Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018.

Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement.Methods. We gathered data via semistructured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for 106 randomly selected people in solitary confinement in the Washington State Department of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, or guilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are eventually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.

Not an 'iron pipeline', but many capillaries: regulating passive transactions in Los Angeles' secondary, illegal gun market.

OBJECTIVES: California has strict firearm-related laws and is exceptional in its regulation of firearms retailers. Though evidence suggests that these laws can reduce illegal access to guns, high levels of gun violence persist in Los Angeles (LA), California. This research seeks to describe the sources of guns accessed by active offenders in LA, California and reports offenders' motivations for obtaining guns. SETTING: Los Angeles County Jail (LACJ) system (four facilities). METHODS: Random sampling from a screened pool of eligible participants was used to conduct qualitative semistructured interviews with 140 incarcerated gun offenders in one of four (LACJ) facilities. Researchers collected data on firearm acquisition, experiences related to gun violence, and other topics, using a validated survey instrument. Grounded theory guided the collection and analysis of data. RESULTS: Respondents reported possession of 77 specific guns (79.2% handguns) collectively. Social networks facilitate access to illegal guns; the majority of interviewees acquired their illegal guns through a social connection (85.7%) versus an outside broker/unregulated retailer (8.5%). Most guns were obtained through illegal purchase (n=51) or gift (n=15). A quarter of gun purchasers report engaging in a passive transaction, or one initiated by another party. Passive gun buyers were motivated by concerns for personal safety and/or economic opportunity. CONCLUSIONS: In LA's illegal gun market, where existing social relationships facilitate access to guns across a diffuse network, individuals, influenced by both fear and economic opportunity, have frequent opportunities to illegally possess firearms through passive transactions. Gun policies should better target and minimise these transactions.

Excess mortality in U.S. prisons during the COVID-19 pandemic.

U.S. prisons were especially susceptible to COVID-19 infection and death; however, data limitations have precluded a national accounting of prison mortality (including but not limited to COVID-19 mortality) during the pandemic. Our analysis of mortality data collected from public records requests (supplemented with publicly available data) from 48 Departments of Corrections provides the most comprehensive understanding to date of in-custody mortality during 2020. We find that total mortality increased by 77% in 2020 relative to 2019, corresponding to 3.4 times the mortality increase in the general population, and that mortality in prisons increased across all age groups (49 and under, 50 to 64, and 65 and older). COVID-19 was the primary driver for increases in mortality due to natural causes; some states also experienced substantial increases due to unnatural causes. These findings provide critical information about the pandemic's toll on some of the country's most vulnerable individuals while underscoring the need for data transparency and standardized reporting in carceral settings.

Triaged Out of Care: How Carceral Logics Complicate a 'Course of Care' in Solitary Confinement.

Incarceration, along with its most restrictive iteration, solitary confinement, is an increasingly common experience in America. More than two million Americans are currently incarcerated, and at least one-fifth of incarcerated people will experience solitary confinement. Understanding the barriers to care people experience in prison, and especially in solitary confinement, is key to improving their access to care during and after incarceration. Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two key barriers to care that people in solitary confinement face: cultural barriers (assumptions that incarcerated people do not need or do not deserve care) and structural barriers (physical spaces and policies that make contacting a healthcare provider difficult). While scholarship has documented both the negative health consequences of solitary confinement and correctional healthcare providers' challenges navigating between the "dual loyalty" of patient care and security missions, especially within solitary confinement, few have documented the specific mechanisms by which people in solitary confinement are repeatedly triaged out of healthcare access. Understanding these barriers to care is critical not only to improving correctional healthcare delivery but also to improving healthcare access for millions of formerly incarcerated people who have likely had negative experiences seeking healthcare in prison, especially if they were in solitary confinement.

Does a Public Health Crisis Justify More Research with Incarcerated People?

Covid-19 has infected thousands and killed hundreds in prisons, jails, and immigration detention facilities across the United States. Responding to this crisis, leading medical researchers have called for expanding opportunities for people in prison to participate in vaccine trials. These calls, like current regulations, focus on individualized risk assessments around consent, coercion, and harm, while ignoring the unnaturalness of deprivation conditions in U.S. prisons. We need new frameworks of analysis that refocus on structural, rather than individual, risk assessments. Integrating structural perspectives-including skepticism of claims of scarcity, avoidance of representational distortions, and attention to institutional agency-into our existing, overly individualistic frameworks might permit the design of more ethical research projects involving people who are incarcerated. Still, the unnatural deprivations of incarceration might be so great that research subjects might need to be removed from prison entirely in order to ethically participate in research.

Window dressing: possibilities and limitations of incremental changes in solitary confinement.

BACKGROUND: In light of mounting evidence of the physical and psychological harms associated with solitary confinement, many correctional systems, state legislators, courts, and even international human rights bodies are increasingly recommending and implementing reforms to mitigate the harms of solitary confinement, if not abolish the practice entirely. In this piece, we examine three specific infrastructural changes to solitary confinement conditions and practices implemented in Washington state prisons with such harm minimization goals in mind: (1) building so-called "nature imagery rooms" to play videos of outdoor spaces, (2) eliminating punishments for self-harm, and (3) conducting daily cell-front wellness checks. RESULTS: Drawing on 183 in-depth qualitative interviews with both staff working in and people imprisoned in solitary confinement units conducted in Washington state restrictive housing units in 2017, we find that these three reforms not only resulted in limited successes but also generated new conflicts. Institutional logics such as deprivation, risk-management, and responsibilization ultimately impeded even the most modest attempts to mitigate the inherently harsh practice of solitary confinement. The limits of these reforms are due in part to individual choices made by people imprisoned in solitary confinement and staff working in these units, as well as the larger cultural norms that shape life in restrictive housing units. CONCLUSIONS: Incrementalist reforms aimed at softening the environment of solitary confinement may actually serve to increase the strain and stress experienced by people confined to and working within them. Even the most well-intentioned reforms, like those attempted by the Washington DOC, should be scrutinized in order to determine if they are producing the desired outcomes, or instead, reproducing a different, but nonetheless damaging set of harms to people imprisoned in solitary confinement. Further, even well-intentioned reforms are often stymied by the underlying institutional logics of restrictive housing spaces.

The body in isolation: The physical health impacts of incarceration in solitary confinement.

We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.

Coercion and Access to Health Care.

In this issue of the Hastings Center Report, Paul Christopher and colleagues describe a study of why prisoners choose to enroll in clinical research. The article represents an important methodological and policy contribution to the literature on prisoner participation in research and medical experimentation. Given the methodological and ethical debates to which this research seeks to make an empirical contribution, the careful manner in which the study was conducted and the transparency with which the authors describe the research is especially noteworthy. In sum, I respect the research steps the authors took. However, I disagree with their conclusions about both the absence of coercion for prisoner clinical research participants and the merits of applying risk-benefit models to govern prisoner research participation.