Reducing the Use of Segregation for People with Serious Mental Illness

Date01 June 2022
AuthorLeigh Graham,Serena Maszak-Prato
Published date01 June 2022
Subject MatterArticles
Reducing the Use of
Segregation for People
with Serious Mental
Serena Maszak-Prato
and Leigh Graham
This study, using data from a state correctional agency, examines the use of
segregation for people with serious mental illness in prisons. Our investiga-
tion shows deviations from departmental policy regarding the housing of
individuals with serious mental illness (SMI); frequent use of segregation
as a response to self-harm episodes and suicide attempts; and that people
determined to be most impaired by a serious mental illness were typically
placed in segregation. These f‌indings suggest that correctional staff need
to decouple disciplinary actions and responses from mental health symp-
toms, and avoid a punitive approach to incidents of self-harm or suicidality.
serious mental illness, segregation in prison, suicidality, self-harm
The widespread use of segregation, or solitary conf‌inement in prisons is a
topic of increasing debate and reform (Anthony-North et al., 2017). There
are varying def‌initions of segregation, and specif‌ic instances of this
John Jay College of Criminal Justice, New York, NY, USA
Ariadne Labs, Boston, MA, USA
Corresponding Author:
Serena Maszak-Prato, John Jay College of Criminal Justice, Department of Psychology, 524 W.
59th St., New York, NY 10019, USA.
The Prison Journal
2022, Vol. 102(3) 283303
© 2022 SAGE Publications
Article reuse guidelines:
DOI: 10.1177/00328855221095519
correctional systems use of restrictive environments are discussed in the
methods section of this article. Segregation is def‌ined by the American
Correctional Association (ACA) as spending 22 or more hours in a single
cell for extended periods, with little to no stimulation or social contact
(American Correctional Association, 2018). A report published by the
Association of State Correctional Administrators and Yale Law School
def‌ines restrictive housing as separating incarcerated persons from the
general population, and conf‌ining them to their cells for an average of
22 hours a day or more, for at least 15 days at a time (The Association of
State Correctional Adminsitrators, 2018). Differences in terminology also
ref‌lect differences in correctional agenciesattempts to def‌ine the intent and
purpose of different forms of restrictive housing (e.g. Treatment Units,
Intensive Management Units, Security Housing Units) (Labrecque, 2016).
Segregation is present in every form of correctional custody, and the situ-
ations described by segregation or restrictive housing vary considerably.
Three categories often used to differentiate types of segregation are discipli-
nary segregation (used as punishment for in-prison infractions), administra-
tive segregation (often used to separate individuals who are presumed to be
dangerous), and protective segregation or protective custody (used to separate
individuals who are presumed to be likely victims) (Browne et al., 2011).
The use of administrative segregation in particular grew exponentially since
the mid-1980s (Frost & Monteiro, 2016), with its use initially designed as a
way of maintaining control over those who posed the worstthreat to
prison management (Browne et al., 2011). However, its use has become
institutionalized, and it is applied to respond to a range of situations. This
growth has been followed by concern about the short- and long-term
mental and physical effects of holding someone in isolation. There is scien-
tif‌ic consensus that segregation aggravates and incites mental health symp-
toms like suicidality and depression, and a recent study found that social
isolation was a primary risk factor for suicide and other suicide-related out-
comes (Calati et al., 2019).
The link between use of segregation and mental healthimpacts on incarcer-
ated people is particularly concerning to some clinicians and researchers
because data also document the increasing prevalence of serious mental
illness (SMI) in the criminal justice system (Prins, 2011). Def‌initions of SMI
vary, but generally SMI means: 1) diagnosis of a major mental disorder such
as schizophrenia or bipolar disorder, and 2) impacted daily life because of
this diagnosis (Metzner & Fellner, 2010). Federal regulation def‌ines SMI as
a mental, emotional, or behavioral disorder, excluding substance use and
developmental disorders, that causes serious functional impairment to major
284 The Prison Journal 102(3)

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