THE PODIUM | Safeguarding mental health in jail

May 26, 2021

Article originally found in Colorado Politics.

Imagine yourself or your loved one — distressed and bewildered, unwell, psychotic — isolated in a small, hard cell for 22 hours a day or more, for days, weeks or months. Arrested during a crisis, maybe the worst moment of your life, now waiting for a snail-like justice process to determine your guilt or innocence of charges you may not even understand.

Solitary confinement in county jails — not inpatient health care — remains our state’s default recourse for housing and managing people with the most complex and challenging mental health needs.

Colorado is behind most other states in its imposition of standards on jail management. With the successful passage through the legislature of HB21-1211, Regulation of Restrictive Housing in Jails, state leaders affirm that a significant course correction is underway. Many other states have jail standards that establish guidelines for the use of isolation and restraint as tools for regulating behaviors and preventing injuries and fatalities. Colorado is among a small remaining minority of states with no jail standards.

Defined as involuntary placement that requires an individual to be confined in a cell for 22 hours or more per day with very limited activity, movement, or social interaction, solitary confinement makes sick and distressed people worse. People who have spent time in solitary confinement are significantly more likely to die — by suicide, homicide or overdose — and be reincarcerated, with the risks increasing as the time in solitary increased, according to a 2019 study of over 200,000 people restored to liberty in the community over a 15-year period.

The psychological stress created from solitary confinement is compared to the distress of physical torture. United States District Judge Thelton Henderson in Madrid v. Gomez remarked that putting an individual with a serious mental health condition in solitary confinement is “the mental equivalent of putting an asthmatic in a place with little air.”

According to the National Commission on Correctional Health Care, a national accrediting body for jails, “prolonged solitary confinement is cruel, inhumane, and degrading treatment, and harmful to an individual’s health. Juveniles, mentally ill individuals, and pregnant women should be excluded from solitary confinement of any duration.”

This bill, championed by state Sen. Pete Lee, D-Colorado Springs, and state Rep. Judy Amabile, D-Boulder, will finally provide needed protections for juveniles and people with specific health conditions. When the bill goes into effect, Colorado will begin to monitor (effective January 2022) and set standards for jails on their use of solitary confinement on our state’s most vulnerable populations. (effective July 2022).

When the bill is implemented, we will begin to collect consistent statewide data about health and the conditions of confinement. We will establish some time limits to extremes of punishing isolation that we currently leave to the discretion of our jailers. The bill regulates only our 12 largest jails (over 400 beds), stipulating that they may not place someone in restrictive housing if they are younger than 18 years old, have an intellectual or developmental disability, are pregnant or in the post-partum period, have a serious mental health disorder, have a significant neurocognitive impairment such as dementia or a traumatic brain injury, and other criteria. The 41 smaller jails in the state will remain without set standards — reflecting the shortage of resources and alternatives to solitary confinement deemed to be prevalent in those counties.

Mental Health Colorado recognizes HB21-1211 as an important step forward for our state. It will cast some much-needed light on the dark matter of the course we’ve taken for too long and bring some relief. The truth is, many Coloradans are punished for having a mental health condition while others with physical conditions get health care. This bill is a small step to protect those who already face so many barriers and stigma to getting quality care and a chance to live a full life.

There is much still to be done. Adequate housing, supports, and services in the community would prevent many from being held in jails. This is undisputed — and that consensus is good encouragement for all the allies and partners working to disentangle mental health and criminal justice. We are headed in the right direction and may hope to end our reliance upon jails and solitary confinement as our de facto mental health system.

Vincent Atchity is the president & CEO of Mental Health Colorado, the state’s leading advocate for promoting mental well-being, ending shame and discrimination, and ensuring equitable access to mental health and substance use care. The Equitas Project (#carenotcuffs) is Mental Health Colorado’s national initiative to disentangle mental health and criminal justice. Email: Twitter: @CO_MentalHealth