This week we are discussing solitary confinement…
Isn’t it freaky how online platforms seem able to predict our interests? Last week, I turned to Disney+ for a crime & punishment film I needed for work purposes. And then this week on a mini-break I logged on to find a nice relaxing movie, only to be confronted by the platform’s 'because you watched' suggestion of yet another crime saga! And the thing is, both on duty and off duty, I am interested in all things crime & punishment. So in for a penny, in for a pound...
Bronson
A biographical film armed with a hefty degree of artistic license, Bronson tells the story of Charles Bronson, the well-known muscled and mustachioed fixture of the solitary cells within Britain's high secure prison estate (HSE). First imprisoned in 1974 aged 22 under his birth name of Michael Peterson, excepting a handful of days he’s been under various kinds of lock and key ever since. How can this be though? After all, his original sentence - for armed robbery - was just seven years!
Mainly it’s due to his behaviour whilst inside prison. Attempted murder. Grievous bodily harm to fellow prisoners and staff. Taking hostage an art teacher, a doctor, and governors. And massive wanton destruction of prison and special hospital property and buildings. Acts like this do not go hand-in-glove with timely release.
Rehab
Proponents of the benefits of imprisonment talk about its potential for rehabilitation. Yes, some prisoners can and do learn useful things behind bars - reading & writing, the wrongness of their offending behaviour, and practical skills for gainful employment after release. Creative avenues of self-expression are also taught within some secure environments. Mr Bronson, for example, attended art classes behind bars and has become a notable prison artist: despite being in solitary, he turns out some impressive pieces.
Still, a key question posed by Bronson is this: are such rehabilitative benefits mere silver linings within a de facto harmful black thunder cloud? Were it possible to write Mr Bronson into a sequel to Sliding Doors, we could rewind his life back to just before the events that led to his first imprisonment. A longitudinal criminal justice case study could then follow, potentially with incredible answers to deep questions. Was he always destined to go down the same disturbing life trajectory - regardless of whether he was imprisoned? Or could he have turned out far more benign and productive, like so many other young men born and bred in post-war Luton? And did his earliest years in solitary confinement and other forms of detention do him significant and lasting psychological harm, mould his longer-term behaviours, and beget his whole life story?
Warning
I'm a HSE healthcare professional (HCP). Mr Bronson has been detained within the HSE for ever so long. And in Britain, Prison Service Order PSO 1700 mandates a nurse visiting all solitary prisoners daily and a doctor every three days. As a result, like many other HSE HCPs I have met and cared for Mr Bronson. So I voice no personal opinion about his case other than noting that the safe housing of such an unusually violent prisoner must pose a fiendishly difficult dilemma for any prison governor.
Leaving him aside though, I have formed definite conclusions about solitary confinement per se - views honed during countless 72-hourly 'Doctor's Seg Rounds' in the UK as well as many visits to various other countries’ solitary confinement units. [1]
So what do I think? Whilst a degree of separation from the rest of the prison population is sometimes necessary, never have I seen solitary confinement produce lasting improvement in a prisoner’s mental and physical health. On the contrary, I often see mental and physical health deteriorate. And for certain, I think that its longer-term use should come armed with a health & safety warning every bit as serious as those emblazoned across modern-day cigarette packets: ‘Solitary confinement is bad for your health'. And I’m far from the first to say this…
COVID
The world has just been groaning under the weight of COVID lockdowns. Though undeniably bitter, our own ‘pandemic sufferings’ have been just a small taste of the horrific suffering endured week in, month out, even year in, decade out by prisoners held in long-term solitary confinement. And solitary confinement wasn’t exactly rare before the pandemic:-
… it [solitary confinement] continues to be used across the globe – including for vulnerable groups such as prisoners with disabilities and children – in contravention of international standards. This is despite increasing recognition of its detrimental psychological and physiological effects, and of the economic costs… New Zealand, for instance, saw a 151 per cent rise in the use of solitary confinement over the five-year period up until 2016, compared to a 16 percent rise in the prison population… In the US, a report detailed how blind and deaf prisoners in solitary confinement experience a heightened form of sensory deprivation as a result of their disability...
(Global Prison Trends 2018, Penal Reform International)
Sensory distortion is a key feature of solitary confinement syndrome. This syndrome is a very real thing. I have seen it in some of my patients around the world and it’s most upsetting to witness. How much worse must it be to experience it?
United
So what does the United Nations (UN) have to say about solitary confinement? Actually, quite a lot. The Nelson Mandela Rules read as follows:-
Rule 43
1. In no circumstances may restrictions or disciplinary sanctions amount to torture or other cruel, inhuman or degrading treatment or punishment. The following practices, in particular, shall be prohibited: (a) Indefinite solitary confinement; (b) Prolonged solitary confinement...
Rule 44
For the purpose of these rules, solitary confinement shall refer to the confinement of prisoners for 22 hours or more a day without meaningful human contact. Prolonged solitary confinement shall refer to solitary confinement for a time period in excess of 15 consecutive days.
Rule 45
1. Solitary confinement shall be used only in exceptional cases as a last resort, for as short a time as possible and subject to independent review…
2. The imposition of solitary confinement should be prohibited in the case of prisoners with mental or physical disabilities when their conditions would be exacerbated by such measures. The prohibition of the use of solitary confinement and similar measures in cases involving women and children, as referred to in other United Nations standards and norms in crime prevention and criminal justice, continues to apply.
At this point we could ask, ‘The UN is so down on it, so why is solitary confinement still such a strong feature across the globe?’
Europe
Leaving the effectiveness of the UN aside though, let’s return to Europe, which of course is the continent within which the star of Bronson is confined.
European detainees benefit from extra protection over and above UN guidelines. That’s thanks to the Council of Europe (CoE) and its European Convention for the Prevention of Torture and Inhuman or Degrading Ill-treatment or Punishment, which itself builds on Article 3 of the CoE’s founding legal instrument, the European Convention of Human Rights:-
No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
The CoE’s European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) monitors compliance with the convention bearing its name, and its position statement on solitary confinement makes persuasive and sombre reading:-
Solitary confinement… can have an extremely damaging effect on the mental, somatic and social health of those concerned. This damaging effect can be immediate and increases the longer the measure lasts and the more indeterminate it is. The most significant indicator of the damage which solitary confinement can inflict is the considerably higher rate of suicide among prisoners subjected to it than that among the general prison population… In addition, it can create an opportunity for deliberate ill-treatment of prisoners, away from the attention of other prisoners and staff.
… ensuring that there is a positive doctor-patient relationship between them is a major factor in safeguarding… medical personnel should never participate in any part of the decision-making process resulting in any type of solitary confinement, except where the measure is applied for medical reasons. On the other hand, health-care staff should be very attentive to the situation of all prisoners placed under solitary confinement...
The CPT’s assertion that solitary confinement is associated with long-term damage to ‘somatic’ or physical health received a boost recently with the publication of the results of a European public health study. A review of over 800,000 person-months spent in Danish solitary confinement showed such incarceration to be associated with a significantly higher chance of death within five years of release. [2]
So the European Prison Rules do right to include a focus on solitary confinement:-
The medical practitioner shall report to the director whenever it is considered that a prisoner’s physical or mental health is being put seriously at risk by… conditions of solitary confinement… Such visits [by healthcare professionals to prisoners in solitary confinement] can in no way be considered as condoning or legitimising a decision to put or to keep a prisoner in solitary confinement.
Statements
In addition to these legal instruments and codes of practice though, groups of international experts have gathered to ponder the best available evidence about the pros and cons of solitary confinement.
In 2007 at the International Psychological Trauma Symposium, the Istanbul statement on the use and effects of solitary confinement was issued. [3] And it's particularly interesting to note that three groups of detainees were picked out as being especially high risk for solitary conditions:-
The use of solitary confinement should be absolutely prohibited in the following circumstances:
- For death row and life-sentenced prisoners by virtue of their sentence.
- For mentally ill prisoners.
- For children under the age of 18.
Then around a decade later, a summit in Santa Cruz was convened to review the interplay between solitary confinement and health. The resulting Consensus Statement from the Santa Cruz Summit on Solitary Confinement and Health includes eight guiding principles:-
1 The Santa Cruz Summit on Solitary Confinement and Health reaffirms the Istanbul Statement as an appropriate framework for reforming solitary confinement… solitary confinement subjects prisoners to significant risk of serious harm and it therefore should be used only when absolutely necessary, and only for the shortest amount of time possible.
2 The Summit reaffirms that the use of solitary confinement should be absolutely prohibited for certain groups of especially vulnerable persons, including the mentally ill, children, older adults, people with chronic health conditions… and pregnant women…
3 Reduction in the use of solitary confinement should be further informed by the growing evidence-based knowledge that prolonged isolation accomplishes few if any legitimate penological purposes…
4 Solitary confinement reform is consistent with ongoing efforts to address and enhance correctional officer health and wellness…
5 The unique ethical challenges faced by correctional medical and mental health care providers who work inside solitary confinement units are not easily resolved…
6 Meaningful forms of independent external and internal monitoring and oversight are essential…
7 As more prison systems significantly limit or eliminate solitary confinement, it is important that stakeholders document and disseminate evidence about the impact of these reforms…
8 Because the overuse of solitary confinement reflects and is related to dysfunction in the larger correctional systems in which it is deployed, its reform should be recognized as part of the broader movement to reform prisons…
Ill
I am struck that both these statements use the term ‘mentally ill’ in their descriptors of those who should not be held in solitary confinement, rather than more detailed phrases such as ‘permanently psychotic’ or ‘severely or enduringly mentally ill’.
This wider bracket of ‘mentally ill’ may be argued to include those with:-
psychiatric effects from withdrawal from alcohol or drugs,
psychiatric effects from drug taking,
personality disorders,
significant difficulty adjusting to prison life,
even mild degrees of anxiety or depressive disorders.
Applying this wider definition would bar the vast majority of Club Solo’s regular patrons - certainly in the prisons I visit or work in, and I suspect in the vast majority of prisons worldwide.
N G
It’s taken the best part of two decades to formulate my own opinions about solitary confinement. That’s quite long enough! So I’ll close now with the best, oldest and thankfully shortest conclusion I’ve ever read on this subject:-
“It is not good [N G] for man to be alone...”
God (Genesis 2:18)
And our Creator should know what’s best for us, His creations, shouldn’t He?
Dr Rachael Pickering is our voluntary Chief Medical Officer. Her personal opinions are not necessarily the same as those of Integritas Healthcare. We are always grateful for support.
Notes
[1] ‘Seg’ is short for ‘segregation’, which is the name that solitary confinement goes under within the UK prison system.
[2] Wildeman, C et al. Solitary confinement placement and post-release mortality risk among formerly incarcerated individuals: a population-based study. Lancet Public Health 2020: Feb;5(2):e107-e113
[3] This statement should not to be confused with the Istanbul Protocol, which deals with the documentation and evidencing of torture in general.