Understanding Offender Needs Over Forms of Isolation Using a Repeated Measures Design
| Author | Elizabeth Thompson Tollefsbol,Melissa A. Kowalski,Laurie A. Drapela,Zachary K. Hamilton,Youngki Woo,Michael F. Campagna,Xiaohan Mei,Mary K. Stohr |
| Date | 01 December 2019 |
| DOI | 10.1177/0032885519877356 |
| Published date | 01 December 2019 |
| Subject Matter | Articles |
research-article2019
Article
The Prison Journal
2019, Vol. 99(6) 639 –661
Understanding
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https://doi.org/10.1177/0032885519877356
DOI: 10.1177/0032885519877356
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Forms of Isolation
Using a Repeated
Measures Design
Michael F. Campagna1, Melissa A. Kowalski2,
Laurie A. Drapela3, Mary K. Stohr4,
Elizabeth Thompson Tollefsbol5,
Youngki Woo6, Xiaohan Mei7,
and Zachary K. Hamilton8
Abstract
A number of studies find that solitary confinement is associated with mental
impairment. Yet, confinement dosage and which individual and exogenous
variables lead to mental impairment have received less attention. This
study of 2 years of data on disciplinary segregation male inmates employs
a repeated measures design to examine how isolation affects mental
health and psychological needs. The findings indicate that the duration of
disciplinary segregation and incarceration, incidence of homelessness, and
other individual-level factors had deleterious effects on mental health and
1Nebraska Center for Justice Research, University of Nebraska Omaha, Omaha, USA
2The College at Brockport, NY, USA
3Washington State University, Vancouver, USA
4Washington State University, Pullman, USA
5Northern Idaho College, Coeur d’Alene, USA
6University of Texas Rio Grande Valley, Brownsville, USA
7California State University, Los Angeles, USA
8Washington State University, Spokane, USA
Corresponding Author:
Michael F. Campagna, Nebraska Center for Justice Research, CPACS 218, 6001 Dodge St.,
Omaha, NE 68182, USA.
Email: mcampagna@unomaha.edu
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The Prison Journal 99(6)
psychological needs. Vocational programming and a high school education
were found to be protective factors for psychological needs.
Keywords
solitary confinement, epidemiology, mental health, homelessness, repeated
measures
Introduction
Prison systems across Western society have experienced a decades-long orga-
nizational crisis centered on balancing order maintenance with offender treat-
ment. The deinstitutionalization movement of the 1950s and 1960s resulted in
fewer hospital beds for seriously mentally ill (SMI) and indigent patients, with
confinement to jails and prisons becoming the more frequent solution (Lamb
& Weinberger, 2017). Once incarcerated, these underlying mental health
issues increased the possibility of further isolation as a result of perceived
rule-breaking (Cloud, Drucker, Browne, & Parsons, 2015), extending the
offender’s stay and/or contributing to criminogenic behavior patterns.
Correctional institutions have thus become de facto mental health institu-
tions in the United States (Haney, 2017; Kurki & Morris, 2001). The United
States currently boasts 10 times as many people with a SMI in correctional
institutions compared with confinement in mental health facilities (Torrey
et al., 2014). Notably, persons with psychiatric conditions are over-represented
in jails and prisons, especially in restrictive housing (Cloud et al., 2015).
Restrictive housing refers to some condition of limited social contact within a
living space while incarcerated, sometimes referred to as isolation, solitary con-
finement (SC), disciplinary segregation (DS), administrative segregation, or
secured housing. Approximately 30% of prison inmates in segregation report
past or current SMIs (Beck, 2015). Often, these inmates are sent to isolation for
disciplinary reasons, as they have difficulty complying with prison/jail rules, and
officials utilize these space alternatives to keep order (Cloud et al., 2015;
Labrecque & Mears, 2019). However, placement in isolation can result in inmates
experiencing worsened psychological symptoms, intensifying misbehavior, and
further prolonging their stay in restrictive housing (Fellner, 2006). While most
agencies limit the time an offender remains in isolation, the frequency and dura-
tion of isolation placements have been difficult to assess (Morris, 2016). Of par-
ticular concern is that, offenders with SMIs are over-represented in SC due to
prison efforts to control unruly behavior (O’Keefe & Schnell, 2007).
Importantly, gradual change in correctional policies regarding inmates with
SMIs has been slowly implemented. The 2016 American Correctional
Campagna et al.
641
Association (ACA) advocated for routine behavioral health assessments for
offenders in isolation, and that offenders with serious SMIs not be placed in
extended restrictive housing. Such policy recommendations represent a marked
shift in our understanding of SC, indicating that although the effects of inca-
pacitation on mental health and other offender needs are not fully settled, there
is emerging evidence of its negative effects (Labrecque & Mears, 2019;
Meyers, Infante & Wright, 2018; Walters, 2018). While inmates may be placed
in some form of SC for their own protections, for administrative or disciplinary
purposes, there is a debate about the effect of isolation on mentally vulnerable
adults (Kapoor & Trestman, 2016; Labrecque & Mears, 2019, p. 200). Kapoor
and Trestman (2016, p. 200) summarize for the National Institute of Justice
some of the problems with the research on SC’s purportedly psychologically
debilitating effects, noting that critics have characterized them as methodologi-
cally weak and/or not generalizable. The current study adds some rigor to the
research by examining a full 2 years of data in a Western state to determine
whether the duration of varying levels of isolation affects offenders’ subse-
quent mental health functioning and other psychological constructs. We also
address a “gap in knowledge” identified by Kapoor and Trestman (2016) in that
we collect information about SC inmates regarding their status in the commu-
nity. Findings from this investigation contribute to the growing body of litera-
ture examining the consequences of SC on mentally ill or vulnerable inmates.
Context of Isolation Policy
The use of SC became widespread in the 1980s as the movement to construct
supermax prisons gained ground. Supermax prisons utilize the most extreme
form of isolation as a means of maintaining prison order, decreasing violence,
and deterring violence (Arrigo & Bullock, 2008; Labrecque & Mears, 2019;
Mears & Reisig, 2006). “The worst of the worst,” offenders were intended to
be placed in supermax prisons to decrease the likelihood of injury to prison
staff and other housed offenders (Ward & Kassebaum, 2009, p. 70).
Nonetheless, as supermax construction increased the capacity of correctional
systems to house high-risk offenders, the number of severely incorrigible
offenders did not keep pace with cell construction, widening the net to include
“nuisance offenders” who irritate correctional staff, or have minor prison
infractions (Shames, Wilcox & Subramanian, 2015; Toch, 2001). Given lim-
ited resources, a bed-driven classification policy thrived.
To help differentiate disruptive or dangerous offenders from those less
likely to be so, Labrecque and Smith (2019) created an intake assessment
designed to inform case management decisions with the ultimate goal of
reducing institutional misconduct. This strategy has the potential to improve
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The Prison Journal 99(6)
order maintenance policies by ensuring agencies limit isolation exposure to
low-risk groups and by providing specialized case management that seeks to
enhance protective factors for institutional violence. Yet, much work on the
potential harms and tolerable lengths of isolation is still needed.
Offenders Placed in Isolation
Offenders with SMIs may be more likely to be placed in restrictive housing
(Beck, 2015; Labrecque & Mears, 2019). For instance, Hodgins and Côté
(1991) assessed offenders from two segregation units and found that offend-
ers in isolation had a higher prevalence of severe SMIs. Furthermore,
Andersen et al. (2000) compared rates of psychiatric disorders of offenders in
SC to those in the general population. They found that 28% of offenders in
SC had psychiatric disorders compared with only 15% of offenders in the
general population and suggested these rates of disorders differed due to SC.
Generally, it is unknown whether those with more SMIs are put in SC at
higher rates, if SC is the cause of decreased psychological functioning, or
whether SC affects offenders with pre-existing SMIs differently than those
without (Kapoor & Trestman, 2016; O’Keefe, 2007).
In contrast, O’Keefe et al. (2013) found that prisoners who entered SC
with a SMI did not suffer significant deterioration in psychological function-
ing relative to prisoners without SMIs who were subjected to administrative
segregation. When the mental well-being of these two groups was measured
against comparison subjects in the general population, all four groups showed
roughly similar rates of change on psychological functioning during the
1-year observation period. These results would make it appear that the condi-
tions of isolation matter little when considering the mental health of inmates.
Finally, two meta-analytic reviews have demonstrated that the average
effect size for SMIs resulting from SC is small to moderate (Morgan et al.,
2014; Smith, Gendreau & Labrecque, 2015). However, less than 10% of the
studies found met the inclusion criteria in these meta-analyses. Studies with
weaker designs tended to have larger negative...
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