Reducing the Use of Segregation for People with Serious Mental Illness

• Author: Serena Maszak-Prato,Leigh Graham
• DOI: 10.1177/00328855221095519
• Published date: 01 June 2022
• Date: 01 June 2022
• Subject Matter: Articles

Reducing the Use of

Segregation for People

with Serious Mental

Illness

Serena Maszak-Prato

1

and Leigh Graham

2

Abstract

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.

Keywords

serious mental illness, segregation in prison, suicidality, self-harm

Introduction

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

1

John Jay College of Criminal Justice, New York, NY, USA

2

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.

Email: serena.maszak@jjay.cuny.edu

Article

The Prison Journal

2022, Vol. 102(3) 283–303

© 2022 SAGE Publications

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00328855221095519

journals.sagepub.com/home/tpj

correctional system’s 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 agencies’attempts 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 “worst”threat 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)