After seven months in isolation at Cresson state penitentiary in Pennsylvania, an inmate identified as “EE” began to deteriorate.

He banged his head against his cell, smeared feces on the walls, and ripped the bandage off of a wound, digging in his fingers until it bled.

EE had been diagnosed with a schizoaffective disorder and an intellectual disability. He’s spent seven of the last 12 years in isolation in various Pennsylvania institutions.

At Cresson, during 15 consecutive months in isolation, he would threaten or attempt to harm or kill himself at least 15 times.

“Isolation,” he would later tell Justice Department officials, “makes me want to rip my face off.”

EE’s condition wasn’t unusual for those in confinement at Cresson, according to what experts describe as an unprecedented government examination of isolation in a prison. The investigation by Justice Department officials, begun in December 2011, concluded late last month. The report on their findings withheld identifying details about inmates it referenced, including why they were in prison.

The investigators found that Cresson’s use of solitary confinement violated inmates’ constitutional rights by subjecting them to cruel and inhumane treatment.

At Cresson, prisoners with serious mental illnesses and disabilities were “warehoused” for months and even years at a time in isolated cells that reeked of urine and feces. They were often denied basic necessities, such as toilet paper. Guards spit in their food, left them restrained in chairs for nearly 20 hours at a time, and stunned them with tasers even when they were calm and posed no threat.

One ordered mentally challenged inmates to sing “I’m a little teapot” in order to improve their living conditions and get more mental-health treatment. One inmate told DOJ investigators that he had tried, but couldn’t remember the song.

The investigation found that the harsh treatment often worsened the inmates’ conditions, particularly those already diagnosed with mental illness. It led to higher rates of suicide than in the general prison population, the DOJ found.

It also poses a greater danger to the community when these individuals are finally released. Isolation tends to exacerbate mental illnesses and make it more difficult for people to interact with others. Once they’re back in civilian life, these inmates no longer have access to mental-health professionals or medication, leaving their illness unchecked and much more likely to lead to unpredictable, and potentially violent behavior.

Pennsylvania said it plans to close Cresson at the end of June and is cooperating with the DOJ. But as disturbing as the incidents there might be, the problems investigators found with solitary don’t appear to be confined to a single institution.

Some of the troubling policies at Cresson may be standard procedure at Pennsylvania prisons, the DOJ found, as prison officials seek to corral mentally disturbed inmates they don’t understand, and can’t — or won’t — properly treat.

Investigators plan to expand their investigation into the use of isolation statewide.

At the same time, a new report from the Government Accountability Office criticized the use of solitary within the federal prison system. It found that even as prisons place more inmates in solitary for longer periods, the federal Bureau of Prisons has no data on how the practice affects inmates, whether they’re treated properly — or whether the practice even works.

The two critical findings, by separate branches of the federal government, mark an “historic” level of scrutiny of the use of isolation, said Amy Fettig, senior staff counsel at the American Civil Liberties Union’s National Prisons Project. The federal investigations come as several states are also starting to turn away from the practice, because of both the human and economic costs.

The GAO report found that housing inmates in isolation costs significantly more than confinement for the general population, largely because of the extra staffing required. The Bureau of Prisons doesn’t regularly calculate the cost of housing inmates in solitary, but it did estimate that the daily cost per inmate for isolation at one sample facility was $119.71, compared to $69.41 for the general population.

Solitary in America

Solitary confinement, or isolation, has different labels depending on the facility and population it targets. It’s sometimes called “administrative segregation,” “special management,” or “restricted” housing. Cell sizes vary: The American Correctional Association recommends that cells have a minimum of 80 square feet of floor space if prisoners are kept there for more than 10 hours per day, but not all facilities follow those guidelines.

Corrections officials often don’t use the term “solitary confinement.” The Bureau of Prisons argues that because prisoners held in these segregated housing units interact with guards when food is delivered through the small slot in their cell, they aren’t technically in isolation, the GAO found. At Cresson, the state facility, those in “isolation” were sometimes double-bunked due to overcrowding, a practice that isn’t unusual.

But most experts, including the DOJ in its findings on Cresson, agree on the common features of isolation or solitary confinement — terms they use interchangeably: In all of these facilities, such prisoners are confined to a cell for 22 hours a day or more, alone or with other prisoners, with limited contact with others.

Isolation on the Rise

Today, an increasing number of inmates are held in isolation.

The GAO report found that since 2008, the rate of inmates in solitary confinement in U.S. federal prisons has been rising faster than the general population. Today about 7 percent of federal inmates are in segregated housing.

The GAO estimated that 12,460 inmates are currently in isolation in federal prisons. But the wider number across all facilities in the U.S. is believed to be around 80,000, although that number may be higher, according to those who study the issue.

Does It Work?

Even as prisons are locking up more inmates in solitary, the report found that they’re also failing to address major concerns about the practice — such as whether it works.

Corrections officials began relying on solitary confinement in the ’70s and ’80s, when prisons became overcrowded, as a way to manage the influx of prisoners and corral trouble-makers. Often, the mentally ill ended up here, too, as prison guards lacked the training or expertise to understand and treat their conditions.

Those critical of solitary point to California, which for decades has relied heavily on the practice as a punitive measure for those who join prison gangs or instigate violence, but still wrestles with one of the worst gang problems in the country.

“If you’re using it to change behavior, it should work,” said Terry Kupers, a psychiatrist and professor at the Wright Institute in San Francisco, who studies solitary confinement.

The federal system has also argued that isolation is necessary to remove dangerous inmates from the general population. But it wasn’t able to show government investigators any evidence that showed the use of solitary had cut down on assaults or other violence.

Some state prison systems have actually found that it didn’t. Five states — Colorado, Kansas, Maine, Mississippi and Ohio — have cut back on their use of solitary due to budget cuts and litigation. Since then, GAO said, these states have reported “little or no adverse impact on institutional safety.” They found no marked increase in violence either.

How Much Is Too Much?

The Bureau of Prisons also hasn’t done any study on how solitary impacts institutional safety or its long-term effect it has on inmates’ mental health, the report found. Officials told the GAO that its psychologists found “little or no adverse impact” of isolation on inmates.

But the bureau’s own Psychology Services Manual acknowledges long-term health risks in the practice, noting that it “recognizes that extended periods of confinement in Administrative Detention or Disciplinary Segregation Status may have an adverse effect on the overall mental status of some individuals.”

There is other evidence that suggests long-term confinement can be dangerous, particularly for people with mental illnesses or young people, but even for otherwise healthy adults.

“I think it is the consensus in the academic and health community that solitary confinement does nothing positive for people,” said Craig Haney, a psychology professor at the University of California who has worked extensively with inmates in isolation. “The best-case scenario is they come out no worse than they went in — and it goes downhill from there.”

Juan Mendez, U.N. Special Rapporteur on Torture said that any isolation longer than 15 consecutive days should be considered abusive. For juveniles and people with mental illnesses, solitary confinement “always constitutes cruel, inhuman, or degrading treatment and even torture when applied to these categories,” he said.

In the U.S., most stays in solitary begin at 30 or 60 days. If inmates act out, often because they are struggling to deal with isolation, they end up prolonging their stays for 90 or even 180 days. Some inmates have been in solitary for decades.

Everyone responds differently in isolation, Haney said. But for many inmates, isolation exacerbates existing mental illnesses, such as depression and anxiety, and can lead to deep anger problems, as well as cognitive deterioration, Haney said. They become uncomfortable or fearful of basic human touch, such as a handshake.

It also vastly increases the risk of suicide: Kupers estimates that about half of suicides in detention happen in solitary, even though those inmates make up less than 10 percent of the general prison population.

The Bureau of Prisons agreed with the government assessment and says it’s working to make improvements. It started reviewing inmates’ mental health in January this year, but without long-term data to compare it to, the report was skeptical about how useful that information would be or how soon change might come.

States Lead on Reform

Fettig, at the ACLU, said a handful of states are now at the forefront on solitary confinement reform.

Several have changed their criteria for placing inmates in isolation, reserving it only for serious infractions, and reducing the length of time prisoners stay there. Some have also introduced incentives, such as opportunities to cut back their time in isolation for good behavior, and more social programming.

Mississippi has changed its policies so that only inmates guilty of serious infractions, those who are active, high-level gang members; or those who have attempted to escape could be placed in isolation. The change drastically reduced the number of inmates in isolation, the GAO found. In 2010 it was able to shut down an entire supermax, saving $6 million annually for the cash-strapped state.

After the Colorado legislature mandated a review (pdf) of isolation in state facilities, officials began reviewing cases of all inmates who had been in solitary for more than a year. Nearly 37 percent were moved to the general population. The reforms led to the closure last year of a 316-bed isolation facility, and saved $5 million that year alone.

This year, Illinois closed its only “supermax” prison after multiple reports (pdf) of inhumane treatment of its inmates.

After Maine conducted its own study, it made changes in policy, including a requirement that officials receive permission from the Commissioner of Corrections to leave an inmate in isolation for more than 72 hours. The changes have cut the number of inmates in solitary by half, according to an assessment of state reforms by the ACLU.

In Michigan, officials put in place a program of incentives that has cut back on the number of inmates in isolation and the length of time the remain there, as well as the level of violence.

Other states are also eyeing change: New Mexico and Texas have both launched similar studies.

In “The Dead Man’s Zone”

But as the problems at Cresson showed, there are still plenty of troubling findings at the state level as well, particularly when it comes to the mentally ill.

Despite Mississippi’s reforms, the ACLU and the Southern Poverty Law Center filed suit (pdf) against a state facility late last month on behalf of inmates in solitary confinement, many of whom are mentally ill. The suit says the prisoners at the Mississippi Correctional Facility “live in barbaric and horrific conditions,” that have cost inmates “their health, and their limbs, their eyesight, and even their lives.”

The suit said that one solitary confinement area is known as “the Dead Man’s Zone” because prisoners there are virtually unsupervised, left locked down in filthy cells for days or weeks at a time, often without working toilets or functioning lights.

Inmates set fires to get the staff’s attention, but security officials often ignore the flames, the suit said, and let them burn out.

Rats climb over their beds in the dark.

“As our nation as a whole wakes up from our hangover from over-incarceration, and takes a hard look at what we’ve been doing, solitary confinement stands out as an area where we went too far — and hurt people in the process — without giving it a second thought,” said the ACLU’s Fettig. “These institutions dehumanize everyone involved.”

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