|Correctional Health Care Experts Recommend Minimizing Use of Solitary Confinement
|By The National Commision on Correctional Healthcare
CHICAGO — The National Commission on Correctional Health Care, the nation’s leading authority on health care systems in jails, prisons and juvenile detention facilities, has released a position statement on solitary confinement to help correctional health professionals address its use in the facilities in which they work.
The 17-point position statement calls for an end to prolonged solitary confinement, defining “prolonged” as longer than 15 consecutive days. That is substantially shorter than the months, years and even decades that some individuals are kept in isolation, and corresponds to the maximum acceptable time period cited by the United Nations Standard Minimum Rules for the Treatment of Prisoners.
The new position statement also states that juveniles, mentally ill people and pregnant women should be excluded from solitary confinement of any duration. It calls for an end to the use of solitary confinement as punishment, and recommends that as a means of maintaining security, it be used only on an exception basis when less restrictive options are not available. In all cases, it is to be used for the shortest time, in the least restrictive conditions and with as much human contact as possible.
With this statement, NCCHC joins a growing chorus of voices calling attention to the psychological, social, emotional and physical damage that solitary confinement inflicts. As background, the statement presents some of the overwhelming evidence of the practice’s harmfulness, quoting, among others, the World Health Organization, the U.S Attorney General’s office, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry and the U.N. Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment.
“It is extremely important and timely that NCCHC, the leading organization for promoting quality correctional health care and promulgating health care standards in jails, prisons and youth detention facilities, has joined the many national and international organizations calling for limiting the use of solitary confinement,” said Joe Goldenson, MD, consultant with San Francisco Jail Health Services.
“Most public health organizations agree that, in addition to being cruel and inhumane, solitary confinement is harmful to an individual’s health and well-being, and presents a barrier to the delivery of needed medical and mental health services,” he said. Dr. Goldenson is the American Public Health Association liaison to the NCCHC Board of Directors and a member of the committee that created the position statement.
Time spent in solitary confinement is especially damaging to mentally ill individuals. Continued misconduct related to their underlying mental health issues, which are often exacerbated by isolation, can result in their being held in solitary confinement indefinitely. Even in people without a history of mental illness, lack of meaningful social interaction can cause anxiety, depression, anger, diminished impulse control, paranoia, hallucinations, obsessive thoughts, paranoia, hypersensitivity to stimuli, post-traumatic stress disorder, self-harm, suicide and/or psychosis. For young people, the developmental, psychological and physical damage is more extensive and lasting.
“Just as many of us today wonder how previous generations tolerated harsh and often inhumane conditions in mental health hospitals, future generations will wonder how we tolerated solitary confinement of distressed youth in desperate need of mental health treatment,” said Kevin Fiscella, MD, MPH, professor of Family Medicine at the University of Rochester, the American Society of Addiction Medicine liaison to the NCCHC Board and a member of the committee that created the position statement.
For health professionals working in the correctional environment, NCCHC’s position statement defines what their role should, and should not, be vis-à-vis solitary confinement. In summary:
Read the entire position statement at www.ncchc.org/position-statements.
NCCHC position statements serve to augment the organization’s Standards for Health Services for jails, prisons and juvenile facilities, and express NCCHC's expert opinion on important issues that are not addressed in the Standards.
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