“Mental Health Units” in Prison Are Solitary Confinement by Another Name, Activists Say

Christian Hill has been diagnosed with borderline personality disorder and major depressive disorder. In the New York State prison system, this classifies him as having a serious mental illness and confers a “1-S” designation upon him.

Under the newly implemented HALT Solitary Confinement Act, people with this mental health designation cannot be punished by being placed in the Special Housing Unit, or SHU, where they would spend at least 17 days alone in their cells. Instead, Hill and others with this designation must be sent to a Residential Mental Health Unit, a prison unit for incarcerated people with serious mental health needs. Jointly operated by the state’s prison agency and its office of mental health, these units are supposed to be therapeutic rather than punitive.

But despite its therapeutic intention, Hill still spends 20 hours in his cell on weekdays and 24 hours on weekends and holidays. For one hour each day, a door at the back of his cell is opened remotely, allowing him to go into a fenced-off pen adjoining his cell for recreation. “I do a lot of sleeping out of boredom,” Hill wrote in a letter from his Residential Mental Health Unit to Truthout.

Hill says he’s being punished because of his mental health needs. According to a new report, he’s one of hundreds who are punished despite the state’s laws designed to protect them.

Residential Mental Health Units Appear No Better Than Solitary

In April 2022, Hill spent four days in the Intermediate Care Program, a nonpunitive residential mental health treatment unit at Sullivan Correctional Facility. On the fourth day, he was feeling suicidal and asked officers to contact mental health staff so that he could be placed on suicide watch.

This was not the first time that Hill had expressed suicidal ideation during his 10 years in prison. “This was one of over 300 times I have been in need of or placed on suicide watch,” he wrote, adding that two of his suicide attempts had nearly succeeded. Because of this history, his requests to be placed on suicide watch are usually taken seriously.

This time, however, Hill said that officers told him, “Go fuck yourself.”

Hill repeatedly requested mental health staff, but said that officers continued to ignore his requests, eventually telling him to kill himself. Only after Hill threw water out of his cell was he taken to suicide watch, where he was stripped of all his clothing and belongings and placed under 24-hour observation for four days.

After those four days, staff charged him with several rule violations: assault on staff, violent conduct, engaging in an unhygienic act, threats, creating disturbance and interference with an employee. He was sentenced to 180 days in the SHU. But because of his mental health classification, he is serving his SHU sentence in a Residential Mental Health Unit instead, which offers several hours of programming, including 20 hours of group therapy each week, individual counseling once every 30 days, and a medication review every 90 days.

Prison officials also punished him with 180 days’ loss of access to commissary, packages and phone calls. This means that, during his time in the Residential Mental Health Unit, he cannot order items from the prison’s commissary (the prison store), receive packages from loved ones, or use the phone.

Just before he was transferred from Sullivan to the Residential Mental Health Unit at Marcy Correctional Facility, he says he was assaulted during the pre-transfer strip search. When he arrived at Marcy, he was placed in the Residential Mental Health Unit there and charged, separately, with an additional six rule violations, including assault on staff, violent conduct, threats, creating a disturbance and interfering with an employee.

He was sentenced to an additional 365 days in isolation on those charges and an additional 365 days’ loss of commissary, packages, phone calls and tablet use, which would have allowed him to utilize the prison’s e-messaging system to communicate with loved ones and advocates. For the next 545 days, he can only communicate by writing letters.

In 2008, four years before Hill entered prison, New York passed the SHU Exclusion Law, limiting solitary for people with serious mental illness. Under the Act, people who have been diagnosed with serious mental illness, such as schizophrenia, major depressive disorder, bipolar disorder and/or active suicidality, can only be placed in the SHU for up to 30 days if they have broken a prison rule.

After those 30 days, prison officials must divert them to a Residential Mental Health Unit. In these units, separate from the rest of the prison population, people must receive four hours of structured therapeutic programming and mental health treatment five days a week, and disciplinary sanctions for acts such as refusing medication and self-harm are prohibited. The 2008 law also prohibited punishing people in these units with additional isolation except if their conduct “poses a significant and unreasonable risk to the safety of [incarcerated persons] or staff, or to the security of the facility.”

But, according to a new report by the HALT Solitary and the Mental Health Alternatives to Solitary Confinement campaigns, isolating people as punishment happens fairly frequently. Residential Mental Health Units “essentially have failed to provide an effective and humane therapeutic environment for a large percentage of its residents,” charges the report, entitled “Punishment of People with Serious Mental Illness in New York State Prisons.”

Reviewing data from January 2017 through May 2019, the report concludes that New York’s state prison system and its Office of Mental Health have not been following the law’s limits on punishment.

“Although these units are supposed to be therapeutic, they are frequently punitive,” said Jennifer Parish, who is director of criminal justice advocacy at the Urban Justice Center and a founding member of the Mental Health Alternatives to Solitary Confinement campaign. She noted that she has heard frequent complaints from people who have cycled through the SHU and various Residential Mental Health Units and many, she said, “felt they were treated worse than people in the SHU. This is not how this is supposed to work.”

Hill agrees. He notes that, under the HALT Solitary Act, if he were in typical solitary confinement (i.e., the SHU), he would be allowed his personal property, including his radio, fan, calculator, lamp, hot pot for cooking and prison-issued tablet on which he can send e-messages to family members. But in the Residential Mental Health Unit, he has none of these to help him pass the hours that he spends alone inside his cell.

Adding Hundreds of Days in Isolation

In the 1974 case Wolf v. McDonnell, the United States Supreme Court ruled that people in prison have the right to due process under the 14th Amendment — even for hearings involving internal prison rules violations. That same right applies to those in the Residential Mental Health Units, but according to the report, 94 percent of the 1,925 disciplinary hearings held between 2017 and mid-2019 resulted in guilty findings — and the vast majority of people were punished with additional time in isolation. The report also found that the most frequent sanction was for disobeying a direct order (15.2 percent), followed by creating a disturbance (12 percent) and interfering with staff (10 percent).

Both charges are vague and can encompass behaviors such as shouting or yelling, noted Tyrell Muhammad, a senior advocate at the Correctional Association of New York, a nonprofit that monitors New York’s prisons. The charges can also encompass actions such as watching staff extract a cellmate despite orders to face the wall, or yelling for staff when someone attempts suicide, explained Muhammad, who spent 27 years in New York State prisons, including seven in the SHU.

“The above are actual incidents that I have experienced and was given disciplinary tickets and a Tier III for,” he said, referring to the highest-level infraction for prison rule violations that carries the most severe penalties. “Many would believe that if one is charged with these types of infractions that [it] is serious to the point where violence was used, [but that] is very rare. These infractions are a form of retaliation. It is usually because someone witness[ed] something and these disciplinary tickets are a way of intimidation.” He and other advocates have noted that staff make the decision on what actions constitute creating a disturbance or interfering with staff.

In contrast, the report found that fewer than 4 percent of people in Residential Mental Health Units were charged with assault on staff, and fewer than 1 percent were charged with assault on another incarcerated person.

Despite the lack of severity of the charges, hundreds have been punished with additional isolation. According to the report, of the 399 people in a Residential Mental Health Unit during that time, 99 percent were punished with solitary confinement. Eight-five percent were sentenced to six months or more of additional isolation time. Their total amount of time in isolation came out to more than 823 years with an average of 753 days (or more than two years) for each person.

In addition to the punitive nature of being confined to their cells for 20 to 24 hours each day, most people in these units are handcuffed when they are escorted to therapy and counseling and, once at their destination, shackled to the floor with leg irons. If they remain free of misbehavior reports or infractions known as “negative informational reports” for 120 days, they are allowed to leave their cells without handcuffs and attend programs without being shackled. They are also moved to a cell with a television mounted on the wall, allowing them to watch TV to break up the monotony. But, Hill says, staff members at the Residential Mental Health Unit frequently write negative informational reports, which do not require a hearing or allow an incarcerated person to defend themselves against allegations of negative behavior. Instead, they must begin their 120 days again.

The report also charges that people in these units — who are primarily Black and Latinx people with serious mental health needs — have been punished at much higher rates than others in the prison system and frequently because of behavior caused by their underlying mental health conditions.

Over 80 percent in the Residential Mental Health Units were Black and/or Latinx. Black and Latinx people make up 72 percent of those incarcerated in New York State prisons and 37 percent in the state at large.

In contrast, white people, such as Hill, comprised 14.5 percent of people in Residential Mental Health Units compared to 24 percent in all New York prisons and nearly 62 percent of the state at large. They also made up nearly 26 percent of people in the Intermediate Care Program, the nonpunitive mental health unit (or, as the report notes, 77 percent higher than white people in the more punitive Residential Mental Health Units.)

Jack Beck, the report’s author and a member of the HALT Solitary campaign, noted that people sent to the nonpunitive Intermediate Care Program and to the Residential Mental Health Unit have the same serious mental health classifications. “There’s tremendous racial bias in the disciplinary system — and in the whole [Department of Corrections],” he said.

Punitive Residential Reentry Units

In 2021, 13 years after the passage of the SHU Exclusion Act, New York’s legislature passed the HALT Solitary Confinement Act, limiting solitary confinement to no more than 15 consecutive days (or 20 days within a 60-day time period).

The law went into effect on March 31, 2022. It required the creation of Residential Reentry Units where people sentenced to more than 15 days in SHU will be transferred on Day 16. According to the Department of Corrections and Community Services, these units too are meant to “be therapeutic and trauma-informed and aim to address individual treatment, rehabilitation needs, and underlying causes of problematic behavior.”

People who have serious mental illnesses are not placed in SHU at all and, like Hill, are sent directly to a Residential Mental Health Unit, where they still spend at least 20 hours each day alone in their cells.

Now, Parish, Beck, and other advocates are concerned that these new Residential Reentry Units will replicate the problem of alternatives that are still punitive rather than therapeutic. “This is a cautionary message,” Beck said of the report and its findings. “If you’re going to have people in these treatment units but you’re going to constantly discipline them, it doesn’t work. It doesn’t change behavior. It’s totally ineffective.”

The Department of Corrections and Community Supervision did not respond to Truthout’s queries about these units or its policy regarding suicidal ideation.

The report concludes that the ongoing punitive approach to imprisoned people with mental health needs, even in units designated for these more vulnerable populations, “indicate that prison is not an appropriate environment for people with mental health needs.”

Its first recommendation exhorts the state to stop incarcerating people with mental health needs. Instead, it urges legislators and policy makers to expand and enhance community-based mental health care, diversion programs, crisis response, and alternatives to incarceration.

“Jails and prisons can’t provide effective treatment,” Beck told Truthout.