“Kids in solitary confinement: America’s official child abuse”

Kids in solitary confinement: America’s official child abuse

Thousands of teenagers, some as young as 14 or 15, are routinely subjected by US prisons to this psychological torture

One teen who participated in the Human Rights watch report wrote that being in isolation felt like ‘a slow death from the inside out’.Juvy-191 (2)

Molly J said of her time in solitary confinement:

“[I felt] doomed, like I was being banished … Like you have the plague or that you are the worst thing on earth. Like you are set apart [from] everything else. I guess [I wanted to] feel like I was part of the human race – not like some animal.”

Molly was just 16 years old when she was placed in isolation in an adult jail in Michigan. She described her cell as being “a box”:

“There was a bed – the slab. It was concrete … There was a stainless steel toilet/sink combo … The door was solid, without a food slot or window … There was no window at all.”

Molly remained in solitary for several months, locked down alone in her cell for at least 22 hours a day.

No other nation in the developed world routinely tortures its children in this manner. And torture is indeed the word brought to mind by a shocking report released today by Human Rights Watch and the American Civil Liberties Union. Growing Up Locked Down documents, for the first time, the widespread use of solitary confinement on youth under the age of 18 in prisons and jails across the country, and the deep and permanent harm it causes to kids caught up in the adult criminal justice system.

Ian Kysel, author of the 141-page report, interviewed or corresponded with more than 125 young people who had spent time in solitary as children in 19 states. To cope with endless hours of extreme isolation, sensory deprivation and crippling loneliness, Kysel learned that some children made up imaginary friends or played games in their heads. Some hid under the covers and tried to sleep as much as possible, while others found they could not sleep at all.

“Being in isolation to me felt like I was on an island all alone dying a slow death from the inside out,” a California teen wrote in a letter to Human Rights Watch.

One young woman, who spent three months in solitary in Florida when she was 15, described becoming a “cutter” while in isolation:

“I like to take staples and carve letters and stuff in my arm … Each letter means something to me. It is something I had lost.”

She started by carving into her arm the first letter of her mother’s name. Another girl who cut herself in solitary said, “because it was the only release of my pain.”

In fact, solitary confinement has been shown to cause severe pain and psychological damage to the tens of thousands of adults who endure it every day in American prisons. On children, the report states, the practice has a “distinct and particularly profound impact.” Because of “the special vulnerability and needs of adolescents, solitary confinement can be a particularly cruel and harmful practice when applied to them.” This is all the more true because for many of these kids, “developmental immaturity is compounded by mental disabilities and histories of trauma, abuse, and neglect.”

Yet, prisons and jails commonly use isolation as punishment for violating prison rules, including both violent and nonviolent infractions. One boy who entered a Colorado jail at age 15 said the guards doled out stints in solitary for crimes that would, in any other setting, be deemed normal adolescent behavior:

“15 days for not making the bed; 15 days for not keeping the cell door open; 20 or 25 days for being in someone else’s cell.”

On Rikers Island in New York City, more than 14% of adolescents between 16 and 18 spent some period in “disciplinary segregation”. This despite the fact that nearly half of all adolescents on Rikers have been found to have a “diagnosed mental disorder”.

Other kids are isolated as a form of “protective custody”, because they are vulnerable to physical or sexual abuse. Even though they are being locked down “for their own good”, many receive no educational or rehabilitative programming while in solitary, and some are barred from seeing their families.

Still, other children are placed in solitary confinement for “treatment” purposes, especially after threatening or attempting suicide – even though isolation has been shown to sharply increase the risk that prisoners will take their own lives.

“There is nothing to do so you start talking to yourself and getting lost in your own little world. It is crushing,” said Paul K, who spent 60 days in solitary when he was 14.

“You get depressed and wonder if it is even worth living. Your thoughts turn over to the more death-oriented side of life.”

No one knows precisely how many children live in these conditions, since many state and local correctional systems do not keep such data. But the overall rate of solitary confinement in American prisons is thought to be between 3% and 5%, and anecdotal evidence suggests that, in some systems, children may be isolated at even higher rates than adults. Given that nearly 100,000 youth under the age of 18 pass through adult prisons and jails annually, there exists the staggering possibility that thousands of children are spending time in solitary confinement each year.

Liz Ryan, who directs the Campaign for Youth Justice, points out that 20 states have laws requiring that juveniles be kept apart from adult prisoners. Yet most of the nation’s 3,000 jails lack dedicated facilities for children – leaving them with no alternative but to place kids in solitary. A majority of people in jail are there awaiting trial, which means many children in solitary have not even been convicted of a crime.

In addition, Ryan said, “A kid could be held in jail not because there is a risk to public safety, but because they don’t have the resources to make bail.” So the racial and class disparities endemic to the criminal justice system are likely reflected in the population of children languishing in isolation. Ian Kysel said in an interview:

“I think one of the greatest impediments to change is trying to unravel the policy issue that is at the root of this problem: a criminal justice system that treats kids as if adults without providing resources or guidelines for their care,”

For this reason, Human Rights Watch and the American Civil Liberties Union recommend that state and the federal governments “prohibit the housing of adolescents with adults, or in jails and prisons designed to house adults”. However, “regardless of how they are charged and held,” Kysel says unequivocally:

“We need to ban the solitary confinement of young people across the board. There is simply no reason that a child or adolescent ever needs to be held in a cell, alone, for 22 let alone 24 hours at a stretch.”

For this to happen, though, the American public will need to accept what numerous international bodies have already concluded – that solitary confinement is cruel, inhuman and degrading treatment, and clearly rises to the level of torture when levied against vulnerable populations, including children.

“If my story can stop another kid from coming” to solitary confinement, one Florida teen wrote, then, “Hopefully my pain serve[s] some purpose.”

• Editor’s note: this article originally referred to the Campaign for the Fair Sentencing of Youth; this was amended to the Campaign for Youth Justice at 10am (ET) on 12 October 2012

Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics
Volume 38, Number 1, 2010


Jeffrey L. Metzner, MD, and Jamie Fellner, Esq

Published in:

The Journal of the American Academy of Psychiatry and the Law

March 1, 201

  1. Solitary Confinement and Mental Illness in US Prisons (PDF)



Kids will be kids, except when we suddenly judge them as adults

In America, we’re just not sure whether to treat kids with protective gloves or ‘they should know better’ adults

Children wave to the camera. Photograph: A-Star Sports

An 18-year-old can vote for the president of the United States, but he can’t order a beer. An eight year-old can’t buy firecrackers, but she can pack her own .22. A 13 year-old can’t get into an R-rated movie, but can be tried as an adult in criminal court.

In America, we’re clearly confused about childhood.

On 1 May, President Barack Obama’s Justice Department announced it would challenge a federal judge’s ruling that Plan B, the “morning after” pill, should be available to girls of any age, without a prescription, without having to ask the pharmacist to fetch it from behind the counter. When she overruled the Food and Drug Administration’s clinical experts in 2011, Health and Human Services Secretary Kathleen Sebelius insisted on 17 as the age a girl should be to get emergency contraception without a prescription. Now she and the president say they’ll compromise on 15.

The right howled in predictable fashion, the Catholic Church denouncing Plan B as an abortifacient, the Family Research Council arguing for the recriminalization of contraception, and columnist Kathleen Parker gasping:

“What about the right of parents to protect their children? A 15-year-old can’t get Tylenol at school without parental permission, but we have no hesitation about children taking a far more serious drug without oversight?”

Actually, Tylenol is a much more “serious” drug than Plan B, as the New England Journal of Medicine points out:

“A 12-year-old can purchase a lethal dose of acetaminophen in any pharmacy for about $11, no questions asked. The only documented adverse effects of a $50 dose of levonorgestrel are nausea and delay of menses by several days. Any objective review makes it clear that Plan B is more dangerous to politicians than to adolescent girls.”

But progressives weren’t happy, either. Obama was supposed to be the guy who based decisions on science, not emotion, the guy who gave a tub-thumping speech at Planned Parenthood’s recent conference, vowing to support their work – more than a third of which is providing contraceptives. Yet when it came to Plan B, he invoked his own daughters, saying he wasn’t comfortable with young girls buying it in a drugstore “alongside bubble gum or batteries“. Never mind that teenaged girls are precisely the population most in need of an accessible form of birth control. They’re just children, for God’s sake.

Unless they’re not. Sixteen year-old Florida student Kiera Wilmot has been charged with two felonies: “possession/discharge of a weapon” and “discharging a destructive device”. The state wants to try her as an adult. If convicted, she could be sent to prison.

The “weapon”-cum-“destructive device” was actually a science experiment. Kiera, reportedly an inquisitive sort with good grades and no disciplinary issues, heard that hydrochloric acid plus aluminum produces a reaction. On 22 April, she went into a field behind Bartow High School and mixed toilet bowl cleaner with balls of foil in an eight-ounce plastic water bottle. The lid popped off and smoke came out. No one was hurt, no property damaged, and she immediately owned up to her infraction. Still, the cops hauled her off and the school expelled her.

This school is one of many in America with a policy of “zero tolerance” towards, well, anything kid-like a kid might do. An eight year-old in Alton, Illinois was handcuffed and shackled and taken off to juvenile detention for throwing a tantrum at school earlier this year. School officials across the country have called the police on kids for such heinous crimes as farting, belching, possession of an aspirin tablet, and doodling on a desk.

If, instead of performing freelance chemistry, Kiera Wilmot had tried to buy Plan B, she’d have merely been denied, not busted. The law says she’s a child who must be steered away from illicit use of her own body. In committing what the Polk County School Board called a “serious breach of conduct”, she became a willful malefactor deserving not protection, but punishment. As the school board spokeslady said primly, “there are consequences to actions”. Twenty-first century America is stuck between two visions of childhood: the sentimental one where kids come wrapped in Wordsworthian intimations of immortality, innocents who must be guarded from the wicked ways of the world, and the Puritan one which assures us that kids are just as nasty as anyone else. Perhaps nastier. The Rev Benjamin Wadsworth, president of Harvard, author of The Well-Ordered Family (published in 1712), said children’s “hearts are naturally a nest, root, fountain of sin and wickedness”. Most parents do not think their rugrats are evil – not most of the time, anyway. But our repressed Calvinist unconscious keeps coming back, telling us that even babies are sunk in Original Sin. We punish because we love – or something like that. As Cotton Mather, the famous Puritan Divine, put it, “better whipped than damned”. Or, to put it in contemporary terms, “zero tolerance”.

Published on The Root (http://www.theroot.com)

Home > Life Sentences Should Not Apply to Children

Life Sentences Should Not Apply to Children

By: Vincent Southerland

Posted: May 13, 2013 at 12:44 AM

Your Take: Despite Supreme Court ruling, states still condemn young offenders to lengthy prison terms.

(Special to The Root) — Nearly a year ago, the U.S. Supreme Court reminded us of something that we all know and understand: Age matters. Children are immature and irresponsible. They do not appreciate the risks and consequences of their behavior.

Biologically, their brains are not yet fully developed. They can fall prey to peer pressure and other outside influences. As they grow older, young people change — invariably for the better — even when they commit the worst of crimes. These differences mean that children require different treatment from what is appropriate for adults.

Relying on this fundamental, commonsense and scientifically supported truth, the court’s decision in Miller v. Alabamabarred mandatory life-without-parole sentences for young people who committed their crimes when they were under the age of 18. Miller restored some hope to the more than 2,000 individuals serving mandatory life-in-prison sentences for crimes committed before they were old enough to vote or serve in the military.

Unfortunately, many of those now tasked with molding the post-Miller landscape have chosen to ignore science, common sense and the court’s command. Instead they have continued to call for lengthy, draconian sentences as an answer to adolescent criminal conduct.

For example, in the immediate wake of the ruling, the governor of Iowa commuted the mandatory life sentences of youthful offenders in his state but instead required them to serve 60 years before seeking parole. Other states have left life without parole on the table for adolescents and added lengthy mandatory minimum sentences — some up to 35 years’ imprisonment — before they can seek an opportunity for release.

Three months ago, Wyoming’s governor signed a bill that eliminated life without parole for adolescents and replaced it with life. Juveniles in that state will become eligible for release after their sentences have been commuted to a term of years or they have spent at least 25 years in prison. Nebraska’s post-Miller response, signed into law just last week, imposes a minimum sentence of 40 years on children convicted of serious offenses, though they may seek parole after serving two decades in prison. Life without parole, however, remains a sentencing option.

As states grapple with Miller, a look back at what preceded the court’s decision is in order. That reflective look reveals our often misguided penchant for quick and unwise decisions around crime and punishment, especially when it comes to children.

The path to life-without-parole sentences for children is a prime example. The late 1980s and early 1990s were punctuated by modest spikes in violence among youngsters. In response, many states enacted sentencing reforms that were rooted in racial imagery about a new so-called superpredator (pdf) — a menacing youthful offender of color who dwelled in America’s urban centers and preyed on the innocent.

The media, academics and legislators portrayed these youths as exceedingly dangerous, violent and blameworthy. Appeals to reason were discarded in favor of the politics of fear and a perceived need to get “tough on crime.” Laws were passed to ensure that young people were tried in adult courts and faced outsized punishments like life without parole.

Although the myth of the superpredator was debunked while violent crime among teenagers steadily declined, the harsh treatment of young offenders became the norm. Meanwhile, racially disparate sentencing left African-American youngsters six times more likely than their white counterparts to be sentenced to life without parole. The recent exoneration and release after 20 years of the teens accused and convicted of rape and assault in the infamous Central Park-jogger case is a stark reminder of how our superpredator hysteria, with its toxic racial overtones, destroyed the lives of innocent children.

Sadly, these draconian responses are part of a greater historical pattern — one that has countenanced, for decades, the mistreatment of children charged with crimes large and small. Florida’s Arthur G. Dozier School for Boys, founded in 1900, provides just one powerful example. Children at Dozier, a home for boys accused of crimes like trespassing and stealing cars, suffered under horrific conditions and unspeakable abuses until the school’s reign of terror ended when it closed in 2011.

Known as the Florida State Reform School, at one point it was the largest facility of its kind in the country. Children sent there for everything from running away from home to assault were routinely violently beaten and abused; some even ended up dead. These children were considered irredeemable in the eyes of the state, much the way a teenager charged with a serious crime is today. The boys buried on Dozier’s grounds and those who survived its horrors should serve as a grim reminder of the obligation we have to treat children as children.

Anyone on the front lines of the post-Miller era would be wise to take stock of this history for guidance about what to do now. For starters, hyperbole, fear and racially coded pleas cannot continue to drive policy decisions about children and crime. Adult sentences cannot be the starting point that lawmakers use to craft sentences for young people.

Instead, legislators and policymakers should look to the wealth of multidisciplinary research around adolescent-brain development to identify appropriate sentences that account for the diminished culpability of young offenders and a child’s capacity for rehabilitation. Special attention must be given to addressing the root causes of a child’s behavior, and resources must be dedicated so that he or she can effectively navigate the path to maturity.

Miller gave America an opportunity to address the way we treat our children by remedying the mistaken policies of the past with a sensible, balanced approach toward children in trouble with the law. Those tasked with shaping the future must work to ensure that every child — even those who have committed crimes — has the chance to grow, reflect and re-enter society as a law-abiding citizen.

Vincent Southerland is a senior counsel in the Criminal Justice Project at the NAACP Legal Defense and Educational Fund, Inc.

The Root aims to foster and advance conversations about issues relevant to the black Diaspora by presenting a variety of opinions from all perspectives, whether or not those opinions are shared by our editorial staff

Physicians who work in U.S. prison facilities face ethically difficult challenges arising from substandard working conditions, dual loyalties to patients and employers, and the tension between reasonable medical practices and the prison rules and culture. In recent years, physicians have increasingly confronted a new challenge: the prolonged solitary confinement of prisoners with serious mental illness, a corrections practice that has become prevalent despite the psychological harm it can cause. There has been scant professional or academic attention to the unique ethics-related quandary of physicians and other healthcare professionals when prisons isolate inmates with mental illness. We hope to begin to fill this gap.

Solitary confinement is recognized as difficult to withstand; indeed, psychological stressors such as isolation can be as clinically distressing as physical torture.[1],[2] Nevertheless, U.S. prison officials have increasingly embraced a variant of solitary confinement to punish and control difficult or dangerous prisoners. Whether in the so-called supermax prisons that have proliferated over the past two decades or in segregation (i.e., locked-down housing) units within regular prisons, tens of thousands of prisoners spend years locked up 23 to 24 hours a day in small cells that frequently have solid steel doors. They live with extensive surveillance and security controls, the absence of ordinary social interaction, abnormal environmental stimuli, often only three to five hours a week of recreation alone in caged enclosures, and little, if any, educational, vocational, or other purposeful activities (i.e., programs). They are handcuffed and frequently shackled every time they leave their cells.[3],[4],[5] The terms segregation, solitary confinement, and isolation will be used interchangeably to describe these conditions of confinement.

Isolation can be psychologically harmful to any prisoner, with the nature and severity of the impact depending on the individual, the duration, and particular conditions (e.g., access to natural light, books, or radio). Psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis.[6]

The adverse effects of solitary confinement are especially significant for persons with serious mental illness, commonly defined as a major mental disorder (e.g., schizophrenia, bipolar disorder, major depressive disorder) that is usually characterized by psychotic symptoms and/or significant functional impairments. The stress, lack of meaningful social contact, and unstructured days can exacerbate symptoms of illness or provoke recurrence.[7] Suicides occur disproportionately more often in segregation units than elsewhere in prison.[8],[9],[10] All too frequently, mentally ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization. Many simply will not get better as long as they are isolated.

Mental health professionals are often unable to mitigate fully the harm associated with isolation. Mental health services in segregation units are typically limited to psychotropic medication, a health care clinician stopping at the cell front to ask how the prisoner is doing (i.e., mental health rounds), and occasional meetings in private with a clinician.[11] Individual therapy; group therapy; structured educational, recreational, or life-skill-enhancing activities; and other therapeutic interventions are usually not available because of insufficient resources and rules requiring prisoners to remain in their cells.[12]

The use of segregation to confine the mentally ill has grown as the number and proportion of prisoners with mental illness have grown. Although designed and operated as places of punishment, prisons have nonetheless become de facto psychiatric facilities despite often lacking the needed mental health services.[13] Studies and clinical experience consistently indicate that 8 to 19 percent of prisoners have psychiatric disorders that result in significant functional disabilities, and another 15 to 20 percent require some form of psychiatric intervention during their incarceration.[14] Sixty percent of state correctional systems responding to a survey on inmate mental health reported that 15 percent or more of their inmate population had a diagnosed mental illness.[15]66666

Despite significant improvements in correctional mental health services, often related to litigation and development of standards and guidelines by the National Commission on Correctional Health Care (NCCHC), the American Psychiatric Association (APA), and other professional organizations, in many prisons the services remain woefully inadequate. Relative to the number of prisoners needing help, there is an insufficient number of qualified staff, too few specialized facilities, and few programs.[16] Mindful of budget constraints and scant public support for investments in the treatment (as opposed to punishment) of prisoners, elected officials have been reluctant to provide the funds and leadership needed to ensure that prisons have sufficient mental health resources. Twenty-two of 40 state correctional systems reported in a survey that they did not have an adequate mental health staff.[17]

Persons with mental illness are often impaired in their ability to handle the stresses of incarceration and to conform to a highly regimented routine. They may exhibit bizarre, annoying, or dangerous behavior and have higher rates of disciplinary infractions than other prisoners. Prison officials generally respond to them as they do to other prisoners who break the rules. When lesser sanctions do not curb the behavior, they isolate the prisoners in the segregation units, despite the likely negative mental health impact. Once in segregation, continued misconduct, often connected to mental illness, can keep the inmates there indefinitely.[18],[19]

In class action cases challenging the segregation of inmates with serious mental illness as unconstitutionally cruel because of the psychological harm it can inflict, U.S. federal courts have either issued rulings or accepted settlements that prohibit or sharply curtail the practice. According to one federal judge, putting mentally ill prisoners in isolated confinement “is the mental equivalent of putting an asthmatic in a place with little air… .”[20] Unfortunately, except in the small number of prisons governed by the outcome of such litigation, mentally ill prisoners continue to be sent to segregation; indeed, they are often disproportionately represented in segregation units.[21],[22]

International treaty bodies and human rights experts, including the Human Rights Committee,[23] the Committee against Torture,[24],[25] and the U.N. Special Rapporteur on Torture,[26] have concluded that solitary confinement may amount to cruel, inhuman, or degrading treatment in violation of the International Covenant on Civil and Political Rights[27] and the Convention against Torture and other Cruel, Inhuman, and Degrading Treatment or Punishment.[28] They have specifically criticized supermax confinement in the United States because of the mental suffering it inflicts.[29],[30] Whatever one’s views on supermax confinement in general, human rights experts agree that its use for inmates with serious mental illness violates their human rights.

Principles of ethics regarding beneficence, nonmaleficence, and respect for the rights and dignity of all patients have led international and national professional organizations to affirm that physicians are ethically obligated to refrain from countenancing, condoning, participating in, or facilitating torture or other forms of cruel, inhuman, or degrading treatment.[31],[32],[33],[34] Involvement of healthcare practitioners in abusiveinterrogations recently prompted the American Medical Association[35] and the APA[36] to oppose the participation of physicians in interrogations. Two years ago, the NCCHC issued a position statement that correctional health care professionals “should not condone or participate in cruel, inhumane or degrading treatment of inmates.”[37] To date, however, the medical organizations have not formally acknowledged that prolonged isolation of the mentally ill constitutes cruel or inhuman treatment in violation of human rights, nor have they addressed health professionals’ ethics-related responsibilities when faced with such cases.

Correctional health care professionals struggle with constrained resources and large caseloads that limit the services they can provide their patients. It is ethical for them to do the best they can under the circumstances rather than resigning, which would result in even fewer services for their patients. But what are practitioners’ ethics-related responsibilities when prison officials impose conditions of confinement that exacerbate the symptoms of a prisoner’s mental illness?

The ethic-based calculus physicians face when prisoners are isolated for disciplinary or security reasons is different than that created by the struggle with limited resources. Segregation of mentally ill prisoners (or any other prisoner) is not an unintended consequence of tight budgets, for example. It reflects a penal philosophy and the conscious decision by prison officials about whom to isolate, for how long, and under what conditions. If health professionals simply do their rounds but say nothing, are they implicitly legitimizing the segregation of mentally ill prisoners and thereby contributing to the continuation of the harm? What must they do to avoid being complicit in conditions of confinement that may well constitute a human rights violation?

We believe it is ethical for physicians to treat prisoners who have been abused, but they must also take measures to end the abuse. In addition to providing whatever services they can to segregated patients, they should advocate within the prison system for changed segregation policies and, if that fails, they should undertake public advocacy.[38],[39],[40]

Publically exposing and urging change in harmful prison practices is difficult and, needless to say, can threaten job security, but individual practitioners should not have to wrestle alone with a prison practice that violates human rights norms. Their professional organizations should help them. Through the organizations, health professionals collectively can support colleagues who work in prisons in the quest to ensure ethically defensible correctional policies. The APA[41] and the NCCHC[42] have provided basic frameworks for increased mental health monitoring and treatment of segregated inmates. They must do more, however.

Professional healthcare organizations should acknowledge that prolonged segregation of inmates with serious mental illness violates basic tenets of mental health treatment. The mental health standards of the NCCHC include the “optional recommendation” that mentally ill prisoners be excluded from extreme isolation,[43] noting in an appendix that clinicians “generally agree that placement of inmates with serious mental illnesses in settings with ‘extreme isolation’ is contraindicated because many of these inmates’ psychiatric conditions will clinically deteriorate or not improve (Working Group on Schizophrenia,1997).”[44],[45] In light of that general consensus, shouldn’t the NCCHC make the exclusion mandatory, instead of optional? The APA and AMA should also formally adopt a similar position.

However, adopting a similar position is easier said than done. Very few physicians in the APA and AMA have experience or knowledge regarding correctional mental health care, let alone correctionalenvironments in general. They are not familiar with the differences between a general population housing unit and a disciplinary segregation housing unit. Administrative segregation, supermax, rules infractions, mental health rounds, and “kites” are terms most noncorrectional physicians do not understand. In short, we recognize that a serious educational effort must be mounted so that noncorrectional mental health practitioners have a better understanding of the world in which their correctional colleagues work and the unique challenges they face, including the isolation of seriously ill patients for months, even years, that would never be condoned in a noncorrectional mental health setting.

No doubt some correctional mental health clinicians will not agree with us. They may believe the isolation of volatile mentally ill prisoners is necessary for security reasons. They may believe they are guests in the house of corrections who have no business addressing custody policies, or they may have become so accustomed to the extended use of isolation that they have lost sight of its potential to cause psychological harm.

Experience demonstrates that prisons can operate safely and securely without putting inmates with mental illness in typical conditions of segregation. Because of litigation, in some prisons, mentally ill prisoners who would otherwise be locked in their cell for 23 to 24 hours a day are given more time outside their cells, including time in group therapy and other therapeutic interventions.[46] The improved clinical responses of prisoners with mental illness have been achieved without sacrificing needed controls or relinquishing the goal of holding those accountable, whether mentally ill or not, who willfully violate prison rules.

The professional organizations should acknowledge that it is not ethically defensible for health care professionals to acquiesce silently to conditions of confinement that inflict mental harm and violate human rights. They should affirm that practitioners are ethically obligated, not only to treat segregated inmates with mental illness, but also to strive to change harmful segregation policies and practices.[47],[48],[49] Finally, the organizations should not be content with clarifying the ethics-related responsibilities of individual practitioners in these circumstances. They should actively support practitioners who work for changed segregation policies, and they should use their institutional authority to press for a nationwide rethinking of the use of isolation. The medical professions’ commitment to ethics and human rights would be well served by such steps.


[1] Reyes H: The worst scars are in the mind: psychological torture. Int Rev Red Cross 89:591-617, 2007

[2] Basoglu M, Livanou M, Crnobaric C: Torture vs. other cruel, inhuman and degrading treatment: is the distinction real or apparent? Arch Gen Psychiatry 64:277-85, 2007[Abstract/Free Full Text]

[3] Riveland C: Supermax prisons: overview and general considerations. Washington, DC: U.S. Department of Justice, National Institute of Corrections, January 1999

[4] Fellner J, Mariner J: Cold storage: super-maximum security confinement in Indiana. Human Rights Watch, October 1997

[5] Commission on Safety and Abuse in America’s Prisons: Confronting confinement: a report of the Commission on Safety and Abuse in America’s Prisons. Washington, DC: Vera Institute of Justice, June 2006, pp 52-61. Available at http://www.prisoncommission.org/pdfs/Confronting_Confinement.pdf. Accessed May 12, 2009

[6] Smith PS: The effects of solitary confinement on prison inmates: a brief history and review of the literature. Crim Just 34:441-568, 2006

[7] Abramsky S, Fellner J: Ill-equipped: US prisons and offenders with mental illness. Human Rights Watch, 2003, pp 145-68

[8] Patterson RF, Hughes K: Review of completed suicides in the California Department of Corrections and Rehabilitation, 1999 to 2004. Psychiatr Serv 59:677-81, 2008

[9] White T, Schimmel D, Frickey R: A comprehensive analysis of suicide in federal prisons: a fifteen-year review. J Correct Health Care 9:321-43, 2002[Abstract/Free Full Text]

[10] Hayes LM: Prison guide: an overview and guide to prevention. Washington, DC: U.S. Department of Justice, National Institute of Corrections, 1995. Available athttp://www.nicic.org/pubs/1995/012475.pdf. Accessed May 13, 2009

[11] Abramsky S, Fellner J: Ill-equipped: US prisons and offenders with mental illness. Human Rights Watch, 2003, pp 145-68

[12] Metzner JL, Dvoskin JA: An overview of correctional psychiatry. Psychiatr Clin North Am 29:761-72, 2006[Medline]

[13] Abramsky S, Fellner J: Ill-equipped: US prisons and offenders with mental illness. Human Rights Watch, 2003, pp 145-68

[14] Metzner JL: Class action litigation in correctional psychiatry. J Am Acad Psychiatry Law 30:19-29, 2002[Abstract/Free Full Text]

[15] Hill C: Inmate mental health care. Correct Compend 29:15-31, 2004

[16] Abramsky S, Fellner J: Ill-equipped: US prisons and offenders with mental illness. Human Rights Watch, 2003, pp 145-68

[17] Hill C: Inmate mental health care. Correct Compend 29:15-31, 2004

[18] Abramsky S, Fellner J: Ill-equipped: US prisons and offenders with mental illness. Human Rights Watch, 2003, pp 145-68

[19] Fellner J: A corrections quandary: mental illness and prison rules. Harv CR-CL L Rev 41:391-412, 2006

[20] Madrid v. Gomez, 889 F. Supp. 1146, 1265 (N.D. Cal. 1995)

[21] Lovell D: Patterns of disturbed behavior in a supermax prison. Crim Just Behav 35:985-1004, 2008[Abstract/Free Full Text]

[22] O’Keefe M, Schnell MJ: Offenders with mental illness in the correctional system. J Offend Rehabil 45:81-104, 2007

[23] United Nations Human Rights Committee: CCPR General comment No. 20: replaces general comment 7 concerning prohibition of torture, or other cruel, inhuman or degrading treatment or punishment. New York: UNHRC, 1992

[24] United Nations Human Rights Committee: Consideration of reports submitted by States parties under Article 40 of the Covenant, concluding observations of the Human Rights Committee, United States of America. New York: UNHRC, UN Doc. CCPR/C/USA/CO/3, 2006

[25] United Nations Committee Against Torture: Consideration of reports submitted by States parties under Article 19 of the Convention, Conclusions and Recommendations of the Committee Against Torture, United States of America. New York: UN Committee Against Torture, UN Doc. CAT/C/USA/CO/2, 2006

[26] Interim Report of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. UN General Assembly. New York: United Nations, UN Doc. A/63/ 175:18-21, 2008

[27] International Covenant on Civil and Political Rights. Available at http://www1.umn.edu/humanrts/instree/b3ccpr.htm. Accessed January 29, 2010

[28] Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Available at http://www1.umn.edu/humanrts/instree/h2catoc.htm. Accessed January 29, 2010

[29] United Nations Human Rights Committee: Consideration of reports submitted by States parties under Article 40 of the Covenant, concluding observations of the Human Rights Committee, United States of America. New York: UNHRC, UN Doc. CCPR/C/USA/CO/3, 2006

[30] United Nations Committee Against Torture: Consideration of reports submitted by States parties under Article 19 of the Convention, Conclusions and Recommendations of the Committee Against Torture, United States of America. New York: UN Committee Against Torture, UN Doc. CAT/C/USA/CO/2, 2006

[31] World Medical Association: Guidelines for medical doctors concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Adopted by the 29th WMA Assembly, Tokyo, Japan, October 1975

[32] American Medical Association: Code of Medical Ethics. Opinion 2.067, Torture, 1999

[33] The World Psychiatric Association: Madrid Declaration on Ethical Standards for Psychiatric Practice. Approved by the WPA General Assembly, 1996

[34] American Medical Association: H-65.997, Human Rights. Health and ethics policies of the AMA House of Delegates. Adopted December 1978

[35] American Medical Association: Code of Medical Ethics. Opinion 2.068, Physician participation in interrogation. Issued November 2006

[36] American Psychiatric Association: Position statement: Psychiatric participation in interrogation of detainees. Adopted May 2006

[37] National Commission on Correctional Health Care: Position statement: correctional health care professionals’ Response to Inmate Abuse. Adopted October 14, 2007

[38] Dual loyalty and human rights in health professional practice: proposed guidelines and institutional mechanisms. Physicians for Human Rights and School of Public Health and Primary Health Care, University of Cape Town, 2003. Available at http://physiciansforhumanrights.org/library/documents/reports/report-2002-duelloyalty.pdf. Accessed May 13, 2009

[39] Nielsen NH, Heyman JM: Letter from the American Medical Association President and Chair of the Board of Trustees (respectively) to the Honorable Barak Obama, April 17, 2009. Available athttp://www.ama-assn.org/ama1/pub/upload/mm/-1/obama-letter-torture.pdf. Accessed May 17, 2009

[40] World Medical Association: Declaration concerning support for medical doctors refusing to participate in, or to condone, the use of torture or other forms of cruel, inhuman or degrading treatment. Adopted by the 49th WMA Assembly. Hamburg, Germany, November 1997. Available at http://www.wma.net/en/30publications/10policies/c19/index.html. Accessed January 29, 2010

[41] National Commission on Correctional Health Care: Standards for mental health services in correctional facilities. Standard MH-E-07, 2008

[42] American Psychiatric Association: Psychiatric services in jails and prisons: a task force report of the American Psychiatric Association (ed 2). Washington, DC: American Psychiatric Association, 2000, pp 4-5

[43] Ibid.

[44] Metzner JL: Mental health considerations for segregated inmates. Appendix E to Standards for Mental Health Services in Correctional Facilities. Chicago, IL: National Commission on Correctional Health Care, 2008, pp 129-31

[45] Work Group on Schizophrenia: American Psychiatric Association practice guidelines: practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 154(April Suppl.):1-63, 1997

[46] Metzner JL, Dvoskin JA: An overview of correctional psychiatry. Psychiatr Clin North Am 29:761-72, 2006[Medline]

[47] Dual loyalty and human rights in health professional practice: proposed guidelines and institutional mechanisms. Physicians for Human Rights and School of Public Health and Primary Health Care, University of Cape Town, 2003. Available at http://physiciansforhumanrights.org/library/documents/reports/report-2002-duelloyalty.pdf. Accessed May 13, 2009

[48] Nielsen NH, Heyman JM: Letter from the American Medical Association President and Chair of the Board of Trustees (respectively) to the Honorable Barak Obama, April 17, 2009. Available athttp://www.ama-assn.org/ama1/pub/upload/mm/-1/obama-letter-torture.pdf. Accessed May 17, 2009

[49] World Medical Association: Declaration concerning support for medical doctors refusing to participate in, or to condone, the use of torture or other forms of cruel, inhuman or degrading treatment. Adopted by the 49th WMA Assembly. Hamburg, Germany, November 1997. Available at http://www.wma.net/en/30publications/10policies/c19/index.html. Accessed January 29, 2010


A Palestinian child attempted suicide in an Israeli jail

RAMALLAH, (PIC)– Human rights lawyer Heba Masaleha said one of the Palestinian children detained in an Israeli jail tried to commit suicide as a result of the severe depression he suffers from because of his exposure to maltreatment at the hands of jailers.

Masaleha refrained from mentioning the name of the child, but she said she visited him in jail.

She stated that the child has been staying in bed for three days without moving or talking to anyone, except about his intention to commit suicide, adding that the child cannot sleep properly at night and already refused to eat food for two days.

She affirmed that the prison doctor said the child suffered from a psychological problem, adding that the prison administration also brought an Arab doctor from Nazareth to oversee him without any noticeable improvement in his condition.

Aside from their exposure to abuse and humiliation at the hands of Israeli soldiers and jailers, the mere separation of the Palestinian minors and children from their parents and families causes them to suffer psychologically, the lawyer warned.

In another incident, the Israeli occupation forces (IOF) kidnapped a group of Palestinian minors working as a drum band without any reason, according to Bayarek center for prisoners’ affairs on Sunday.

The center said that the children were on their way to a Palestinian folkloric festival that was held in the West Bank in solidarity with prisoner Samer Issawi, who ended his months-long hunger strike recently after a deal with his jailers.

The center underlined that the Israeli occupation regime deliberately kidnap Palestinian children to break their spirits in violation of the international law, which stipulates the need for protecting the children and their right to grow safely without any restrictions on their freedom.

It noted that there are about 321 children, 30 of them patients, in Israeli jails.





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