End Prolonged Solitary Confinement
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A Preventable Harm: Solitary Confinement
Petition addressed to the the American Medical Association, the American Psychiatric Association, the American Psychology Association, the American Academy of Psychiatry and the Law, American Association of Nurse Practioners, American Association of Physician Assistants, National Association of Social Workers.
Solitary confinement is housing someone in a tiny cell for up to 23 hours a day without meaningful human contact and minimal property. Prisons, detention centers, and jails have relied on solitary confinement to reduce violence and other disturbances resulting from mass incarceration and overcrowding. However, there is no evidence that this most restrictive segregation makes these institutions safer or address the root cause of these disturbances. Contrary to popular belief, the majority of those in solitary are not there for violent infractions. The poor, minorities, and the mentally ill are overly represented in this marked isolation. One in five U.S. prisoners are housed in solitary confinement at some point during their incarceration. In any given day, roughly 80,000 people are held in some form of solitary confinement with duration ranging from days to decades.
Solitary confinement is an expensive management tool. Studies have found that inmates who have spent time in solitary confinement are more likely to re-offend than those who have not. Housing a prisoner in solitary confinement can cost 2-3 times more than would cost to have them in the general prison population. Additionally, the human suffering is unmeasurable. Solitary confinement is at odds with the goal of rehabilitation or the facilitation of social reintegration. Placing someone in an extreme environment such as prolonged solitary confinement taxes the body and psyche, and often overwhelms a person’s capacity to cope. Within days, a person’s mood, behaviors, cognition, physiology, and reality testing are disrupted. Across the country, approximately 50% of prison suicides occur in solitary confinement. Inmates in segregation have the highest rates of self injurious behaviors. Furthermore, extreme isolation breaks support system which is one of the most important protective factors we know against suicide and one of the most vital ingredients for health. Meaningful social interaction is an essential human need, as essential as adequate food, clothing, and shelter.
Considering that 95% of those incarcerated will be released back to the community, bringing with them the negative health consequences of their confinement, the conditions and traumas they face while incarcerated should concern us all, especially us as health providers.
Lastly, we pledge that solitary confinement is in direct violation of our code of ethics as healers, knowing the risks of such placement. Rule 43 of the Mandela Rules of the United Nations Standard Minimum Rules on the Treatment of Prisoners prohibits both indefinite solitary confinement and prolonged solitary confinement (defined as lasting more than 15 days).
The World Health Organization (WHO) states health care staff “should not certify a prisoner as being fit for disciplinary isolation or any other form of punishment.” Similarly, the National Commission on Correctional Health Care (NCCHC) their April 2016 position statement write: “Health staff must not be involved in determining whether adults or juveniles are physically or psychologically able to be placed in isolation...in systems that do not conform to international standards, health care staff should advocate with correctional officials to establish policies prohibiting the use of solitary confinement for juveniles and mentally ill individuals, and limiting it use to less than 15 days for all others.” We are in solidarity with the Physicians for Human Rights (PHR) who agree with The United Nation (UN) Principles of Medical Ethics that “specifically hold that it is a contravention of medical ethics for a doctor to ‘participate in the certification of the fitness of prisoners or detainees of any form of treatment or punishment that may adversely affect their physical or mental health’” (PHR 2002).
Alternatives to solitary confinement exist that can maintain institutional security and offer rehabilitation while protecting human rights. In 2017, Colorado corrections ended the practice of solitary confinement beyond 15 days and any direct release to community from solitary confinement. On January 17, 2018, Canadian Supreme Court Judge Leask ruled “Prolonged segregation is both unnecessary for and, indeed, even inconsistent with, the objective of maintaining institutional security and personal safety...Based on the evidence, I find that segregation breaks down inmates’ ability to interact with other human beings; deprives them of rehabilitative and educational group programming; risks mentally healthy inmates descending into mental illness; and exacerbates symptoms for those with pre-existing mental illness.”
We the undersigned who made an oath to do no harm and serve our fellow citizens in their journeys to heal, call upon our respective organizations to recognize the harm solitary confinement brings to individuals, communities, and our country. There is a great need for agreement among individuals and organizations to uphold human rights and ethical principles but also to reduce reprisals against whistle-blowers. Individual practitioners need their organizations to use their authority and influence. We ask that the American Psychiatric Association modify its readopted December 2017 position statement on solitary confinement to be more in harmony with the PHR, WHO, NCCHC, UN position which all agree prolonged segregation longer than 15 days is cruel, inhumane, and harmful to an individual's health. We ask that the other professional organizations develop a similar position statement in solidarity.
Respectfully and sincerely submitted,
Mariposa McCall, MD
Board Certified Psychiatrist
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