Isolation in Confinement

The New Yorker recently published an article by Atul Gawande, the surgeon and writer, about the phenomenon of solitary confinement in US prisons.  Gawande describes the extraordinarily negative psychological and physical symptoms that occur in individuals who have experienced solitary confinement, and the widespread use in prisons in the United States.  It is a compelling and devastating article.

What Gawande doesn’t talk about is the extent to which the process of solitary confinement, usually called ‘room confinement,’ is used in juvenile detention and residential facilities across the United States.  In the New York City jails, young people are locked up as much as 23 hours a day in ‘room confinement’ or in the ‘bing,’ which is the Rikers Island facility where youth who have commited an infraction are sent.  Though they are supposed to receive their school work in these facilities (which they don’t consistently receive), they have few other rights or opportunities afforded to them.  In these places where boredom already hampers their agency and impacts on their well-being, this experience of confinement — which could last for the entire time they are incarcerated — is soul destroying.

In a recent report released by the Office of Juvenile Justice and Delinquency Programs, researchers found that 62% of juveniles who committed suicide in confinement had experienced room confinement, and half of those who committed suicides had been on room confinement at the time of their death.

It may be important to begin to document some of the uses and experiences of solitary confinement amongst young people, and whether the deleterious effects documented by Gawande may manifest themselves differently amongst young people, and may have longer-lasting consequences.

Resource

When I worked in New York City as a social worker, I represented a young woman who suffered from serious mental illness, what we informally thought might be Borderline Personality Disorder.  She was arrested and charged with attempting to stab her sister.  Her behavior was erratic and full of drama.  While visiting her in the ‘pens,’ the holding facilities behind the courtrooms, she screamed and cried about her predicament, then quickly resorted to a passive smile.  The judge in her case recognized that she required long-term mental health care, but felt he had no choice but to put her in detention while we attempted to find care for her.  She was sent to Riker’s Island, where she remained for nearly a year while we worked tirelessly to find a facility for her.  We twice applied to the New York Office of Mental Health to try to place her in long term care, and were twice rejected because she did not have a primary diagnosis of a psychotic disorder.  We tried to place her in various intensive out-of-home care homes, but were consistently prevented from placing her by the New York State Administration for Children’s Services, despite extensive documentation that her mother had neglected to care for her on numerous occasions, even facilitating her escape from an earlier facility where she was receiving treatment.  This young woman suffered needlessly on Riker’s Island while facility after facility and program after program rejected her.

This young woman’s plight, I learned recently, is not unique.  Rep. Henry Waxman and Senator Susan Collins commissioned a report in 2003 on the incarceration of youth who are awaiting mental health services in the U.S.  The results are shocking: of the 524 juvenile detention centers included in the survey, 2/3 of these facilities report that they hold youth waiting for mental health treatment.  Forty eight percent of these facilities report that these youth have attempted suicide, and 27% report poor, very poor or no mental health treatment available in their facilities.  This survey represents a really dire national issue that, as I learned during my work in New York, few state authorities seem willing to find a solution to.

From my experience working with young people, I see a real need to develop highly structured day mental health treatment programs that are alternatives to detention and incarceration.  They would provide medication management, housing and income support, and meaningful activities that recognize the strengths in young people.  This is a group of young people that is overrepresented in the youth prison and detention population, and the problem can only get worse if the conditions of these facilities stays the same.

The survey can be read here:

Incarceration of youth who are waiting for mental health treatment