By Taylor Knopf

The year after five prison officers were killed by inmates in 2017, the state prison system almost doubled the number of inmates with mental illness held in solitary confinement.

Previously, North Carolina’s prison system made significant strides to reduce the number of prisoners with mental illness who are held in isolation for up to 23 hours a day. Prison officials were also meeting regularly with mental health advocates.

Solitary confinement has been shown to worsen psychiatric symptoms. A recent North Carolina study found that inmates who are held in isolation are more likely to die within 12 months of release than their peers.

That all changed when five corrections officers were killed in 2017, the first in April at Bertie Correctional Institution, and four in October at Pasquotank Correctional Institution.

The officers’ deaths contributed to this backward shift in mental health treatment, according to Gary Junker, director of behavioral health for North Carolina adult corrections.

“Tragic events during 2017 within North Carolina state prisons resulted in a reversal of this trend. It is anticipated that with time, this pattern will stabilize before the number of people with mental illnesses in restrictive housing again begins to decline,” Junker wrote in an article for the Vera Institute of Justice.

Corrections officers are not mental health professionals, but prisons house more people with mental illness than hospitals. So when inmates act out or don’t follow rules, they are frequently sent to solitary confinement as a disciplinary action.

“We know that in a prison system, we have a lot of inmates with behavior issues who have issues following prison rules,” Kay Castillo, a lobbyist for the North Carolina chapter of the National Association of Social Workers, told state lawmakers during a special prison safety committee meeting convened after the officers’ deaths. “What happens is they have an infraction, they get put into solitary confinement and their mental illness gets worse as a result.”

“They have more problems following rules,” she continued. “They have another infraction, they go back to solitary, and they can’t get out of solitary.”

Making safer prisons

Since the 2017 deaths, there’s been a lot of conversation about how to make prisons safer. The first officer was intentionally targeted and killed with a fire extinguisher by an inmate at Bertie during a staff shortage. Four officers died during one escape attempt at a sewing plant at Pasquotank, where federal officials subsequently cited problematic staffing shortages and security concerns.

Advocates say that in order to make the facilities safer, prison officials must stop their heavy use of solitary confinement and increase mental health treatment.

“Mental illness isn’t to blame for the recent tragic deaths,” Castillo told lawmakers during the committee on prison safety.

“Prisons will become less safe, not more, if we continue to roll back the progress that has been made,” Castillo said.

That committee made eight recommendations to improve prison safety, including a call to reduce the use of solitary confinement. Lawmakers also recommended new hiring and salary incentives for prison workers to help fill staffing gaps.

Two steps forward

For the last several years, North Carolina prison officials have been working on ways to reduce the use of solitary confinement, particularly for inmates with mental illness.

Between 2015 and 2017, the prison system cut in half the number of inmates with mental illness in solitary confinement. At the time, top public safety officials said they were moving away from the practice because it didn’t lead to positive behavior changes in inmates and was less safe for prison workers.

There was a widespread recognition that prolonged isolation only worsens a person’s psychiatric symptoms, causing anxiety, depression, anger, paranoia and psychosis. National experts came to North Carolina and helped officials assess their needs and create a plan.

The state prison system opened Therapeutic Diversion Units (TDU) in 2016, which are prison housing facilities with daily structured programs designed to help move inmates with mental illness out of solitary.

These units decreased the incidents of self-injury, assaults on staff and other inmates, and admissions to inpatient care, according to a report Junker shared with the legislative committee on prison safety. As of April, 542 offenders participated in the TDU program and 63 percent completed the program or were released back into society.

Over the past eight years, prison officials had been meeting regularly with various groups of mental health advocates from the National Alliance for Mental Illness N.C., Disability Rights N.C., N.C. Psychological Association, N.C. Psychiatric Association, the N.C. Chapter of the National Association of Social Workers, American Civil Liberties Union of N.C. and N.C. Prisoner Legal Services.

One step back

After the deaths of the prison officers, the advocate meetings were suspended in the spring of 2018 and have not resumed.

“Part of our concern is what we have seen in recent years is that the progress as stopped,” Castillo said.

“There’s been no additional funding for the TDUs. When they were first established, the goal was to continue them and put them in every facility. Nursing and mental health staffing positions have been eliminated because of prolonged vacancies,” she said.

And prisoners with mental illness are being sent to solitary at higher rates.

“People are being released from solitary to the community with not enough time to give inmates a proper discharge,” Castillo said.

Approximately 650 inmates being treated for mental illness were released from a solitary cell straight back to the community between January 2018 and July 2019, according to data from the N.C. Department of Public Safety. In comparison, 135 inmates with mental illness were released to the community from solitary confinement in 2015.

Inmates held in solitary at any point during their incarceration are 24 percent more likely than their peers to die within a year of their release, according to a recent study.

The study found that they were 78 percent more likely to die by suicide and 54 percent more likely to die by homicide in the first year. Inmates held in solitary were 127 percent more likely to die by an opioid overdose within two weeks of their release.