By Kelli South is the research associate at the Treatment Advocacy Center.
Incarcerated individuals with serious mental illness are much more likely to be placed in solitary confinement compared to incarcerated individuals without serious mental illness. There is a wealth of research that shows the deleterious effects that solitary confinement can have on an individual, including increasing rates of depression, anxiety and other psychiatric symptoms, and this concern is even greater for those with severe mental illness.
In some states, prisons have been trying out new programs that divert individuals, particularly those with serious mental illness, away from solitary confinement and other so-called restrictive housing measures and into treatment programs. A recent study published in the American Journal of Preventive Medicine found that individuals placed in a treatment diversion program had significantly lower rates of prison infractions, inpatient mental health admissions and self-harm incidents compared to individuals placed in solitary confinement.
This study used data from 3,480 people incarcerated in North Carolina state prisons between 2016 and 2019. North Carolina’s state prisons developed the use of Therapeutic Diversion Units (TDUs) to decrease their use of solitary confinement and other forms of restrictive housing in prisons, particularly for inmates who have a serious mental illness. TDUs involve the use of evidence-based treatments for inmates with treatment plans that are customized according to each individual’s need. The plans are designed to incrementally increase the amount of time an individual is out of their cell and offers incentives for participants to continue along their treatment plan.
The authors found significant impacts of TDUs in every category that they measured. Prison infractions were approximately three times higher for those in solitary confinement than those in TDUs. Interestingly, they also found that the most severe category of infractions were five times higher for those in solitary than those in TDUs. The authors also found that the rate of inpatient mental health admissions were four times higher, and the rate of self-harm injuries were 3.5 times higher for the group in solitary compared to the group in TDUs.
People with severe mental illness are overrepresented in the criminal justice system across the board, including overrepresentation in prison populations. The use of solitary confinement as a method of controlling prisoners with mental illness is shown to significantly worsen their overall well-being and mental illness symptoms. The results from this study suggest that there are far better alternatives than solitary confinement for incarcerated individuals who also have a serious mental illness.
North Carolina’s Therapeutic Diversion Units are one method to help individuals access treatment while they are incarcerated and prevent their mental illness symptoms from deteriorating. The authors suggest that prisons across the country should consider employing similar diversions from solitary confinement as a viable alternative that helps incarcerated individuals carry out their sentences in a safer, more treatment friendly environment.
References Remch, M., Mautz, C., Burke, E. G., et al. (November 2021). Impact of a prison therapeutic diversion unit on mental and behavioral health outcomes. American Journal of Preventive Medicine.