell and his placement in another cell, until the team is debriefed before dispersing. Abuse, they say, would show up on the video. But prisoners claim not everything is captured on video. There were gaps in the tape in two of the three videos reviewed by HRW during visits to the SHU and the MCF.
Four-Point Restraints
The beds of some SHU and MCF cells are equipped with leather restraints that are used to immobilize prisoners by strapping and holding secure their arms and legs. The Indiana DOC policy on the use of physical force includes a section on restraints that permitted their use in an unduly wide range of circumstances, e.g., “if the history, present behavior, or emotional state of an offender indicates that bodily injury, property damage or escape might occur” [103]. Under the terms of the Agreed Entry-which only covers administrative segregation prisoners at the MCF-four-point restraints may only be used if an offender presents himself as an imminent threat of inflicting serious harm to himself or others by assaulting a person, engaging in significant destruction of property, attempting suicide, inflicting wounds upon himself, or displaying other signs of imminent violence.” Inmates may be placed in four-point restraints for up to four hours, but the period can be renewed. Restrained inmates must be checked at least three times an hour and allowed up attend to physical needs for fifteen minutes every four hours. Indiana DOC policies are also explicitly preclude the use of leather restraints “as a form of punishment . . . Leather restraints to control a prisoner in his cell shall be used only as long as necessary to control the prisoner” [104].
International law does not prohibit four-point restraints but limits their use to the control of prisoners who are a danger to themselves or others, and then only for so long as is “strictly necessary” [105]. The use of restraints as punishment is
expressly forbidden. Correctional standards contain the same principles: the American Correctional Association cautions that four-point restraints “should be used only in extreme instances and only when other types of restraints have proven to be ineffective” [106].
The standards governing use of restraints were not followed in the early years of the MCF. Under former Superintendent Wright, MCF prisoners were regularly placed in four-point restraints following cell extractions. The MCF’s use of force records suggest that between July 1991 and October 1992, prisoners were never kept in restraints for less than four hours [107]. In the following years, until the end of Superintendent Wright’s tenure, restraints continued to be used routinely following all cell extractions, but the amount of time prisoners were recorded as having been restrained ranged for the most part between one and four hours. Some prisoners were restrained as long as seven and eight hours. The routine use of restraints for a minimum of several hours is consistent with prisoner assertions to us that they were restrained as punishment, not because they posed danger to themselves or others for that period of time.
One MCF prisoner, Paul Komyatti, was held in four-point restraints for a total of fifteen days (five days, then a six-day break, then ten more days) in June 1992. Although this incident occurred when he was transferred to the infirmary of the Westville Correctional Center toward the end of a long hunger strike, it was former Superintendent Wright who gave the order for restraints [108].
Komyatti filed a pro se challenge to this abusive treatment in federal court, which he won. As the judge said in his decision, “Nothing in the record indicates that Mr. Komyatti was restrained pursuant to a health professional’s appropriate exercise of judgment,” nor does it “permit the inference that exigent circumstances justified the initial use of four-way restraints in this action, let alone restraining Mr. Komyatti for five and ten days at a stretch” [109].
Under the current superintendent of the MCF, four-point restraints are used very infrequently, and then only for very limited periods of time. The MCF’s use of force records indicate the prisoners who are cell extracted are not routinely placed in restraints. The records also indicate that prisoners who have been restrained are usually released relatively quickly, e.g., within half an hour.
Prisoners have also claimed that four-point restraints have been used abusively at the SHU. The SHU’s use of force records indicates the frequent use of leather restraints but do not specify the total amount of time each prisoner was kept in restraints. Data included in the records suggests, however, that some prisoners-including many who are mentally ill-have been kept in restraints for periods ranging from eight hours up to one and three days. A few mentally ill prisoners have apparently been kept in restraints for even longer.
Prisoners report recent incidents suggesting restraints might have been used as punishment, or that for purposes of punishment prisoners were kept in restraints longer than necessary. For example, one prisoner reported to us that in June 1997, he had an altercation with a guard and that later in the day he spit on the guard. He was placed in restraints for four hours [110].
Prisoners reported to Human Rights Watch that the SHU’s psychiatrist frequently ordered them placed in restraints. The psychiatrist confirmed that he sometimes restrained prisoners, but he insisted it was always for medical purposes, and not as punishment [111]. He explained that he faced a situation at the SHU of dozens of inmates who needed medication but refused to take it, either because they denied being ill or because they are unwilling to accept the medication’s side effects. When these prisoners became particularly disruptive or began to act in ways that suggested they posed a danger to themselves or staff, rather than following procedures for involuntary medication [112] he would “encourage” them to take medication. This “encouragement” could amount to coercion. It included restricting prisoner privileges, such as by placing them on bag lunches, threatening to house them in isolated ranges and placing inmates in four-point restraints, sometimes for long periods.
One prisoner reported to Human Rights Watch an incident in which he had been kicking his cell door in anger at a guard and the psychiatrist, who happened to be nearby, threatened to place him in four-point restraints. When the inmate responded with an obscenity, the psychiatrist made good on his threat and the prisoner was placed in restraints for twenty-four hours. According to the prisoner, every four hours, he was asked if he would be willing to take a shot of anti-psychotic medication [113]. Such reliance on restraints for reasons of coercion-to punish inmates for refusing to accept medication-is inconsistent with international rules restricting their use.
The psychiatrist also ordered mentally ill inmates who were on medication to be placed in restraints when he deemed it necessary in their best interests. In one particularly extreme case, he kept an actively psychotic, very depressed, self-mutilating inmate in restraints for over a month, progressively reducing the time in restraints as the prisoner’s behavior improved. In our judgment, such an extended use of four-point restraints is a cruel and medically unacceptable practice. If a prisoner is severely ill and disruptive enough to require extensive placement in restraints, he should be placed in a hospital or other more therapeutic setting than a super-maximum-security cell [114].
Racial Harassment
Prisons are a fertile breeding ground for racial tension and animosity, with racial problems occurring both among prisoners and between prisoners and corrections staff. Prisoners at the SHU-though not the MCF-spoke convincingly of the facility’s atmosphere of racial hostility. Numerous prisoners, most of them African-American but some of them white, claimed that SHU guards were often particularly aggressive and disrespectful toward black prisoners [115].
Mirroring the racial makeup of rural southern Indiana, the great majority of correctional officers who work at the SHU are white. Outside of the prison setting they have had little exposure to urban African-Americans, a group that figures large in the prison population. At the MCF, in contrast, the corrections staff is much more racially diverse, with an African-American superintendent and a substantial number of African-American guards.
Racial harassment by SHU guards was said to take the form of slurs and confrontations. Several prisoners said that the epithet “nigger” was frequently used by certain guards. Another prisoner spoke of a recent incident where he was told that “all blacks look alike.” During Human Rights Watch’s 1996 visit to the facility, prisoners alleged that one guard had a swastika tattooed on his arm.
The racial tensions aggravating relations between prisoners and guards at the SHU are only a subset of a larger racial problem. Some white prisoners at the SHU are self-proclaimed white supremacists-indeed, at least one of them was incarcerated for a violent hate crime-while some black prisoners have black nationalist leanings; the two groups interact poorly. Prisoners claimed that guards sometimes try to perpetuate racial animosities by, for example, deliberately placing a black prisoner in a cell between two known white supremacists.
The way in which prisoner racism and guard harassment can intersect was demonstrated by a situation that Human Rights Watch representatives witnessed during our July 1997 visit to the SHU. Walking through a housing section in the B-East pod, we were startled to find an African-American prisoner in a cell covered with racist graffiti. Among the cell’s more prominent markings was the slogan “White Power,” which was scrawled on the wall in thick, four-foot-high black letters and interrupted by a large swastika; the phrase “fuck all niggers” scratched into the mirror, and an intricate drawing of a hooded Klansman poised over the bed. The prisoner stated that he had been transferred to the cell, which had been defaced by a prior occupant, six days previously in the wake of conflict with a guard.
When questioned as to why a black prisoner was forced to spend over twenty-three hours a day in a cell where he had little to do but contemplate racially offensive symbols and slogans, corrections officers said that the prisoner had been placed there purely out of space considerations: they needed a lexan-covered cell and none other was available. They first stated that a work order was on file requesting that the cell be painted, but then said that because the housing area was already due for general renovations the work order had not in fact been filed. When asked about the urgency of rectifying the situation, they stated that because it did not raise security concerns, it was “not a priority” [116].
Even if, as correctional staff insisted, this situation was not the product of deliberate and conscious racism, it demonstrated extraordinary insensitivity. Particularly given the racially polarized atmosphere evident at the SHU, guards should take pains to alleviate racial tensions, rather than exacerbate them. Although we were told that guards take a racial sensitivity class called “Shades of Grey” as part of their annual training, it is obvious that more needs to be done [117].
Preventing Abuse
Patterns of excessive and unnecessary use of force reflect either toleration by prison administrators or an unwillingness or inability to property supervise and discipline staff. In the unusually fraught environment of super-maximum-security prisons, firm guidance from prison authorities is particularly crucial “Environments in which one group of people is given near total control over another invariably degenerate into places pervaded by mistreatment and abuse,” unless conscious steps are taken to prevent such abuse [118]. Preventive measures include intensive staff training, meaningful disciplinary sanctions for abusive staff, and-perhaps most importantly-strong leadership that sends the message that abuse will not be tolerated and that disciplinary sanctions will be applied.
The history of the MCF and SHU exemplifies the importance of adequate supervision and monitoring of the use of force. In both facilities, changed policies and approaches by management resulted in dramatic reduction in the use of force-and diminished, although by no means extinguished-complaints of abuse. It is worth underscoring as well that the experience of these facilities gives lie to the belief that “the worst of the worst” respond only to heavy-handed force. The dramatic decrease in forcible cell extractions and other incidents of force has not resulted in increased incidents of violence or breaches of security by inmates.
VIII. Psychological impacts of conditions
Concern about the psychological impact of solitary confinement has persisted as long as the practice. That concern has increased in the United States with the proliferation of super-maximum-security prisons in which inmates can be held for years in administrative or disciplinary segregation. There is little doubt that prolonged confinement in conditions of social isolation, idleness and reduced stimulation is psychologically destructive. How destructive depends on each inmate’s prior psychological strengths and weaknesses, the extent of the social isolation imposed and absence of activities and stimulation, and the duration of confinement in those conditions. For individuals with preexisting psychological disorders, it can be devastating. Under international human rights standards, the question arises whether the imposition of mental harm through conditions of segregated confinement constitutes torture or other cruel, inhuman or degrading treatment.
For many inmates at the MCC and the SHU, confinement in isolation is not a new experience. They have been confined in disciplinary segregation at their “home” institutions; some have been at the SHU or MCC before. Some told Human Rights Watch that they “know how to handle it” and insisted “it’s no big deal.” “Doing time is doing time.” They manage to pass the time: they read-a few become avid students of particular subjects, play solitary chess games with handmade paper chess pieces, do legal research and prepare legal documents, write letters, sleep. A few prisoners told us they preferred the security and relative comfort of the restricted environments at the MCF and even the SHU to the bedlam and dangers of general population facilities and to what they claimed were appalling conditions in the disciplinary segregation units at their home institutions. Superintendent Newkirk told Human Rights Watch representatives that at least one prisoner at the MCF is so determined to stay there that he deliberately engages in disciplinary infractions every time his conduct record might otherwise require him to be transferred out. Some inmates, particularly those aided by their strong religious faith or staunch political convictions, impressed us with their strength of character and their apparent ability to continue to develop as human beings despite years of confinement in extreme conditions. Our interviews were too short, however, to ascertain what psychological and emotional scars they may also carry from the experience.
But given the opportunity to describe the experience of the MCF or SHU, most prisoners paint a stark picture of bleak lives, of useless tedium and tension. “Few people can take this type of isolation. I’m suffering, but I can deal with it.” The MCF is “a tomb.” “There’s no way you can know what it’s like for us in here.” “I rarely write [to my family] . . . not much to talk about. I’m not part of the world.” “I have even seen some [inmates] lose their grip on sanity due to the conditions here and due to treatment by staff . . . [T]he goal seem to be . . . to dehumanize and derange all men who encounter the SHU.” The place is “psychological torture “that is “made worse by not being able to see trees or grass or birds” [119]. True to the prison culture of not acknowledging weakness [120], many prisoners we interviewed denied confinement was affecting them psychologically. But one acknowledged vicious mood swings and crying spells as a result of the isolation. Another insisted he was introverted so the isolation did not affect him much. They described feelings of anger and frustration [121]. One inmate claimed he could not tolerate the conditions at the SHU: since he had arrived there his “whole world fell apart” and as a result he acts out by attacking the guards. The SHU, he claimed, “breeds monsters.” Some inmates expressed concern that the experience of prolonged solitary confinement would make it harder for them to adjust to general-population imprisonment or life outside of prison [122].
By its very nature, all “prison confinement may have a deleterious impact on the mental state of prisoners . . . Especially for those facing long sentences, `depression, hopelessness, frustration, and other such psychological states may well prove to be inevitable byproducts'” [123]. But prolonged confinement in conditions such as those at the MCF and the SHU can have an adverse psychological impact far greater than the usual psychological effects of incarceration [124]. The literature on the effects of punitive isolation clearly establishes its potentially damaging consequences [125].
The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) has reviewed a number of European prisons with conditions similar to those of supermax confinement in the U.S. [126]. In these reviews it has affirmed that isolation can militate against reform and rehabilitation and can impair physical and mental health. According to the CPT:
“It is generally acknowledged that all forms of solitary confinement without appropriate mental and physical stimulation are likely, in the long term, to have damaging effects resulting in deterioration of mental faculties and social abilities” [127].
The CPT has criticized isolation units in which for extended periods of time inmates’ activities consisted of spending time alone in their cells with little to occupy them and one hour of outdoor exercise each day [128]. It has insisted that solitary confinement be as short as possible [129], and it has emphasized the importance of activities in special security units to “counter the deleterious effects for a prisoner’s personality of living in the bubble-life atmosphere of such a unit.” It has reminded European governments, “The principle of proportionality calls for a balance to be struck between the requirement of the situation and the imposition of a solitary confinement-type regime, which can have very harmful consequences for the person concerned. Solitary confinement can in certain circumstances amount to inhuman and degrading treatment; in any event, all forms of solitary confinement should last for as short a time as possible” [130].
In the United States, the psychological impact of prolonged confinement in conditions akin to those at the MCF and the SHU has been a focus of several lawsuits [131]. In the landmark case of Madrid v. Gomez, plaintiffs asserted, among other things, that conditions in the secured housing unit of California’s super-maximum-security prison at Pelican Bay caused such psychological harm as to violate the Eighth Amendment of the U.S. constitution. Federal Judge Thelton Henderson concluded that the evidence before him proved that prolonged confinement in such conditions at best “may press the outer bounds of what most humans can psychologically tolerate” [132]. At worst, the conditions have a high risk of provoking or exacerbating serious mental illness. “Although not everyone will manifest negative psychological effects to the same degree, and it is difficult to specify the point in time at which the destructive consequences will manifest themselves, few [long-term supermax inmates] escape unscathed . . . The psychological consequences of living in these units for long periods of time are predictably destructive, and the potential for these psychic stressors to precipitate various forms of psychopathology is clear-cut” [133].
Interviews of inmates at Pelican Bay’s SHU documented the psychopathological effects of long-term segregation: the SHU prisoners possessed extraordinarily high rates of symptoms of psychopathology. The psychologist who conducted the study concluded that the SHU “was inflicting unprecedented levels of psychological trauma on the prisoners . . . and it is producing precisely the kinds of psychopathological effects that have been associated elsewhere with extreme and harmful levels of social deprivation” [134]. The psychologist concluded that the SHU produced such extremely painful psychological consequences that it could be likened to “psychological torture” [135].
Dr. Stuart Grassian, a psychiatrist who has evaluated the psychological impact of several super-maximum-security prisons, has identified a number of psychiatric symptoms frequently observed in prisoners confined in such facilities. His research has led him to conclude that solitary confinement can cause such symptoms as perceptual distortions and hallucinations, massive free-floating anxiety, acute confusional states, delusional ideas and violent or self-destructive outbursts, hyperresponsivity to external stimuli, difficulties with thinking, concentration and memory, overt paranoia, and panic attacks [136]. The conditions of confinement seem to cause symptoms that are usually associated with psychosis or severe affective disorders even though not all of the prisoners who exhibit these symptoms are actively psychotic. The clinical symptoms can be provoked even in healthy personalities, but prisoners who enter solitary confinement with pre-existing psychiatric disorders are at an even higher risk of suffering psychological deterioration and psychiatric decompensation.
A variety of individuals are especially prone to psychopathologic reactions to the reduced environmental stimulation and social isolation of supermax confinement. Professor Hans Toch’s study of prison inmates led him to conclude, for example, that suicidal inmates can be pushed over the edge and pathologically fearful inmates can regress into a psychologically crippling panic reaction [137]. According to Dr. Grassian, “individuals whose internal emotional life is chaotic and impulse-ridden, and individuals with central nervous system dysfunction” are particularly unable to handle supermax conditions, yet among the prison population, these are the very individuals especially prone to committing infractions that result in segregation [138]. Even the expert in prison mental health care retained by the California Department of Corrections for the Madrid v. Gomez litigation acknowledged that some people cannot tolerate supermax conditions. “Typically, those are people who have a pre-existing disorder that is called borderline personality disorder, and there-there’s a fair amount of consistent observation that those folks, when they'[re locked up in segregation] may have a tendency to experience some transient psychoses, which means just a brief psychosis that quickly resolves itself when they’re removed from the lockdown [segregation] situation” [139]. Indeed, individuals with psychopathic personality disorder are, by virtue of their condition, particularly unable to tolerate restricted environmental stimulation [140].
Mental health experts also agree that individuals with histories of psychiatric illness are particularly vulnerable to increased mental suffering and injury from confinement in super-maximum-security conditions. Based on his evaluation of the psychological effects of solitary confinement, Dr. Grassian has concluded that incarceration in supermax conditions can cause “either severe exacerbation or recurrence of pre-existing [mental] illness” [141]. Another expert on the impact of super-maximum-security confinement, Prof. Craig Haney, has concluded:
[P]risoners who enter these places with pre-existing psychiatric disorders suffer more acutely from [the] psychological assaults [of solitary confinement]. The psychic pain and vulnerability that they bring into the lockup unit may grow and fester if it goes unattended. In the absence of psychiatric help, there is nothing to keep many of these prisoners from entering the abyss of psychosis . . . . [For mentally ill prisoners to be] confined in a lockup unit that inflicts levels of social deprivation, virtually complete enforced idleness, totality of surveillance and control, and an absence of meaningful psychiatric treatment . . . poses very serious risks of psychological deterioration and psychiatric decompensation [142].
Many mentally ill prisoners suffer from “a combination of psychiatric disorders predisposing them to both psychotic breakdown and to extreme impulsivity . . . [S]uch individuals [tend] to be highly impulsive, lacking in internal controls, and [tend] to engage in self-abusive and self-destructive behavior in the prison setting, and especially so when housed in solitary . . . . [T]hey are among the most likely to suffer behavioral deterioration” in supermax confinement [143].
In Madrid v. Gomez, a federal district court ruled that it constituted cruel and unusual punishment in violation of the U.S. constitution to confine in the secured housing unit (SHU) of Pelican Bay prison
“those who the record demonstrates are at a particularly high risk for suffering very serious or severe injury to their mental health, including overt paranoia, psychotic breaks with reality, or massive exacerbations of existing mental illness as a result of the conditions in the SHU. Suchinmates consist of the already mentally ill, as well as persons with borderline personality disorders, brain damage or mental retardation, impulse-ridden personalities or a history of prior psychiatric problems of chronic depression . . . . Such inmates are not required to endure the horrific suffering of a serious mental illness or major exacerbation of an existing mental illness before obtaining relief . . . [S]ubjecting individuals to conditions that are `very likely’ to render them psychotic or otherwise inflict a serious mental illness or seriously exacerbate an existing mental illness cannot be squared with evolving standards of humanity or decency . . . A risk this grave-this shocking and indecent-simply has no place in civilized society” [144].
Summarizing his findings, Judge Thelton Henderson trenchantly observed that placing mentally ill or psychologically vulnerable people in such conditions “is the mental equivalent of putting an asthmatic in a place with little air to breathe” [145]. Just as individuals who are prone to severe psychiatric disorders are more likely than the average person to break down in an environment of sensory deprivation, so a person who has a tendency to confuse fantasy and reality, or to regress when stressed or traumatized, or to lose the sense of time in a relatively unstructured situation, is more prone than the average person to break down when placed in an environmental as stressful as a super-maximum-security unit.
Solitary confinement cells are “grossly inappropriate for the mentally ill” because of the need severely disturbed people have for supportive relationships and meaningful, productive activities [146]. For example, mental health practitioners carefully structure each day in residential treatment facilities to ensure that patients do not stay in bed too long or are too idle and that treatment plans include intensive interpersonal interactions (individual and group psychotherapy, meetings to discuss activities, and so forth) as well as vocational training, supervised athletic or arts and crafts. A large amount of empirical research demonstrates that the longer an acutely mentally disordered individual remains acutely disturbed, the worse the prognosis. Rapid and intensive treatment of acute psychiatric disorders offers the best chance for rapid recovery and serves to minimize long-term symptomatology and disability.
The problem of mental breakdown and disability in super-maximum-security units is thus two-fold: First, the conditions of confinement tend to exacerbate pre-existing psychiatric disorders to cause decompensation in individuals who are psychologically vulnerable under duress. Second, with continued confinement in these same conditions-particularly in the absence of meaningful psychiatric services-the afflicted prisoner’s condition tends to deteriorate even further, and the long-term prognosis worsens.
As noted above, our team’s psychiatrists in July 1997 identified many prisoners, particularly at the SHU, who were suffering from serious mental disorders with a range of psychiatric symptoms. It appears that most of them had previous histories of mental disorder prior to super-maximum-security confinement. That is, we cannot say that confinement at the MCF or the SHU caused them to become mentally ill. But their condition was exacerbated by confinement at the MCF and SHU. For example, one psychotic inmate at the SHU interviewed by our team’s psychiatrists has acute panic attacks in solitary confinement that he relieves by self-mutilation. He insisted to us that the opportunity to be taken out of his cell for medical attention, even if only temporarily, was worth the pain.
Some of the mentally ill inmates are well aware of the risks to their sanity from supermax confinement. One actively psychotic prisoner described the effect of being at the SHU in the following terms: “The walls close in on you, it really scares me. You really can’t sleep at night, for weeks at a time, and then you sleep all the time for another two weeks-you can’t really tell whether it’s day or night. Then you get paranoid, and angry.” Another inmate plagued with hallucinations told us the SHU made him “violent and confused.” Another, who is delusional and schizophrenic, told us: “You have angry thoughts. They won’t leave your mind. You want to get back at someone who’s hurt you. On the outside, you can walk away and find your composure. Here you can’t walk away or hide” [147].
Disciplinary Infractions by the Mentally Ill
Mentally ill people often have difficulty complying with rules, especially in prison settings where the rules are very restrictive, the stresses intense, and there is scant assistance to help the prisoners’ manage their disorders. Those whose psychiatric disorders are reflected in aggressive or disruptive behavior can accumulate long histories of disciplinary infractions that land them in administrative segregation or disciplinary detention. Once confined at the MCF or the SHU, the infractions continue. We reviewed official disciplinary records for a number of the actively psychotic prisoners at the SHU whom we interviewed in July 1997. We found, for example, histories of sixty-nine disciplinary “write-ups” in two years at the SHU; ten in two months; forty-eight in two years; thirty-nine in seventeen months. The records we reviewed suggest that mentally ill inmates are most frequently charged with self-mutilation, refusing orders, making threats, throwing urine and feces, assault, battery, disorderly conduct, physically resisting a staff member, destruction of state property, and insolence and vulgarity.
In some cases, it appears the rate of infractions increases once a mentally ill prisoner is transferred to the SHU. For example, one prisoner accumulated a total of thirty-eight conduct reports in nineteen years of incarceration, but in less than three years at the SHU he had received thirty. We do not have sufficient information to know whether this increase is due to a worsening of the underlying psychiatric disorder-and, if so, whether that deterioration was caused by the conditions of confinement-or whether because of the disorder the prisoner has an even harder time adjusting to the highly restrictive conditions and social isolation of supermax confinement.
MCF and SHU staffs do not distinguish between rules violations by the mentally ill and those by healthy prisoners: disruptive or aggressive behavior by the mentally ill receives conduct reports and sanctions. The mentally ill, however, account for the most pressing disciplinary problems that are resolved with use of force, cell extractions, and placements in four-point restraints. Human Rights Watch reviewed official use of force records from 1994 through June 1997 provided to us by SHU officials. The preponderance of names that appear-and appear time and again-are those of mentally ill individuals, including people whom our psychiatrists found to be actively psychotic and suffering from such severe psychiatric disorders as schizophrenia and manic depression [148]. The names of mentally ill individuals also appear regularly on the MCF’s use of force reports.
The net result of the mentally ill prisoners’ inability to adjust to segregation is usually more time in segregation, through the imposition of additional sanctions and the loss of earned time credits. One psychotic inmate, for example, received a sanction of an additional three years in segregation (in addition to verbal reprimands and a six-month loss of telephone privileges) for throwing human waste on the staff. The situation was aptly summarized in a recent story in the Indiana press:
[Wayne Morris, a paranoid schizophrenic confined at the SHU,] spends his time alone in [his] cell, where he sometimes spies devils lurking or hears disembodied voices commanding him to rape women and kill himself. The DOC has twice sent Morris, now 20, for brief stays in its outdated psychiatric unit at Westville, returning him each time to [the SHU]. DOC officials say they intended Morris’ time in solitary at the Wabash Valley disciplinary unit as a temporary measure to break his habit of mutilating himself, leaving nasty scars on his neck and along the inside of his right arm. But Morris responded to the isolation by tossing feces and urine at guards and spitting. He says his captors taunted him. In due course, Morris reaped a stack of conduct violations thick enough to keep in solitary for a long, long time [149].
Although they are not given specialized training in the handling of mentally ill prisoners, some guards react to prisoners’ illness, including bizarre or outrageous behavior, with understanding and compassion. We were struck, for example, by the genuine sympathy which Captain Royal, the officer in charge of the SHU, displayed in talking about certain psychotic prisoners. But we also received numerous reports of mentally ill prisoners who have been kicked, beaten, taunted and harassed by guards. In particular, mentally ill inmates who throw excrement report numerous physical confrontations with guards. In a particularly notorious case, a mentally ill prisoner at the MCF engaged in a range of bizarre behavior, including smearing feces all over his body, and was aggressive towards the staff. To control his habit of spitting at the guards, he was forced to wear a hockey mask on his face whenever he was taken out of his cell. According to other prisoners, he was also beaten by the staff on more than one occasion.
We do not believe the DOC has intended to cause mentally ill inmates increased pain and suffering by placing them at the MCF and the SHU. Rather, the DOC confines mentally ill and dangerous or disruptive inmates at these facilities because it has not created alternatives. The MCF and especially the SHU are essentially institutions of last resort for inmates who present severe management problems for correctional officials, regardless of the mental health origin of those problems. The Indiana DOC must develop secure facilities in which appropriate mental health treatment could be provided to mentally ill and dangerous or disruptive inmates who do not meet current criteria for acute-care inpatient hospitalization but who require intensive long-term mental health treatment [150]. It cannot, consistent with fundamental decency and international human rights, continue to respond to inappropriate behavior at the MCF and the SHU “as the occasion to increase punishment, rather than as a reflection of the destructive effects of conditions that they themselves created, and a manifestation of psychiatric problems that they refused to adequately treat” [151].
IX. Mental health treatment
The cruelty of housing mentally ill inmates in conditions that are likely to be psychologically destructive is compounded by the failure of the DOC to ensure they receive adequate psychiatric treatment. The insufficient mental health services provided at the MCF and the SHU are cause for scandal [152].
Staffing
The mental health staff at MCF in July 1997 consisted of a behavioral clinician with a Masters degree in counseling psychology, who also served as the superintendent’s administrative assistant-a position that left him unable to devote much time to his mental health responsibilities. There was no psychiatrist on staff; the psychiatrist in charge of the inpatient unit at Westville was called upon to provide psychiatric services, but his schedule left him little time to visit the MCF.
At the SHU, a psychiatrist was under contract with the Indiana DOC to provide care at the SHU four days a week. In addition, a psychologist (working twenty hours a week), and four part-time mental health professionals (including a masters-level psychologist, a social worker and other therapists) provided a total of eighty hours a week to service both the SHU and the entire WVCF facility (a total of approximately 1,000 prisoners; ). The WVCF medical director stated
repeatedly and with exasperation to Human Rights Watch that the facility lacked enough mental health staff to provide adequate support and services for the number of mentally ill inmates sent to the SHU.
Subsequent to our visit to the MCC and the SHU in July 1997, new medical and mental heath staffing was instituted. A new psychologist has joined the staff at the MCC, replacing the behavioral clinician assigned to the unit. As of September, medical services at both facilities were being provided by a private health corporation, Prison Health Services. Our review addresses conditions as we found them prior to these changes.
Screening and Monitoring
Neither the MCF nor the SHU provide appropriate mental health screening and monitoring of inmates [153]. Adequate corrections practice includes mental health screening upon admission to supermax housing [154]. At the MCF, there was no screening at all of the inmates transferred for disciplinary segregation. The behavioral clinician claimed that he screened inmates who were transferred there for administration segregation, but the presence at the MCF of psychotic individuals with histories of psychiatric disorders suggests that the screening was inadequate [155].
The monitoring of the mental health status of prisoners in super-maximum-security confinement is crucial because of the well-known possibility that the stresses of such confinement can precipitate or exacerbate psychiatric symptoms [156]. Effective monitoring permits prompt identification of problems and timely intervention [157]. Under the terms of the Agreed Entry and its subsequent modification, inmates in administrative segregation at the MCF were to be monitored for mental health every thirty days. Inmates in disciplinary segregation on medication were to be monitored “appropriately,” and any “prisoners who displays signs of mental disturbance as determined by the mental health staff shall receive a mental health evaluation.” These requirements were not met. The behavioral clinician acknowledged to us in July 1997 that he had not been able to fulfill his monitoring responsibilities for several months and that he never monitored inmates in disciplinary segregation. But inmates and guards told us that even administrative segregation inmates at MCF inmates had never had regular meetings with the behavioral clinician for purposes of psychological monitoring.
The absence of monitoring for DSU inmates was particularly egregious. Those inmates received no pre-transfer mental health screening-which makes monitoring even more important. Moreover, the modified Agreed Entry permits the Indiana DOC to place in disciplinary segregation at the MCF prisoners who are mentally ill inmates and receiving psychotropic medication. Such a population requires close monitoring of the symptoms of the illness, the efficacy of medication, and any negative side effects.
At the SHU, the psychiatrist visits new inmates within a week of their arrival at the facility to determine whether they require mental health treatment, i.e., whether they were on or need to be on medication. After the initial meeting at the prisoner’s cell door-which lasts between a few minutes and an hour-there is no regular, timely monitoring of each inmate’s mental health status. Mental health staff simply lack the time to provide such monitoring, acknowledging that they are not even able to appropriately monitor all the prisoners on medication.
Treatment and Care
The treatment of mentally ill inmates at the MCF and the SHU is egregiously deficient. There are too few qualified mental health professionals to attend to the large number of seriously mentally disordered prisoners, and there are too few therapeutic treatment options [158]. Too many seriously ill inmates go untreated or undertreated because their symptoms are dismissed by staff as faking or manipulation. The physical design and the rules of social isolation and forced idleness at the MCF and the SHU also preclude treatment measures that would help mentally ill inmates. In other words, the very conditions that can exacerbate mental illness also impede treatment and rehabilitation.
The staff’s insistence that they will not respond to manipulative behavior creates serious problems for the delivery of adequate mental health care. For instance, at the MCF the behavioral clinician is responsible for screening inmate requests for meetings with a psychiatrist. He acknowledged to us that he rarely refers inmates to the psychiatrist; he believes most inmates are faking their symptoms and do not need medication. Thus, for example, he ignored a written request to see a psychiatrist by an inmate who stated that he had a history of schizophrenia and needed to be put back on his medications because he was becoming increasingly suicidal and psychotic. Without ever having met with the prisoner or reviewing his records, the behavioral clinician told us that he thought this inmate was malingering and was not schizophrenic. He also noted gratuitously that the prisoner was a “known homosexual,” as though that justified ignoring his psychiatric concerns.
The behavioral clinician at the MCF also expressed to us the view that even most cases of self-mutilation reflected no more than an inmate’s desire to be transferred out of the MCF. There is no question that behavior such as self-mutilation can be manipulative. But it can also be a symptom of a major psychiatric disorder or a self-reinforcing behavior that requires a psychiatric response. In facilities in which the staff lack either the time or the inclination to pay close attention to prisoner complaints, the only option left to a prisoner is to manipulate in some way-for instance by creating a disturbance or exaggerating his pain-if he is to get any attention at all. The less attentive the staff, on average, the more manipulative the prisoners have to be to get attention, and this is true for prisoners who are suffering from serious medical or psychiatric ailments as it is for those who are not ill but merely want attention. In other words, seriously ill prisoners are also frequently “manipulative” [159].
Absent careful evaluation through diagnostic work-ups, it is impossible to determine whether a self-mutilating individual has genuine psychiatric problems-for instance, he might be commanded by hallucinatory voices to cut himself-which, in turn, he may be exaggerating in order to receive needed help. The situation at the MCF appears to be one in which the “prevailing apprehension among custody and clinical staff [is] of being manipulated into delivering psychiatric services . . . The suspicion of malingering and its accompanying withholding of services are particularly acute in the management of self-mutilation and explosive disorders” [160].
The consequences of this attitude are predictable: seriously mentally ill inmates receive very little professional help. For example, one inmate who had been intermittently under psychiatric care since the age of four, was unable to tolerate solitary confinement and was one of the worst self-mutilators in the history of the MCF. He was repeatedly deemed free of psychiatric disorders and received no treatment. He was eventually sent to the SHU, where we interviewed him. Despite a regime of psychotropic medication, he was still actively hallucinating, displayed other symptoms diagnostic of schizophrenia, and was very depressed. Another MCF inmate requested a meeting with a psychologist upon arrival at MCF because he was upset about the recent death of a sibling and because he would “get angry for no reason.” He quickly accumulated a record of numerous disciplinary infractions at the MCF which resulted in several cell extractions. At the time of Human Rights Watch’s July 1997 visit, two months after this prisoner’s transfer to MCF, he was actively psychotic and manic depressive. Despite a total of three requests for help, he had still not been visited by the behavioral clinician. (The clinician first denied having relied any requests for a meeting, and then, after checking his files, acknowledged that a request had been made by that he had not yet responded.) This inmate should not have been sent to or kept at the MCF. But many, if not most, of his disciplinary problems at MCF might have been avoided if he had received the mental health treatment he sought.
A similar counter-therapeutic attitude prevails at the SHU. The psychiatrist there told us that many of the inmates receiving psychotropic medications were faking psychotic symptoms “to make an excuse of mental illness.” In some cases, the psychiatrist labeled as “manipulative” symptoms that in our judgment, based on interviews with the individual prisoners, were clearly signs of serious psychiatric disorders. But we were also disturbed by his stated willingness to give psychoactive medication to prisoners who are not psychotic. He justified this practice to us with the explanation that while not psychotic, the prisoners did have a mental illness, usually an affective disorder. He admitted that it was not standard medical practice to prescribe antipsychotic medications to treat such disorders. Because many inmates would not take medications willingly, he gives them long-acting intramuscular injections, and the only medications available in this form are antipsychotics [161]. We concluded that he prescribed the medication primarily to control the behavior of disruptive inmates and to reduce aggressive acting out.
Some of the inmates at the SHU are self-mutilators. According to the psychiatrist, these inmates were hurting themselves in order to be sent out of the SHU to a hospital where conditions, presumably, were less onerous. After insisting that the severe self-mutilation of one particular inmate was not related to mental illness, he was at something of a loss to explain why that inmate received high doses of three different antipsychotic medications. (In our judgment, the inmate was psychotic and suffering from schizophrenia.) The psychiatrist also dismissed complaints of side effects from medication as “faking.” He could offer no rationale, however, for why inmates would choose to fake such well-known psychotropic side effects such as akathisia (which includes restlessness and persistent, involuntary muscle movements).
At both facilities, prisoners suffering from severe and chronic mental disorders were underdiagnosed and undertreated. The behavioral clinician at the MCF has limited therapeutic responsibilities. He provides a substance abuse treatment course to a few inmates and meets with prisoners who ask to talk with him for counseling purposes. While the discussions with him may well be helpful, the behavioral clinician is not trained to provide-and no one else comes to the facility to provide-individual psychotherapy or treatment to severely ill individuals. No psychiatrist regularly attends to MCF inmates.
At the SHU, the psychiatrist had a list of 130 inmates requiring mental health attention. He told us that he was able to visit all of them at least once a week. According to numerous inmates we interviewed, the visits were fleeting: the psychiatrist stopped at their door, asked how they were doing, and moved on before they had time to respond with more than a word or two. The psychologists had somewhat longer visits with a small number of prisoners. But many prisoners complained to us that they had been unable to meet with psychologists, despite repeated requests, because they were so overbooked, a problem the psychologists confirmed.
Most of the inmates’ meetings with the SHU mental health staff occur at the cell door within earshot of guards and other prisoners. For security reasons mental health staff do not enter the inmate’s cell, but there are not enough custody staff to apply handcuffs and chains and to escort each prisoner who wants to meet with psychologists in a private room. The lack of privacy precludes one of the fundamental prerequisites for meaningful therapy. It has other unfortunate consequences as well. For example, one inmate told a member of the mental health staff about being raped as a child. The conversation, which took place at his cell door, was overhead by correctional officers, who reportedly spread the word around the prison, exposing the inmate to harassment and humiliation.
The SHU’s psychiatrist told us that he developed a treatment plan for each of the inmates he was caring for and the prisoner’s progress would be reviewed in the weekly team meetings of himself, the psychologists, custodial, nursing and other staff. Treatment consisted primarily of medication, although it also included limited meetings at the cell doors and confinement. In our judgment, mentally ill inmates require additional treatment options. In the community, mental health treatment programs employ a variety of interventions besides psychopharmacology, including group therapy, private individual therapy or counseling, milieu meetings, training in the skills of daily living, psychoeducation aimed at teaching patients about their illness and the need to comply with medication regimes, educational programs, vocational training, other forms of psychiatric rehabilitation, family therapy, supervised recreation, and so forth. In an adequately effective mental health treatment program, some or all of these components play a crucial part in restoring or improving mental health or, at the very least, in preventing further deterioration in the patient’s psychiatric condition.
Human Rights Watch does not recommend particular forms of mental health treatment. Rather, we wish to emphasize to the Indiana DOC that there is a consensus among mental health practitioners that simply confining the mentally ill and prescribing medication is not an adequate treatment plan. Yet, with the exception of medication, the MCF and the SHU do not make available additional effective treatment options. Psychotherapy and counseling are frustrated by the lack of privacy and the lack of staff with whom mentally ill prisoners could have the frequent and meaningful interaction necessary for successful therapeutic interventions. We also wish to underscore the fact that certain treatment options are precluded by rules at the MCF and the SHU which mandate social isolation and idleness. These rules fly in the face of the medically accepted fact that most mentally disordered people need to interact with other people, even if only in incremental socialization. They benefit from group therapy and psychiatric rehabilitation activities. They need structured days. If a person is too disturbed or angry to be with others, he needs a treatment plan that will slowly move him in the direction of socialization. We recognize that security considerations are significant at both facilities, but we believe the Indiana DOC has not sought to develop ways of providing appropriate mental health treatment options within the context of reasonable security precautions.
In July 1997 there were seventy-three inmates at the SHU receiving psychotropic medication. Not having access to prisoner’s medical records nor being able to review each case with the SHU’s psychiatrist, we cannot reach firm conclusions about the medication being given to SHU inmates we interviewed. For some of the inmates, the medications seemed to control their symptoms reasonably. But a sizeable number of prisoners on antipsychotic medications continued nonetheless to have very significant symptoms. This suggests that they may be refractory to standard antipsychotics. In cases where the standard medications do not seem to be fully effective, the prisoners might benefit from one of the new so-called “atypical” antipsychotics that were not, however, available to SHU inmates. But continued symptoms in prisoners on medication might also reflect the impact of conditions of confinement. That is, living at the SHU may have caused more severe psychiatric symptomatology than it is possible to alleviate with medication while the prisoner continues to be subject to the effects of those conditions. We do not have sufficient data, however, to form any conclusions about this possibility.
X. RELEASE FROM THE MCF AND THE SHU
Upon release from either facility, prisoners with additional time remaining on their sentences are sent to other prisons, usually the institutions from which they came. If an inmate’s sentence terminates either prior to or at the same time as completion of his term at the MCF or SHU then he is released to society. Good correctional practice encourages transitional programs to prepare inmates for return to life in society [162]. At the MCF there is a “transition” program for Level 5 inmates, who spend ninety days in a lower-rated facility, but there is none for Level 4 (DSU) inmates. Authorities at the SHU have instituted a pre-release orientation
program for inmates that consists of written materials, tapes, and cell-door visits by relevant staff. Regardless of the amount of time he has spent in disciplinary segregation, an inmate is not given opportunities to interact with other inmates or to live in less restrictive conditions prior to release [163]. He is taken from a life of stringent controls and isolation and released to the street.
Although the Indiana DOC asserts that very few prisoners are released from a secured housing facility directly to the street, prison records and interviews with prisoners suggest otherwise. Of the 153 inmates in disciplinary segregation at the MCF at the time of Human Rights Watch’s visit in July 1997, thirty have projected release dates from the MCF that are the same as their prison release date. During our 1996 visit to the SHU, twelve of the thirty inmates we interviewed were due to be released directly to the street.
To our knowledge, no one in Indiana or elsewhere in the United States has studied what happens to inmates who have been confined for lengthy periods in super-maximum-security conditions and then released directly into the community. Expert opinion and common sense suggest that absent programming and services, inmates who have endured solitary confinement in such settings will have great difficulty adjusting to freedom. Prisoners themselves are concerned about the prospect. Dr. Stuart Grassian describes the problem as follows: “Imagine taking a dog that has bitten someone, and kicking and beating and abusing it in a cage for a year. Then you take that cage and you put it in the middle of a city, open it and hightail it out of there. That’s what you’re doing” 164].
References
[81] Allegations of physical abuse are common in litigation involving super-maximum-security facilities in other states. Prisoners challenging conditions at Marion federal prison alleged, for example, that “guards frequently beat [them], conduct[ed] the rectal searches in an unnecessarily brutal, painful and humiliating manner, and generally behave[d] as lawlessly as the prisoners.” Bruscino v. Carlson, 854 F. 2d 162, 166 (7th Cir. 1988). In Madrid v. Gomez, the court foundpervasive custodial abuse at California’s super-maximum security Pelican Bay prison-including incidents of shocking brutality-and appointed a special master to oversee reforms. 889 F. Supp. 1146. See also Letter to Parris N. Glendening, Maryland governor, from Deval L. Patrick, assistant attorney general, U.S. Department of Justice, Civil Rights Division, May 1, 1996, p. 10 (in describing unconstitutional conditions at a Maryland super-maximum-security prison, stating that investigators had heard numerous allegations “that staff at Supermax are using excessive force against the inmates out of the range of Supermax cameras.”).
[82] See Standard Minimum Rules, Article 54(3) (stating that staff in direct contact with prisoners should not be armed). The facilities do have gas guns (which they keep locked up) that shoot non-lethal wooden blocks. This gun was used once at the SHU in 1994 against an inmate who destroyed his cell property and refused to leave his cell. Human Rights Watch interview, Assistant Superintendent Ron Batchelor, SHU, April 22, 1996.
[83] See SHU Offender Handbook (copy on file at Human Rights Watch).
[84] Indiana Department of Corrections, “The Use of Physical Force,” Policy No. 02-01-109, Manual of Policies and Procedures (effective December 17, 1991), p. 1.
[85] Ibid.
[86] Ibid, section 4.
[87] Standard Minimum Rules, Article 54(1).
[88] Human Rights Watch interview, MCC prisoner, June 25, 1995.
[89] Human Rights Watch interview, MCC, June 27, 1995.
[90] Human Rights Watch interviews, SHU prisoners, April 22, 1996.
[91] Report of disciplinary hearing, May 23, 1995.
[92] Human Rights Watch interview, SHU, July 16, 1997.
[93] Human Rights Watch representatives watched videos of cell extractions during our visits to the MCF and the SHU.
[94] Amended and Corrected Declaration of Steve J. Martin, Madrid v. Gomez, C-90-3094 the (JSB) (N.D. Ca. Oct. 7, 1993), p. 6
[95] Ibid., pp. 4-5.
[96] Human Rights Watch interview, Mike Scott, administrative head, MCC, June 27, 1995.
[97] Human Rights Watch has on file copies of the physical force reports of the MCF from July 12, 1991 to July 7, 1997.
[98] Human Rights Watch has on file copies of the use of force records for the SHU from January 1, 1994 through July 15, 1997.
[99] Faced with a similar staff justification for cell extractions in the secured housing unit of the super-maximum security facility at Pelican Bay, California, an expert in use of force issues pointed out: “Assuming…the meal tray could be turned into a weapon and therefore had to be retrieved, the amount of force needed to effect this security interest is simply that needed to secure the meal tray itself.” Amended and Corrected Declaration of Steve J. Martin, Madrid v. Gomez, p.13.
[100] Human Rights Watch interview, Mike Scott, administrative head, MCC, June 27, 1995.
[101] He pointed out that to the extent they are used, cell extractions are more common in the DSU pods. Those pods house a higher proportion of younger prisoners, who tend to have greater difficulty acclimating to the MCF environment. Human Rights Watch interview, July 15, 1997.
[102] Charles Fenton, a U.S. prisons expert and former warden of Marion penitentiary, has expressly recommended such an approach. In his view, “While there is a reasonable possibility of avoiding the extraction without undue exertions, staff should talk to the inmate, be that for a period of six minutes or six hours.” Declaration of Charles E. Fenton, Madrid v. Gomez, Case No. C-90-3094 THE (JSB) (N.D. Ca., Sept. 27, 1993).
[103] Indiana DOC, “Use of Physical Force” sec.7.
[104] Ibid.
[105] See Standard Minimum Rules, Article 33: “Instruments of restraint . . . shall not be used except in the following circumstances: as a precaution against escape . . . on medical grounds . . . by order of the director, if other methods of control fail, in order to prevent a prisoners from injuring himself or others or from damaging property.” Article 34 specifies that “Such instruments must not be applied for any longer than is strictly necessary.” For a review of the standards of medical, corrections and other associations regarding the use of restraints, see Physicians for Human Rights, Cruel and Inhuman Treatment: The Use of Four-Point Restraint in the Onondaga County Public Safety Building, Syracuse, New York (Boston: Physicians for Human Right, May 1993).
[106] American Correctional Association, 1996 Standards Supplement (Lanham, MD: American Correctional Association, 1996), p.88.
[107] In some cases, the records do not note the amount of time in restraints.
[108] Komyatti also said that the guards prepared food and ate in front of him during his hunger strike, after he had gone without food for thirty-four days. Human Rights Watch interview, MCC, June 26, 1995.
[109] Komyatti v. Wright, No. 3:93-CV-0687RM (N.D. Ind. Apr. 14, 1995) (memorandum opinion), pp. 10-11.
[110] Human Rights Watch interview, July 16, 1997.
[111] Human Rights Watch interview, July 16, 1997.
[112] New procedures governing the involuntary administration of medication were established under Executive Directive No. 97-22, dated May 16, 1997. The procedures call for a due process hearing prior to involuntary medication except in emergency situations.
[113] Human Rights Watch interview, July 16, 1997.
[114] See, for example, National Commission on Correctional Health Care (NCCHC), Standards for Health Services in Prisons (“Generally, an order for therapeutic restraint . . . should not exceed 12 hours”); Report of the Task Force on Psychiatric Services in Jails and Prisons, American Psychiatric Association, “Psychiatric Services in Jails and Prisons, Task Force Report No. 29, March 1989; K. Tardiff, The Psychiatric Uses of Seclusion and Restraint (Washington, D.C.: American Psychiatric Association, 1984) (stating that all other intervention possibilities should be exhausted prior to resorting to any form of restraint, and that lengthy confinement in seclusion without constant monitoring and therapeutic conversation is not permissible); Nancy Heveloff Dubler, ed., Standards for Health Services in Correctional Institutions (Washington, D.C.: American Public Health Association, ed., 1986), pp. 41-42 (“if after four hours in restraints the inmate remains in a highly agitated state . . . the staff should arrange for removal of the inmate to the hospital”).
[115] Some white prisoners, however, insisted that the guards had a disrespectful attitude toward all prisoners-what black prisoners called racism, they called equal treatment. In their view, references to race were simply another weapon in the guards’ arsenal of insults. Human Rights Watch interviews, SHU, July 16-17, 1997.
[116] Human Rights Watch interview, two correctional officers, July 17, 1997.
[117] Human Rights Watch interview, Craig Hanks, superintendent, SHU, July 17, 1997.
[118] Declaration of Craig Haney, Ph.D., Madrid v. Gomez, C-90-3094 THE (N.D. Ca. Sept. 14, 1993), para. 29 (hereinafter “Haney declaration”).
[119] Human Rights Watch interview, July 14-17, 1997.
[120] “As a rule, prisoners struggle to conceal weakness, to minimize admissions of psychic damage or pain. It is part of a prisoner ethic in which preserving dignity and autonomy, and minimizing vulnerability, is highly valued.” Declaration of Craig Haney, Ph.D., Coleman v. Wilson, CIV S 90-0520 LKK-JFM (E.D. Ca.), para. 46.
[121] Psychologists have emphasized that the deprivations and restrictions of super-maximum-security confinement can fill prisoners “with intolerable levels of frustration. Combined with the complete absence of activity or meaningful outlets through which they can vent this frustration, it can lead to outright anger and then to rage. This rage is a reaction against, not a justification for, their oppressive confinement.” Ibid.
[122] Numerous prisoners confined in the secured housing unit of California’s super-maximum-security prison at Pelican Bay expressed similar concerns during extensive interviews with psychologists. See, for example, Haney declaration.
[123] Madrid v. Gomez, 889 F. Supp. at 1262 (citations omitted).
[124] Concern about the psychological impact of rigid solitary confinement in U.S. penitentiaries in the nineteenth century contributed to changed regimes. Charles Dickens, who toured the United States in 1842, described conditions in the Philadelphia prison: “The system here is rigid, strict and hopeless solitary confinement . . . [The prisoner] is a man buried alive . . . dead to everything but torturing anxieties and horrible despair.” Quoted in P. Liederman, “Man Alone: Sensory Deprivation and Behavior Change,” Correctional Psychiatry and Journal of Social Therapy 8 (1962), p. 66.
[125] As one expert stated, “I know of no credible expert on corrections, human behavior in institutional settings, or psychiatry or psychology in general who would argue that confinement in [segregated solitary confinement] does not pose any significant psychological and psychiatric risks for prisoners.” Haney declaration, para. 73.
[126] CPT, “Report to the Norwegian Government on the visit to Norway carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment from 27 June to 6 July 1993,” Strasbourg, France, 21 September 1994, CPT/Inf (94).
[127] CPT, “Report to the Finnish Government on the visit to Finland carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment from 10 to 20 May 1992,” Strasbourg, France, 1 April 1993, CPT/Inf (93) 8.
[128] Ibid.
[129] CPT, “Report to the Swedish Government on the visit to Sweden carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment from 23 to 26 August 1994,” CPT/Inf (95) 5.
[130] CPT, “Report to the Icelandic Government on the visit to Iceland carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment from 6 to 12 July 1993, Strasbourg, France, 28 June 1994, CPT/Inf (94) 8, p. 26. In reviewing the practice of solitary confinement in one of Iceland’s prisons, the CPT notes that a report by the country’s minister of justice states that “psychiatrists, psychologists and other specialists have stressed that solitary confinement as practiced [at the prison] has a harmful effect on prisoners’ mental and physical health, particularly in the case of those detained for long periods.”
[131] See, for example, Eng. v. Coughlin, 865 F. 2d 521 (2d. Cir. 1989); Coleman v. Wilson, 101 F.3d 705 (9th Cir. 1996); Torres v. Dubois, Civil Action No. 94-0270E (filed 1995), Madrid v. Gomez, 889 F. Supp. 1146 (N.D. Cal. 1995).
[132] Madrid v. Gomez, 889 F. Supp. at 1267.
[133] Haney declaration, p. 5.
[134] Ibid., para. 55.
[135] Ibid., para. 118.
[136] Human Rights Watch interview, Dr. Stuart Grassian, Newton, Massachusetts, June 19, 1997.
[137] Fred Cohen, Legal Issues and the Mentally Disordered Prisoner (Washington, D.C.: NIC/DOJ, November, 1988), p. 92. See also Hans Toch, Men in Crisis: Human Breakdown in Prison (1975).
[138] Declaration of Dr. Stuart Grassian, Eng v. Coughlin (80-CV-385S, undated) (hereinafter “Grassian declaration”).
[139] Testimony of Joel Dvoskin, quoted in Madrid v. Gomez, 889 F. Supp. at 1216 (emphasis added by the court).
[140] Grassian declaration, citing H. Quay, “Psychopathic personality as pathological stimulation seeking,” American Journal of Psychiatry 122 (1965), pp. 80-83.
[141] Grassian declaration, p. 7.
[142] Haney declaration, para. 56.
[143] Grassian declaration,citing G. Cota & S. Hodgins, “Co-occurring mental disorders among criminal offenders,” Bulletin of the American Academy of Psychiatry and Law 18, no. 3, pp. 271-81.
[144] Madrid v. Gomez, 889 F. Supp. at 1265-66 (citations omitted).
[145] Ibid. at 1265. Another one federal court had earlier explained, “[E]xperts concurred that the use of isolation for disturbed inmates violates all modern treatment practice and is potentially destructive and physically dangerous. Disturbed persons need at a minimum to be observed and not to feel isolated and abandoned. Isolation is counterproductive in terms of treatment.” Laaman v. Helgemoe, 437 F. Supp. 269, 280 (D.N.H. 1977).
[146] Edward Kaufman, M.D., “The Violation of Psychiatric Standards of Care in Prisons,” American Journal of Psychiatry 137, no. 5 (May 1980), p. 567.
[147] Human Rights Watch interviews, MCF and SHU prisoners, July 14-17, 1997.
[148] Prisoners whose names regularly appear on the use of force reports may also be suffering from “intermittent explosive disorder as defined by the DSM-III-R” or persistent intense anger. Verbal and physical assaults secondary to these disorders are characterized by impulsivity, lack of premeditation, inability of the individual to modulate his behavior, disproportionate response to the perceived provocation, and remorse after the acting out. They should be distinguished from deliberate and purposeful attacks. These disorders and their accompanying behavioral expressions should not be automatically, simplistically, and solely considered as symptoms of antisocial personality disorder which are managed by punishment and physical restrictions alone. NIC/DOJ, Prison Health Care, pp. 149-150.
[149] Kevin Corcoran, “Sick Justice: A Plea for Help,” The Times (Munster, Indiana), September 14, 1997.
[150] The DOC operates a psychiatric facility at Westville for inmates requiring acute psychiatric hospitalization. It does not provide secure care for dangerous or disruptive mentally ill inmates who do not need hospitalization. We were told of several instances of prisoners sent to Westville from either the MCF or the SHU who were subsequently returned to those facilities after a finding that they did not require hospitalization or after a brief period of treatment. This problem is not unique to Indiana. “All too often, self-mutilating inmates and the aggressive mentally ill are shuttled back and forth between regular prison units and inpatient psychiatric facilities. Unit staff keep referring them for treatment because they do not know how to manage them, and staff at the psychiatric facility keep refusing them because they do not meet standard criteria for inpatient care. Often, the default option for such inmates is placement in restraints or administrative segregation, neither of which serves either the inmate or the institution well.” NIC/DOJ, Disruptive Maximum Security Inmate Management Guide, p. 147.
[151] Declaration of Craig Haney, Ph.D., Coleman v. Wilson, para. 80.
[152] An Indiana newspaper, The Times, recently published a stunning indictment of the treatment of mentally ill prisoners in Indiana. The eight-part series by reporter Kevin Corcoran, titled “Sick Justice,” ran from September 14 to 20, 1997. One article explained: “Growing evidence points toward an inescapable conclusion: Indiana’s prisons soon will displace state mental hospitals as the dominant long-term institutional care for the seriously mentally ill . . . The Indiana Department of Corrections, by blunt admissions of its top administrators, is not suited to the task of preparing sick inmates for their eventual return to society . . . Treatment takes a back seat to the primary mission of keeping inmates locked up while protecting prison workers . . . [A psychologist ] describes care given Indiana’s mentally ill prisoners as “absolutely atrocious by any standard.” Kevin Corcoran, “Prison Mental Health Care: `Absolutely Atrocious,'” The Times (Munster, Indiana), September 19, 1997.
[153] According to the National Commission on Correctional Health Care (NCCHC), an accreditation body, all inmates in disciplinary segregation should be evaluated by qualified health personnel “prior to placement in segregation and daily while in segregation . . . Inmates placed in segregation who have been receiving mental health treatment should be evaluated by mental health personnel within 24 hours of being placed in segregation. The evaluation should be documented and placed in the health record.” Standard P-43. NCCHC, Standards for Health Services in Prisons (Chicago: NCCHC, 1997), p.53.
[154] See, for example, NIC/DOJ, Disruptive Maximum Security Inmate Management Guide, p. 74. Human Rights Watch was not able to review prisoner medical records and cannot comment on the nature or thoroughness of mental health evaluations undertaken before transfer to the MCF or the SHU. Our research suggested, however, that mechanisms may be inadequate for forwarding information about the mental health of transferred inmates. For example, although the front sheet of each inmate’s medical file reports psychological problems detected at the intake psychological evaluation, subsequent diagnoses or treatment initiated after the inmate was incarcerated apparently are not always incorporated into the inmate’s records and forwarded to the new facility. One inmate, for example, arrived at the MCF having been on antidepressants at his prior facility. Although his file included a record of the prescription, there was no diagnosis or notes from the prescribing psychiatrist that would assist other doctors in understanding his condition.
[155] According to the behavioral clinician, his “screening” to make sure mentally ill prisoners had not been transferred to the MCF consisted of asking inmates a few questions at their cell door, for example, whether they had thoughts of suicide. He did not review their medical and psychiatric records prior to meeting with them and did not do a formal mental status exam or thorough psychiatric history with the inmates. Most of his meetings with the inmates are conducted at the front of the cell where the presence of guards and other inmates discourages forthcoming responses to questions of a sensitive nature. Records of the information communicated in these meetings were not kept routinely. Human Rights Watch was shown an MCF publicity video showing a new inmate being given a psychological evaluation in a private room upon transfer to the facility. The dialogue on the tape also indicated that a formal evaluation was written for each inmate with recommendations to the staff for how to deal with him. The behavioral clinician acknowledged to us, however, that private evaluation meetings and written reports were rare.
[156] The NCCHC requires that inmates in administrative segregation should be “evaluated by qualified health personnel at least three times a week.” NCCHC, Standards for Health Services in Prisons, Standard P-45, p.55. The ACA requires that a “qualified mental health professional personally interviews and prepares a written report on any inmate remaining in segregation for more than thirty days. If confinement continues beyond thirty days, a mental health assessment by a qualified mental health professional is made at least every three months — more frequently if prescribe by the chief medical authority.” ACA, Standards for Adult Correctional Institutions 3rd Edition, Standard 3-4244, p. 81.
[157] “It is well established in the case of people who are suffering from psychotic decompensation that the sooner the gross symptomatology is controlled by an appropriate medication regimen and other mental health treatment modalities, the better the eventual prognosis. Thus, leaving a psychotic or seriously depressed inmate alone in a cell to suffer for long periods of time…is quite cruel and is likely to cause significant deterioration in their mental condition over time.” Declaration of Terry Kupers, M.D., Coleman v. Wilson, CIV S 90-0520 LKK-JFM (E.D. Ca. Feb. 16, 1993), p. 41.
[158] Article 62 of the Standard Minimum Rules states that “The medical services of the institution shall seek to detect and shall treat any physical or mental illnesses or defects which may hamper a prisoner’s rehabilitation. All necessary medical, surgical and psychiatric services shall be provided to that end.”
[159] Dr. Terry Kupers, a member of the Human Rights Watch delegation that visited the MCF and the SHU in July 1997, has seen several cases of successful suicides in prisons in other states where the prisoner’s chart contained a notation by mental health staff, days before the death, to the effect that the prisoner was merely manipulating to get attention.
[160] NIC/DOJ, Prison Health Care: Guidelines for the Management of an Adequate Delivery System, p. 148 (quoting from correspondence from Walter Y. Quijano, December 3, 1990).
[161] We were concerned at the willingness of the psychiatrist to forego perhaps more medically appropriate medication in pill or liquid form in favor of injectables because of his concern about prisoners hoarding them to overdose or for sale. We were rather surprised, if not incredulous, at his claim that prisoners would “cheek” (i.e., store in their mouths) liquid medicine, and were dismayed at the assertion that the nursing staff which distributes medication does not have the time and is not authorized to watch the inmates to make sure they take their medication.
[162] According to Article 60(2) of the Standard Minimum Rules, “Before the completion of the sentence, it is desirable that the necessary steps be taken to ensure for the prisoner a gradual return to life in society. This aim, depending on the case, by a pre-release regime organized in the same institution or in another appropriate institution, or by release on trial under some kind of supervision.”
[163] The NIC/DOJ, Disruptive Maximum Security Inmate Management Guide recommends the “provision of special privileges, e.g., small group activities, to disruptive inmates who are nearing release from the unit.” p. 87.
[164] Human Rights Watch interview, Newton, Massachusetts, June 19, 1997. Dr. Grassian and Dr. Haney know of at least a half-dozen cases of inmates released from the Pelican Bay SHU who promptly committed murder or other serious felonies. Spencer P.M. Harrington, “Caging the Crazy: `Supermax’ Confinement Under Attack,” The Humanist, January/February 1997, pp. 14-19.
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