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Scrutiny
Supermax prisons employ solitary confinement to isolate predatory, unorderly inmates from the rest of the prison community. Federal Bureau of Prisons create special supermax facilities to contain the most aggressive inmates in a protective effort. Kate King, professor and director of Criminal Justice at Murray State University, Benjamin Steiner, professor of Criminal Justice at the University of Cincinnati, and Stephanie Ritchie Breach, director of the Third District Youth Court, explain how while violence has always been a factor in prison life, the level of aggression is magnified in facilities where all such members of the prison system are concentrated. These scholars argue that the violent nature of supermax prisons such as Pelican Bay State Prison are perpetrated by prison culture itself. King, Steiner, and Breach question the effectiveness of these institutions and claim the violent reputation of American prisons stems from this departure from the treatment model. Supermax prisons are also scrutinized on legal and ethical bases. Scholars Jesenia Pizarro and Vanja Stenius note that the overall constitutionality of these prisons are still quite unclear. Many argue the conditions in which these inmates live do not meet the standards of the Eighth Constitution.

Possible alternatives
Scrutiny of supermax prisons and the institutionalization of solitary confinement is accompanied by suggestions for alternative methods. One alternative is to administer medical treatment for disorderly inmates who display signs of mental illness. The Correction Department of New York City implemented plans to transfer mentally ill inmates to an internal facility for further help rather than solitary confinement in 2013. Dora B. Schriro, correction commisioner, said that treatment would help turn a “one size fits all” policy into a program to promote success in jail and the outside world. A second alternative is to deal with long-term inmates by promoting familial and social relationships through the encouragement of visitations which may help boost morale. Carl Kummerlowe believes that familial counseling and support may be useful for inmates nearing the end of a long-term sentence that may otherwise exhibit signs of aggression. This alternative would help inmates cope with extreme long term sentences in prisons such as those harbored in Pelican Bay. A third alternative would involve regular reevaluation and accelerated transition of isolated inmates back to prison population to help curb long-term effects of solitary confinement. These alternative methods suggest a more restorative justice approach to handling high-security offenders.

Reforms
Many states such as Colorado, Mississippi, and Maine have implemented plans to reduce use of supermax prisons and solitary confinement and have begun to show signs of reform. Joseph Ponte, Corrections Commissioner of Maine, cut supermax prison population by half. Colorado has announced reforms to limit the use of solitary confinement in prisons following a study that showed significant levels of confinement and isolation in prisons.

Self-harm
“Inmates in jails and prisons attempt to harm themselves in many ways, resulting in outcomes ranging from trivial to fatal.” While some inmates are known to have psychiatric disorders prior to entering the prison, others develop mental disorders as a result of being placed in solitary confinement. A main issue within the prison system and solitary confinement is the high number of inmates who turn to self-harm Studies have shown that the longer one stays in the prison, the more at risk he or she is to self-harm.

One study has shown that “inmates ever assigned to solitary confinement were 3.2 times as likely to commit an act of self-harm per 1000 days at some time during their incarceration as those never assigned to solitary.” The study has concluded that there is a direct correlation between inmates who self-harm and inmates that are punished into solitary confinement. Many of the inmates look to self-harm as a way to “avoid the rigors of solitary confinement.” Mental health professionals ran a series of tests that ultimately concluded that “self-harm and potentially fatal self-harm associated with solitary confinement was higher independent of mental illness status and age group.”

Psychological effects
Physicians have concluded that for those inmates who enter the prison already diagnosed with a mental illness, the punishment of solitary confinement is extremely dangerous in that the inmates are more susceptible to exacerbating the symptoms. Professional organizations, like the National Commission on Correctional Health Car (NCCHC) and American Psychiatric Association (APA), work to improve the mental health services, however, the systems within the prisons “remain woefully inadequate.” “Psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis.” These studies suggest that a main issue with isolating prisoners who are known to have mental illnesses is that it prevents the inmates from ever possibly recovering. Instead, many “mentally ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization.”

Environment is a factor
‘Prisoner mental health is becoming increasingly important’, and has caught the attention of the World Health Organization, who aims to reduce the ‘effects of imprisonment on mental health.” One study focused on the ‘prison environment rather than on individual factors.’ The study tested two time periods, short-term and long-term, that evaluated the ‘mental state changes in response to changes in the environment or prison setting.’ It ultimately concluded that solitary confinement was ‘associated with negative effects on mental health.’ Similar to solitary confinement, segregation on the other hand, could not be proven to have lasting negative effects on inmates although those who were segregated had a worse mental health than those who were not segregated. The study also concluded that crowding, ‘increased levels of social density had negative effects on the mental health of inmates.”

Ethical issues
Treating mentally ill patients by sentencing them into solitary confinement has captured the attention of “human rights experts” who conclude that “solitary confinement may amount to cruel, inhuman, or degrading treatment” that violates rights specifically targeting cruel, inhuman treatment. Health care professionals and organizations recognize the fact that solitary confinement is not ethical, yet the segregating treatment fails to come to a halt. “Experience demonstrates that prisons can operate safely and securely without putting inmates with mental illness in typical conditions of segregation.” Despite this and medical professionals’ obligations, segregation policies have not changed because mental health clinics believe that “isolation is necessary for security reasons.”

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