The High Cost of (No) SuperMax

Recently NPR featured a story on All Things Considered about the state of Illinois closing its SuperMax prison in Tamms. The story talked about the fact that the prison cost twice as much as other prisons to run, in spite of the fact it housed only 200 prisoners. It mentioned human rights organizations that felt control unit prisons or "SuperMax" facilities were environments that inflicted cruel and unusual punishment. The story implied that longterm solitary confinement caused mental illness and that such prisons did nothing to improve safety in the correctional system.


Wow, I wonder which correctional system they were working in.


I work in a system that at one time had one of the highest internal homicide rates in the country. (Internal homicide refers to murders committed within prison, by prisoners.) I have worked in a control unit prison, and I can tell you that the average citizen can't comprehend the level of depravity shown by some of the inmates there. I'm talking about prisoners who have long histories of violence, dating back to elementary school years. When the New York Times ran a story recently about nine-year-old psychopaths, the first people I thought of were some of my SuperMax inmates.


In my correctional system you have to work to end up in a control unit prison. Beds are few, they are expensive, and they aren't given out like candy. SuperMax inmates are people who are repetitively assaultive to their peers or staff, who repeatedly destroy property or set fires, or who actually kill someone at a lower level of security. Single incidents short of murder are rarely enough to warrant a high security transfer.


Even housing in a control unit prison is not a guarantee of safety: control unit prisoners have continued to run gangs and even to kill in spite of that high security environment.


And now advocacy groups want these facilities closed, and these prisoners turned loose upon their peers in lower security settings. Frankly, if I were a parent of a medium security inmate I would be very concerned about that.


Then there is the allegation of mental deterioration. I've ranted...er, written...about this topic a few times before here on Shrink Rap and also on Clinical Psychiatry News. Briefly, what advocacy groups don't mention---and their expert consultants also sometimes overlook---is that control unit prisoners are a very disturbed group to begin with, even prior to transfer to the facility. They have severe personality disorders which press the limits of our psychiatric diagnostic criteria. They have maladaptive learned behaviors that seem bizarre to the outsider but serve a clear, logical purpose to those familiar with the correctional environment. In spite of this, recent research has shown that solitary confinement can actually improve rather than worsen this psychological disturbance.


Let's assume for a minute that longterm solitary confinement did have detrimental effects for most prisoners, just for the sake of argument. Most systems do have psychological services in place to address this. Prisoners eligible for longterm solitary can be screened for pre-existing psychiatric conditions, and those conditions can be treated with medication, counselling and behavior management even in a control unit environment. Most SuperMax facilities have policies that require regular rounds on segregation inmates, and psychological services are available.


Abolition of an entire facility is an extreme response to a theoretical problem. The violence posed by control unit inmates, unfortunately, is not theoretical.

Cruelty and Context

I've always been struck by the similarity between solitary confinement inmates and monks. Historically, monks were kept under the vow of silence. They could only leave their cells to attend religious services. The only visitors they were allowed to have were their religious advisors. (If any of you have seen the movie Into Great Silence you'll know what I'm talking about.)  The idea of the modern penitentiary came from this 'penitence' process: put someone in a room by himself, give him religious guidance while he's there and he'll reflect, repent and reform. This was how prisons were run in the Nineteenth Century too: prisoners were kept under the rule of silence and they could only come out of their cells for religious services or for work. No one ever alleged that monks became psychotic because of this though.

Then there's the psychiatric seclusion room. Again, a bare cell with a bed or a mattress, no visitors, no clothes except a hospital gown. There is no 'vow of silence' or 'rule of silence' though.

So what makes the difference between the prison segregation cell, the monk's cell and the psychiatric seclusion room?

Off the top of my head, the obvious one would be the 'voluntariness' (if that's the word) of the confinement. (Although some people became monks because it was either that or get thrown into the king's dungeon---crime did compel men into the priesthood!) Other would be the purpose of the confinement. Segregation is a disciplinary action for a misbehaving prisoner, although it could also be used to protect the safety of other inmates in the facility. The purpose of segregation is also, theoretically, reformation (and their is research to show that disciplinary infractions drop off after one or two episodes of segregation). Reformation and enlightenment would be the purpose of the monk's isolation as well. Psychiatric seclusion is used both for the protection of the patient and others.

As we've heard from some of our blog readers, involuntary segregation feels the same regardless of the purpose.

Solitary Confinement

 

Sunny CA recently asked me my thoughts about the use of solitary confinement in light of allegations that this can cause mental illness.

My short answer to this is, "Don't believe everything you read in the media about solitary confinement."

When I first started working in corrections I started with the same assumption, that locking someone in a single cell might cause something called the "SHU syndrome". The exact symptoms that make up the SHU syndrome vary a bit but the gist of it is psychosis with disruptive or self-injurious behavior.

Once I had some experience under my belt working in maximum security and control unit environments, I started to question this theory because I just wasn't seeing the new onset psychosis that everybody suggested should be happening. I reviewed the literature and discovered that some of the articles that were repeatedly cited about this were written by psychiatrists who were plaintiff's experts in class action suits involving longterm segregation. I also found out that the articles describing SHU syndrome were no more than series of case report studies. In the classic Grassian article about solitary confinement, the author even admitted that he had to encourage the inmates to report their symptoms! And there were no well controlled studies about it. I did find a series of four papers in the British Medical Journal that did repeated measures of various psychological test batteries on inmates, and compaired scores against the subjects' accumulated incarceration history. These papers found no deleterious effects from confinement in general, but was not specific to segregated confinement. Another study from Canada (I think Wormith was the first author) found no negative effects, but this was a short term (just a few months) study.

The best designed research on the effects of longterm segregation was just published this past November. The University of Colorado researchers studied a few hundred inmates who were taken to disciplinary adjustment hearings and were at risk for longterm segreation. They compared those who were transferred to segregation with those who were returned to general population, and had an additional control group of inmates in the prison psychiatric hospital who also had disciplinary and behavioral problems. They compared the mentally ill inmates to the non-mentally ill inmates in all three settings over time (Ad Seg, Gen Pop and psych infirmary). They did testing every three months over the course of one year.

They used tests that measured eight different symptom dimensions, in addition to ratings done by the clinical and correctional staff (the BPRS).

Here, in a nutshell, are their findings as quoted from the executive summary with the "bottom-line" conclusions in bold-face:

"The results of this study were largely inconsistent with our hypotheses and the bulk of literature that indicates AS (administrative segregation) is extremely detrimental to inmates with and without mental illness. We hypothesized that inmates in segregation would experience greater psychological deterioration over time than comparison inmates, who were comprised of similar offenders confined in non‐segregation prisons."

"In examining change over time patterns, there was initial improvement in psychological well‐being across all study groups, with the bulk of the improvements occurring between the first and second testing periods, followed by relative stability for the remainder of the study. "

"We stated that offenders in segregation would develop an array of psychological symptoms consistent with the SHU syndrome. As already discussed, all of the study groups, with the exception of the GP NMI group, showed symptoms that were associated with the SHU syndrome. These elevations were present from the start and were more serious for the mentally ill than non‐mentally ill. In classifying people as improving, declining, or staying the same over time, the majority remained the same. There was a small percentage (7%) who worsened and a larger proportion (20%) who improved. Therefore, this study cannot attribute the presence of SHU symptoms to confinement in AS. The features of the SHU syndrome appear to describe the most disturbed offenders in prison, regardless of where they are housed. In fact, the group of offenders who were placed in a psychiatric care facility (SCCF) had the greatest degree of psychological disturbances and the greatest amount of negative change."

This study describes exactly what I see. The inmates who end up in solitary confinement have significant problems to begin with, but segregation doesn't necessarily make them worse.

The ACLU and other advocacy organizations are understandably not happy with this study and you can find the major criticisms just by Googling "Colorado solitary confinement." The study itself is not so easy to track down but I found a link Colorado Longterm Segregation study.

Thanks for asking the question Sunny, it's a topic that I've been particularly interested in.

Leave Me Alone: Does SHU Syndrome Exist?

[Note: This is the second in a two part series discussing the effects of longterm segregation. The first part in the series can be read here.]

When you read legal opinions or listen to professionals talk about the psychiatric effects of longterm segregation you will sometimes hear them refer to something called the "SHU syndrome". The "SHU" stands for Special Housing Unit, another name for a control unit prison or a tier in a regular prison where inmates are kept in longterm segregation.

The commonly accepted definition of "syndrome" is a constellation of signs and symptoms that are common to all sufferers of a disease. Syndromes are validated by showing that the particular syndrome can distinguish between people who have the disease versus those who don't, and can distinguish one disease from others.

The SHU syndrome has had a variety of symptoms attributed to it, but they generally include some type of altered mental state, specifically changes in mood and cognition or orientation. It is presumed to be caused by the conditions of confinement in segregation. One of the earliest descriptions, and the one that probably gets cited most often by correctional experts and the judiciary, is in a 1983 article by Grassian, The psychopathological effects of solitary confinement. He interviewed fourteen segregation inmates who had been confined from eleven days to ten months. These inmates reported heightened sensory acuity, affective disturbance (particularly anxiety), difficulty with concentration and memory, as well as illusions and misperceptions. All symptoms reportedly resolved within hours of release from segregated confinement. It should be noted however that all the subjects in this study were inmates who had filed a class action Eighth Amendment suit based upon their condition of solitary confinement. The author himself noted that he was required to “actively encourage disclosure of information” in order to obtain symptom reports, because the subjects initially denied problems. This aspect of the study is rarely (make that never) cited in legal opinions.

I could post a series of studies, using small sample sizes of actual prisoners, to detail things people have done to see if segregation actually does cause physiologic changes or changes in psychiatric symptoms, but that would basically end up being a tedious listing of article summaries (a big reason why my book chapter on the effects of segregation was never finished---I even bored myself!). The bottom line is that studies using control groups showed either no significant differences with controls, or only minor differences that disappeared quickly after removal from segregation.

If anyone really really wants me to post the draft of a book chapter I could but I'm not sure my co-bloggers would forgive me.

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Grassian, Psychopathological effects of solitary confinement, American Journal of Psychiatry 140: 1450-1454, 1983.