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

Christian Hill was diagnosed with major depressive disorder and borderline personality disorder. In the New York State prison system, this classifies him as having a serious mental illness and confers a “1-S” designationHis name is engraved upon it.

People with this mental health designation can’t be placed in the Special Housing Unit (or SHU) where they would spend at most 17 days in their cells alone under the HALT Solitary Confinement Law. Hill and others with this designation should be sent to a Residential Mental Health Unit. This is a unit for people with serious mental illnesses. Jointly operated by the state’s prison agency and its office of mental health, these units are supposed to be therapeutic rather than punitive.

Hill spends 20 hours a week in his cell, and 24 hours on weekends or holidays. Hill has the option to access a fenced-off pen adjacent to his cell for recreation for an hour every day by opening the door at his cell’s back remotely. “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 Look No Better than Solitary

Hill spent four days in the area in April 2022. Intermediate Care ProgramSullivan Correctional Facility, a residential nonpunitive mental health treatment unit. On the fourth day, he felt suicidal. He asked officers to contact mental healthcare staff so that he could be placed under suicide watch.

Hill had been suicidal several times during his 10 year imprisonment. “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. His requests to be placed under suicide watch are often considered serious because of his past.

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

Hill repeatedly asked for mental health staff. But, he said that officers continued to ignore him, and eventually told him to commit suicide. Hill was taken to suicide watch after he threw water out his cell. There, he was stripped naked and placed under 24-hour surveillance for four days.

After four days, staff brought him before the SHU with several violations of rules: assault on staff and violent conduct, engaging with an unhygienic act or threat, creating disturbance, and interfering with an employee. He was sentenced for 180 days in the SHU. Because of his mental health, he is currently serving his SHU sentence in an Residential Mental Health Unit. It offers several hours programming, including 20 hours per week of group therapy, individual counseling every 30 days, and medication review every 90.

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.

He claims that he was assaulted in the pre-transfer stripsearch just before he was transferred from Sullivan at Marcy Correctional Facility to the Residential Mental Health Unit. He was taken to Marcy and charged separately with six additional rule violations. These included assault on staff, violent conduct and threats, creating disturbances, and interfering in the lives of employees.

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 systemTo communicate with family members and advocates. For the next 545-days, he will be unable to communicate via letters.

New York passed its 2008 Constitution four years before Hill was sent to prison. SHU Exclusion LawFor people with serious mental illnesses, this will limit the amount of time they can remain in isolation. The Act allows people with serious mental illnesses such as schizophrenia, major depression disorder, bipolar disorder, and/or active suicide to be admitted to the SHU for a maximum of 30 days, unless they have broken any prison rules.

After 30 days, prison officials will have to divert them into a Residential Mental Health Unit. People must receive treatment in these units, which are separate from the rest prison population. four hours of structured therapeutic programming and mental health treatmentFive days per week, and disciplinary sanctions are prohibited for acts such self-harm and refusing medication. 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.”

A new report by the HALT SolitaryThe Mental Health Alternatives to Solitary ConfinementPeople are often punished by campaigns that involve isolating them. 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.”

The following data were reviewed from January 2017 to May 2019. 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. Hill agrees. He doesn’t have any of these items in the Residential Mental Health Unit to help him get through the hours he spends alone in his cell.

Isolation of hundreds of days

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. This same right applies to residents of Residential Mental Health Units. 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 thatThe most common sanction was for disobeying an order (15.2%), followed by creating disturbance (12%) and interfering in staff (10%).

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. Muhammad, who was a prisoner for a decade, explained that the charges could also include actions such as watching staff remove a cellmate despite being told to face the wall or shouting at staff when someone attempts to commit suicide. 27 years in New York State prisons, seven of which are 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]serious enough to justify violence. [but that]This is extremely rare. These infractions can be considered a form of retaliation. It usually happens when someone witnesses.[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.

The report showed that less than 4 percent of residents in Residential Mental Health Units were charged for assault on staff and less than 1 percent were charged for assault on another incarcerated individual.

Hundreds of people were punished with isolation, despite the severity of the charges. The report states that 99 percent of the 399 individuals who were in a Residential Mental Health Unit at the time were placed in solitary confinement. Eighty-five percent were sentenced for six months or more in isolation. Their total isolation time was more than 823 Years. The average length of their isolation time was 753 days, or more than 2 years for each person.

Apart from the harsh punishment of being locked up in their cells for 20-24hrs each day, most people in these units are handcuffed while they are escorted to therapy or counseling. Once there, they are tied to the floor with leg irons. If they remain free of misbehavior reports or infractions known as “negative informational reportsThey are allowed to leave their cells for 120 days without handcuffs and can attend programs without being shackled. They are also transferred to a room with a television mounted to the wall. This allows them to keep the monotony at bay. Hill says that staff at the Residential Mental Health Unit often write negative informational reports. These reports do not require a hearing and allow an incarcerated person, Hill claims, to defend themselves against negative behavior allegations. Instead, they must recommence their 120 days.

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.

Residential Mental Health Units: Over 80 percent were Black and/or Latinx. Black and Latinx residents make up 72 percent of the New York State prison population, while 37 percent are held in New York State’s general prisons.

Hill was one example of a white person who made up 14.5 per cent of the population in Residential Mental Health Units. This compares to 24 percent in all New York jails and nearly 62 percent of the state at large. They also made up almost 26 percent of people in Intermediate Care Program, the nonpunitive unit for mental health (or, as noted in the report, 77 percent more than whites in the 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 Rehabilitation 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 was in effect as of March 31, 2022. It required the establishment of Residential Reentry Units, where people who have been sentenced to more that 15 days in SHU would 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 with serious mental illnesses are not admitted to SHU. They are instead sent directly, just like Hill, to a Residential Mental Health Unit. There they will spend at least 20 hours per day alone in their cells.

Parish, Beck and other advocates are concerned about the possibility that these new Residential Reentry Units might replicate the problem with alternatives that are still therapeutic rather than punitive. “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 didn’t respond to my inquiry. 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 calls on the state to end incarcerating those with mental health problems. Instead, it calls on policy makers and legislators not to imprison people with mental health needs.

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