It is time to end solitary confinement

Lynn McDonald | Policy Options / Options politiques | 25 July 2018

It is widely agreed that Canada’s use of solitary confinement is excessive, in both federal (inmates with sentences of two years or more) and provincial prisons (under two years). I choose to use the term “solitary confinement,” although prison authorities prefer the more innocuous “administrative segregation.” Solitary confinement entails lack of meaningful human contact and sensory deprivation. It costs lives (40 percent of prison suicides take place in solitary), results in increased self-harm and suicide attempts, and causes or exacerbates mental illness. First Nations inmates and mentally ill prisoners are disproportionately selected. Moreover, solitary confinement does not make correctional institutions safer for staff or inmates, and the cost per inmate is higher for solitary than for the general population.

The federal government has had to answer for its use of solitary in two lawsuits that were launched in 2015; the Ontario case was decided in December 2017 and the British Columbia case in January 2018. The judges in both largely rejected the evidence brought by Correctional Service Canada (CSC). Yet the two decisions are under appeal.

The government has responded to rising criticism by reducing its use of solitary to roughly half of what it was three years earlier. It brought Bill C-56, An Act to Amend the Corrections and Conditional Release Act and the Abolition of Early Parole Act, to the House of Commons. It would introduce some safeguards, but with loopholes, the worst being the power given to wardens to overrule limits. The Bill itself is on hold (it was never debated) while the appeals are proceeding.

The Ontario government under Premier Kathleen Wynne responded more vigorously to criticism of its poor record by hiring former federal corrections investigator Howard Sapers to review its practices and recommend changes. It then acted promptly on his recommendations, which were both numerous and comprehensive and which featured limits and reviews on the use of solitary. Bill 6, the Correctional Services Transformation Act, 2018, passed just before the legislature was dissolved for the June 7, 2018, provincial election. What will happen now is not clear, as Progressive Conservative MPPs voted against the bill, while the NDP supported it.

The Act is based on the belief that the system can be fixed by implementing tighter rules, more reviews and better oversight by health care professionals to identify suicidal inmates and those deteriorating badly and get them out of solitary in time. But there is no evidence that such confidence in health care professionals is merited. In the tragic example of Ashley Smith, the teenager who strangled herself in her cell in 2007, it was a psychologist who decided that her repeated suicidal gestures were attention-getting stunts and ordered correctional officers not to enter her cell to stop her.

The Ontario Human Rights Commission in 2017 called for no less than an end to the practice of segregation, arguing for interim measures of “strict time limits and external oversight to reduce the harm of segregation on vulnerable prisoners.” The Campaign for the Abolition of Solitary Confinement calls for the abolition of solitary as a disciplinary measure and for the abolition of all versions of “administrative” segregation. The campaign has no confidence in partial measures to protect vulnerable prisoners.

How much solitary is too much?

The United Nations’ Mandela Rules, named after Nelson Mandela, who knew solitary from sad personal experience, stipulate a maximum of 15 days at a stretch. This was never Mandela’s recommendation; he is on record only as saying that he found solitary “the most forbidding aspect of prison life.” The 15-day rule seems to have been a compromise, proposed by the UN’s special rapporteur on torture, Juan Méndez (another solitary survivor), as the way to end prolonged and indefinite solitary terms. His statement that over 15 days’ solitary constitutes “torture” has been adopted by most countries. It is the cornerstone of both Canadian federal and provincial policy. Méndez’s report, however, makes it clear that the harm can start at two days, and there never has been any evidence that 15 days is in any way a valid marker.

The Canadian court cases have been about prolonged or indefinite solitary confinement, the worst possible scenario for inmates. Some First Nations inmates have been effectively lost in the system for hundreds of days. Indigenous inmates form 26.4 percent of federal inmates, although they are under 5 percent of the population. The Indigenous Women’s Association reports that in 2015-16 Indigenous women made up “42% of the maximum security women’s population in Canada, and 50% of segregation placements.”

Black Canadians are also overrepresented both in prison and in solitary. The same applies to mentally ill inmates, yet undertakings to end the use of solitary for them are routinely subverted. The definitions of “seriously mentally ill” are narrow. The preferred option of sending the mentally ill to health care agencies is rarely used.

In June 2018, Prisoners’ Legal Services of Vancouver launched a new challenge to Correctional Service Canada, in a human rights case arguing against the use of solitary for mentally ill inmates. Given the narrow definition of “seriously mentally ill” used by CSC, many inmates are in fact locked up, in solitary or observation cells, put in restraints and pepper sprayed. Observation cells, noted a First Nations inmate, are worse than ordinary segregation: stripped down to an anti-suicide smock and mattress, with constant observation and no therapy.

Can the system be fixed?

Numerous civil society organizations think the system can be fixed. The lawsuits undertaken by the Canadian Civil Liberties Association, the BC Civil Liberties Association and the John Howard Society focused on prolonged solitary; they have not argued that solitary is wrong in itself. A recently formed Coalition on Reforming Segregation in Ontario’s Correctional Institutions again assumes that limits and reviews will work, and that solitary is not in itself wrong.

But safeguards already exist, in both federal and provincial legislation; clearly they are not sufficient. Solitary is supposed to be used only as a last resort, when there is “no reasonable alternative,” and inmates are supposed to be let out “at the earliest appropriate time.” No doubt, the 15-day limits will reduce the amount of suicides, attempted suicides, self-mutilation and mental deterioration, but we must expect that these harms will continue. The 15-day limit is based on pure supposition.

Despite overwhelming evidence, few organizations geared to civil liberties or prison reform have so far opted for abolition. Canada has abolished the use of capital punishment, corporal punishment and a bread-and-water diet as deterrents to crime. Officially, all our prison systems are intended to be rehabilitative. Most prisoners will eventually be released into society. Solitary confinement is an anomaly in an otherwise relatively humane system.

The Campaign for the Abolition of Solitary Confinement was formed in May 2017, to advance the goal of abolition. It holds that lesser measures will not suffice, although limits and reviews will reduce harm and are better than the status quo. The campaign presented a brief in March 2018 to the Ontario legislative committee reviewing Bill 6, calling for full abolition while supporting the improvements in the Bill. The brief also unsuccessfully proposed an amendment to widen the ban on solitary that applies to pregnant women and nursing mothers to include inmates under 25 years old, on the grounds that their brains are still developing and that solitary could do lasting harm.

Before this campaign was launched, only one Canadian organization, the College of Family Physicians of Canada, had called for full abolition (the Elizabeth Fry Societies have called for abolition for women inmates). The time has come to end this barbaric practice forever and for all.

Lynn McDonald is professor emerita of sociology and a former member of Parliament (New Democratic Party). Her private member’s bill, the Non-smokers’ Health Act, 1988, was the first legislation in the world to establish smoke-free work and public places.

An Irish strategy for ending solitary confinement

Excerpted from ‘Behind the Door’: Solitary Confinement in the Irish Penal System. Irish Penal Reform Trust, 2018

1. Elimination of the use of solitary confinement:

1.1 The Minister for Justice and Equality should develop and consult on a Strategy for the Elimination of Solitary Confinement based upon principles of decarceration.

1.2 The Irish Prison Service should ensure, as a minimum, full compliance with the Mandela Rules and should amend its policy on ‘the elimination of solitary confinement’ (IPS, 2017) accordingly.

1.3 The Irish Prison Service should set the minimum out-of-cell time at 8 hours per day. Additionally, a target should be set of at least 12 hours’ out-of-cell time per prisoner per day, based upon meaningful human contact and access to services and activities.

1.4 The term ‘meaningful human contact’ should be defined as contact with family and peers; interactions with professionals, staff or volunteers within the prison system should not be used as a substitute for such contact.

1.5 Separation of a prisoner from others should not be permitted for reasons of punishment, but only for reasons of safety in emergency situations, and for the shortest possible period of time.

1.6 The placement in solitary confinement of adults with mental health difficulties or mental or physical disabilities should be prohibited.

1.7 The placement in solitary confinement of pregnant or breastfeeding women prisoners or mothers with babies should be prohibited.

1.8 Adequate community mental health services should be provided, including access to psychiatric beds, to ensure that no one is detained in prison who would be more appropriately accommodated in mental health facilities.

1.9 The Minister for Children and Youth Affairs should provide, as a matter of urgency, statutory rules governing detention of children. In line with the most recent Concluding Observations by the UN Committee against Torture, such rules should include an absolute prohibition of the use of solitary confinement for children.

2. Separation for reasons of protection:

2.1 The Irish Prison Service should research and develop a range of initiatives to address violence in prisons. These may include, but should not be limited to, restorative justice approaches and weapons amnesties.

2.2 The IPS should ensure all staff are trained on the impact of solitary confinement and restricted regimes as well as in conflict management techniques such as de-escalation

2.3 Prisoners being placed, or requesting to be placed, on a restricted regime for their own protection should be given information, in accessible language, about the implications of such placement including details of the restricted access to education, vocational training, association, etc.

2.4 Where a prisoner requests to be kept on protection for an extended period, this should be kept under constant review.

2.5 Special supports should be put in place to encourage prisoners to come off a restricted regime where it is assessed as safe to do so, including access to a step-down programme.

2.6 Prisoners on protection or other restricted regimes should be provided with meaningful access to work, training and education, as well as other activities and services. As far as possible this should be in association with other prisoners.

2.7 Prisoners on restricted regimes should have increased access to family contact, through telephone and visits.

2.8 The Prison Rules 2007 should be further amended to include regular examination of prisoners isolated under Rule 63 by a prison doctor. Such examination should include both physical and mental health assessment by appropriately trained medical personnel.

3. Access to justice:

3.1 There should be a mandatory notification provided to their solicitors where prisoners are placed on Rule 62 and Rule 6 3. Prisoners should also be informed that they have the right to contact their solicitor and should be given an opportunity to do so as soon as practicable.

3.2 There should be a mandatory notification to a legal representative in cases of placement in Safety Observation Cells and Close Supervision Cells, regardless of the length of time for which such placement is envisaged.

3.3 The situation of prisoners held in isolation and/or subjected to a restricted regime should continue to be afforded particular attention by the Inspector of Prisons, including through thematic inspections. The Government should provide the Office of the Inspector of Prisons with appropriate resources to enable it to fulfil its mandate in this regard.

3.4 Prisoners held in isolation and/or subjected to a restricted regime should have strengthened access to independent complaints mechanisms and should be afforded appropriate assistance to avail of those mechanisms.

4. Collection and publication of statistics:

4.1 The Irish Prison Service should regularly collect and publish data relating to the length of time prisoners spend on restricted regimes in all prisons.

4.2 Data relating to repeated and multiple placements of the same prisoner(s) on restricted regimes should be collected, in particular where such repeated placements concern prisoners with mental health difficulties and those segregated for reasons of discipline.

4.3 Separate statistics for Limerick (male) and Limerick (female) prisons, should be provided.

4.4 The Irish Prison Service should disaggregate data by other characteristics, including ethnicity, nationality, sexual orientation, and disability, to enable monitoring for potential disproportionate use of restricted regimes among particular groups.

It’s time to abolish solitary confinement

Lynn McDonald | Opinion | Canadian Centre for Policy Alternatives: The Monitor, Jan-Feb 2018

CANADA’S FEDERAL CORRECTIONAL investigator has described solitary confinement as “the most austere and depriving form of incarceration that the state can legally administer in Canada.”

However, he used the term “segregation,” the standard euphemism used in the corrections system. In reality, solitary means confinement in a very small cell, 23 hours a day, without meaningful human contact. It is the most extreme form of punishment after hanging, flogging, the paddle, and bread-and-water diets, all of which have been abolished in the prison system.

Solitary is used for several purposes in Canadian prisons: as punishment for infractions of prison rules; for the protection of staff and other inmates; and for self-protection (e.g., where an incarcerated former police officer fears attack). Suicidal and mentally ill inmates are still routinely placed in solitary, despite repeated reports showing how harmful it is for their already vulnerable state of mind.

The stated purpose of incarceration, for every type of prison in Canada, is rehabilitation. Solitary confinement was originally established with “penitence” in mind (time to reflect, no bad influences), hence “penitentiaries.” Solitary, however, soon proved to make inmates mad, not rehabilitate them.

There is now a vast academic and professional literature documenting the harm of solitary confinement, augmented by reports from coroners and inquiries on particularly scandalous cases. Recommendations are made, yet little changes. The federal government has reduced its use of solitary since 2014, likely in response to recent lawsuits, and notes that assaults on prison staff have not increased. But the government still insists that solitary is needed.

Proposed reforms

Both the federal and Ontario governments have promised legislative reform.

The Ontario government commissioned Howard Sapers, a former federal correctional investigator, to conduct a review of the use of solitary in Ontario prisons. His report, which was largely excellent, recommended better oversight of solitary confinement, a 15-day time limit for inmates in solitary (and a maximum of 60 days in a year), and the exemption of pregnant women, nursing mothers and the mentally ill. The Wynne government promptly committed to implementing these recommendations.

The federal government introduced its own reforms last spring in Bill C-56. As in Ontario, the legislation would limit stays in solitary — initially to 21 days, then dropping to 15 — and sets a maximum of 90 days per year for any inmate. However, wardens will be able to override these limits under certain circumstances, a loophole that was roundly criticized, along with other contradictory elements of the law.

For example, the 15-day limit is based on a United Nations declaration that solitary confinement beyond that point is tantamount to “torture.” Why 15 days? How is it that 16 days or more is cruel and unusual punishment, even torture, while 14 or 15 days in solitary would be fine?

Doctors have pointed out that both physical and mental harm occurs even with stays in solitary of two or three days. The UN report that recommended the 15-day limit itself acknowledged that harm occurs with as little as 48 hours, as a recent case in Ontario appears to demonstrate.

In December 2016, Soleiman Faqiri, an Ontario inmate with schizophrenia, died in solitary after being beaten and pepper sprayed by correctional officers 11 days after his arrest. It’s not clear what prompted the officers’ entry to his cell, and no charges have been laid.

n short, the 15-day limit is a compromise measure that is not based on evidence but indeed contrary to considerable research documenting harm. There is no good reason to stick to it.

Will correctional officers be at greater risk if solitary is abolished completely? Again, there is no good research to back up this widely held claim. Some countries effectively do without solitary and some U.S. states have radically reduced its use. Correctional Service Canada, and the equivalent provincial and territorial services, should be looking at alternatives.

Support for abolition

The abolition of solitary confinement has been endorsed by the College of Family Physicians of Canada, among other organizations. Some groups support abolition for women inmates, but such a law would likely result in a Charter challenge.

That solitary is disproportionately used for Indigenous and Black inmates and the mentally ill has prompted human rights commissions and civil rights groups to condemn it. However, the point remains that, even if applied equally to all groups, solitary is harmful.

By law, solitary confinement is supposed to be used only when there is “no reasonable alternative,” with release “at the earliest appropriate time.” The reality is that officials leave inmates in solitary for horrendous periods of time, and no one is held accountable for ensuing suicides or other consequences.

The time has come to stop the excuses, by legislating an end to solitary confinement.

Solitary confinement: abolition needed, not regulation

By Lynn McDonald in Hill Times, Ottawa, 4 December 2017, p.22

The federal government has been embarrassed into action by scandalous cases of inmates left in solitary for months or even years. It began reducing its use of solitary in 2014, to find, in a review in 2016, that there was no increase in danger to staff . Yet it continues to believe that solitary is needed. It’s not.

Senator Kim Pate’s litany of the woes of Canadian corrections is a good starting point for taking on the issue of solitary confinement (“‘Repressive’ ‘risk-aversive’ corrections system needs parliamentary oversight,” The Hill Times, Nov. 28, p. 1). What is wrong with solitary (or “segregation” in corrections lingo) has been well-known for decades. It causes harm, mental and physical, even with terms as short as a few days. The over-representation of the mentally ill and Indigenous inmates continues, despite lawsuits and coroners’ inquiries making recommendations for reform. The United Nations calls solitary over 15 days “torture,” and, in the same report, admits that the harm starts with 48 hours.

The federal response

The federal government has been embarrassed into action by scandalous cases of inmates left in solitary for months or even years. It began reducing its use of solitary in 2014, to find, in a review in 2016, that there was no increase in danger to staff. Yet it continues to believe that solitary is needed. In June 2017, it introduced a (flawed) bill to restrict the use of solitary and institute reviews. Bill C-56, as yet undebated, would limit stays initially to 21 days at a time, in 18 months to 15 days—as per the UN’s dictum. But wardens can over-ride the limit, and undoubtedly will.

Bill C-56 allows exceptions so long as the prison head provides “a written rationale” to show that release “would jeopardize the security of the institution, a person or the offender, or interfere in an ongoing investigation.”

But there is no evidence that solitary improves security, but only a widely held supposition. Indeed evidence is now available to the contrary. (Some consideration will have to be given when there is an “ongoing investigation,” say, for a new offence, but this is still no justification for the sensory deprivation aspects of the sentence.)

Bill C-56 would have “independent external reviewers” review files on inmates in for longer than 21 days at a time, or more than 90 days in the same calendar year, or in more than three times in a year.

But why “review” what should not be there in the first place? There is no category of inmate that improves in solitary. Nearly all inmates are released eventually; rehabilitation is the stated goal of all Canadian prisons, including federal penitentiaries. What, actually, will these reviewers review? Self-harm? Suicide attempts? Hallucinations? Can they predict which inmate might commit suicide if kept in? Or for how many more days one can stand before gross mental deterioration? Based on whose reports?

The prison as mental institution

The reality is that Canadian (and American and probably other) prisons are the major housers of the mentally ill. That is, the number of mentally ill persons in prison well exceeds those in psychiatric facilities. An estimated 30 per cent of Canadian inmates suffer from some mental illness.

The United Nations Committee Against Torture in 2012 urged Canada to ban solitary for the mentally ill. Its report also noted the inordinate number of deaths in custody. Suicides disprortionately occur in solitary.

As well, since neurologists warn that the brain continues to develop until age 25, there should be an absolute ban on solitary for those under 25.

Can we do it better?

Some American states have begun to reduce their use of solitary confinement— rampant in the American prison system with its “supermax” prisons. The director of the Colorado Department of Corrections argues, from its data on solitary, stated “the less you use it, the safer your facilities are.” European countries are well ahead of us in limiting solitary (two weeks in Dutch prisons).

Honouring Nelson Mandela

The Mandela Rules, which limit solitary to 15 days, are named after Nelson Mandela, who endured 27 years of prison before his release. He called solitary “the most forbidding aspect of prison life. There is no end and no beginning; there is only one’s mind, which can begin to play tricks.” Mandela was named to the Order of Canada in 1998, and made an honorary citizen in 2001. We could honour him better by abolishing solitary confinement.
Lynn McDonald, CM, PhD, LLD, is a professor emerita, and a former NDP MP from 1982-1988; she is co-founder of the (recently formed) Campaign for the Abolition of Solitary Confinement: http://www.abolishsolitary.ca.

Comment piece by Stewart Phillip in the Globe and Mail

By Stewart Phillip | The Globe and Mail, October 23, 2017
Stewart Phillip is the president of the Union of BC Indian Chiefs.

Mr. Trudeau, stop the residential school to solitary confinement pipeline

Survivors of residential schools carry trauma. But the trauma is also intergenerational: When caregivers of children are hurt by a genocidal system, the trauma is passed on to that child.

Canadian prisons are filled with people who carry the deepest of traumas from a young age. Many of the incarcerated are disproportionately Indigenous people, and about a third of all prisoners who are isolated in segregation cells are Indigenous.

Bobby Lee Worm, for example, is a young Indigenous woman who spent a total of 1,123 days in solitary confinement. There, she attempted to take her own life.

Ms. Worm was a witness against Canada in a recent lawsuit by the BC Civil Liberties Association (BCCLA) and John Howard Society challenging solitary confinement in federal prisons. She is a member of the Daystar First Nation, and her family are residential school survivors. Unfortunately for Bobby Lee, intergenerational trauma meant growing up surrounded by rampant abuse, poverty, and violence. At age 12, she ran away from home and started getting into trouble with the law.

Ms. Worm stated in her testimony: “Since childhood, my sense of being able to control my life has been shattered again and again. This feeling of powerlessness worsened during the years that I spent in segregation. While in segregation … I was literally powerless; every aspect of my every movement was controlled and under scrutiny. I felt like I had been thrown in a hole and left to rot.”

“Administrative segregation” is a vicious code term Canada uses for solitary confinement, when it takes people who are already incarcerated and further contains them in isolated cells. Right now, these decisions are made in the absence of evidence, with no independent oversight and no limits to how long someone can be kept in segregation.
Like Indigenous people, black people are also overrepresented in Canadian prisons and solitary cells. Andre Blair, for example, was once isolated for 363 days “for his own safety” because the guards said he was attacked by other prisoners. Mr. Blair testified that his own voice mattered little when decisions were made to place him in solitary: “When I objected to the allegations against me on the basis that there was no proof, the officer told me that he did not have to prove anything, it was not a court of law, and there was nothing I could do about it.”

In total, Mr. Blair has spent 637 days in solitary confinement.

According to the United Nations, prolonged solitary confinement is a form of torture. Experts agree that it worsens mental illness and increases the risk of suicide.

By keeping Indigenous people in solitary confinement, Canada inflicts new forms of trauma on those already suffering from the traumatic legacy of its own residential schools.

If Canada continues on this path, how is healing possible? How can reconciliation be realized?

Each of the witnesses who testified about their experience of isolation described the serious harms it caused them; for many, it aggravated pre-existing trauma.

“I realized that I was acting out because I had so much pain stored up inside me,” testified Bobby Lee “I understood that in order to move out of solitary … I had to contain all of my emotion. I became paranoid about how much emotion I was showing”

Canada recently responded to criticisms of its segregation practices with Bill C-56, but the proposed fix is meaningless. On paper, the bill would initially limit a person’s stay in solitary confinement to 15 days; however, prison officials could still extend the duration of the stay at their sole discretion. This bill does little more than create more paperwork in order to keep a person isolated in solitary confinement.

Justin Trudeau’s government speaks of reconciliation for past wrongs, but doesn’t seem to recognize its responsibility for the traumatic legacy it actively perpetuates within its own prisons.

If Justin Trudeau’s government truly wants to be responsible for ending the trauma Canada has inflicted and continues to inflict on Indigenous peoples, he must put forward real change, not what’s in C-56.

Why We Ended Long-Term Solitary Confinement in Colorado

By Rick Raemisch in The New York Times, October 12, 2017

COLORADO SPRINGS — For years, the Colorado corrections system had a ready answer for inmates it wanted to punish. For almost any reason — smuggling drugs, talking back to a corrections officer, assaulting another prisoner — it would send an inmate to a cell the size of a parking spot. The inmate would stay there, alone, at least 22 hours a day, for two and a half years on average, but sometimes for decades. This is called administrative segregation, and shortly after I became Colorado’s head of corrections in 2013, I began to ask why we were doing it.

Can you imagine spending years without having regular social interactions or without full access to basic human activities like showering and exercising? When did it become O.K. to lock up someone who is severely mentally ill and let the demons chase him around in the cell? What is wrong with us? I asked.

Then, in 2015 I assisted the State Department with other United Nations countries in modernizing international standards for the treatment of prisoners, now known as the Nelson Mandela Rules. During the debates about the wording of the new standards, it was decided that keeping someone for more than 15 days in solitary was torture.

After listening and being involved in those discussions, I agreed. There now is enough data to convince me that long-term isolation manufactures and aggravates mental illness. It has not solved any problems; at best it has maintained them.

That’s why, in September, Colorado ended the practice.


Continue reading at
https://www.nytimes.com/2017/10/12/opinion/solitary-confinement-colorado-prison.html

The case for abolishing solitary confinement

Lynn McDonald
Toronto Star, May 29, 2017

Support is growing for a substantial reduction in the use of solitary confinement — good news — but is it enough?

Ontario Ombudsman Paul Dubé recently documented the slovenly way solitary is handled: we do a better job in tracking animals than in checking on solitary inmates, he said.

The recommendations Howard Sapers made in his even more recent report, commissioned by the Ontario government, are clear and strong: a ban on solitary for four categories of inmate: the mentally ill, suicidal inmates, pregnant women and new mothers. He would limit solitary to a maximum of 15 days per stay, with a per-year maximum of 60 days.

The minister of Correctional Services, Marie-France Lalonde, promptly stated that all of Sapers’s recommendations would be implemented. Ontario has indeed made a start in announcing the closure of two notoriously inadequate prisons, Ottawa and Thunder Bay.

But why 15 days? The limit is a nod to the 2011 United Nations report that calls solitary confinement any longer “torture or cruel, inhuman and degrading treatment,” which should, as such, be prohibited.

Yet the U.N. expert who hit on that number, Juan Mendez, himself acknowledged that “even a few days of social isolation” can cause “some mental damage.” He urged a total ban on solitary for pretrial detention, juveniles and those with mental disabilities. Yes, and about time for Canada, too.

The question now turns to the magic 15. How is it that 16 or more days amount to “torture,” but 14 or 15 days in solitary is perfectly fine for your health? There is substantial evidence of harm with even short periods in solitary.

The College of Family Physicians of Canada, in a position statement in 2016, documented harm from stays as short as 48 hours.

An editorial in the Canadian Medical Association Journal in 2014 made a similar point on harm, however without this being an official position of the CMA. Effects may develop “within a few days and increase the longer segregation lasts.” In the three years before the study, nearly half the inmates who committed suicide, 14 out of 30, were in solitary at the time. The editorial looked to this 200-year old practice having “had its day.”

To the committed skeptic on solitary confinement no evidence is ever enough. The gold standard is the controlled experiment, which in this case would require assigning inmates to no solitary and different lengths of it, to be tested afterwards on their mental health, self-harm and suicide attempts. This is obviously not possible for ethical reasons.

However, there is relevant research comparing outcomes between inmates in solitary and those not. A New York study found that those at any time in solitary were 3.2 times as likely to commit self-harm than those not. Self-harm means laceration, ligature, swallowing a foreign body, overdose, head banging or setting oneself, or the cell, on fire. “Potentially fatal self-harm,” meaning suicide, was significantly correlated with solitary confinement.

Federal prisons house the more serious offenders. After much bad publicity from suicides in federal prisons, the government has recognized the harm of solitary and has started to reduce its use. But the minister of Public Safety, Ralph Goodale, seems to think that is enough.

So far, he has made only a vague commitment to some reform, not necessarily to the law itself. Yet the existing law, the Corrections and Conditional Release Act, has no effective restrictions on the use of solitary. It permits it when there is “no reasonable alternative,” yet does nothing to require any alternatives. Release is to be at the “earliest appropriate time,” with no specification as to what constitutes “appropriate.”

The problem remains that some sort of segregation will continue to be needed for inmates at risk of assault, such as sex offenders and police officers liable to retaliation. Yet there is no reason why this should amount to the extreme deprivation of solitary confinement. With electronic communications, telephones, books and visits it should be possible for inmates to avoid mental deterioration. This is a design, technology and scheduling issue.!

Solitary confinement should be abolished, not only for juveniles and the mentally ill (priorities), but all solitary, for federal and provincial/territorial prisons.

Rehabilitation is a goal of our prison system and most prisoners are released at some point. Hanging, flogging, the paddle and bread-and-water diets were abolished decades ago. This barbarism, too, should pass.

Lynn McDonald is a former MP, professor emerita at the University of Guelph and Member of the Order of Canada.

College of Family Physicians of Canada statement on solitary confinement

Solitary cell in Prison Jacques-Cartier, Rennes, France

College of Family Physicians of Canada
Prison Health, Community of Practice in Family Medicine (CPFM)
August 7, 2016

Position Statement on Solitary Confinement

Definition and background

Isolation, segregation, separation, cellular, or solitary confinement are some of the terms used to describe a form of confinement where prisoners are separated from the general prison population and held alone in their cell.1 Solitary confinement refers to any confinement of prisoners for 22 hours or more a day without meaningful human contact,2 and with limited or no access to rehabilitative programs.

Solitary confinement may be imposed for administrative or disciplinary purposes. For example, a prisoner who has a violent history or is at risk of injury from other prisoners may be placed in administrative segregation; a prisoner who does not follow the rules and regulations of the institution may be placed in disciplinary segregation.

The United Nations (UN) considers any stay in solitary confinement over 15 days as torture, but the negative consequences of sensory deprivation can be seen as early as 48 hours after segregation.3 These include onset of mental illness, exacerbation of pre-existing mental illness, and the development or worsening of physical symptoms.3 4 5 6 7

Family physicians are health advocates who are called to be socially accountable.8 9 The College of Family Physicians of Canada (CFPC) promotes social justice as the pursuit and/or attainment of equity in society.10 Social justice focuses on addressing the social determinants of health and minimizing their negative effects on individuals’ health.11 12 Accordingly, the CFPC Prison Health Community of Practice in Family Medicine13 advocates for best health outcomes for incarcerated populations in Canada. Therefore, it is the ethical, moral, and professional obligation of health care professionals to advocate for the humane and just treatment of incarcerated persons and to make specific recommendations regarding solitary confinement.14 15 16 17

Recommendations

  1. Abolish solitary confinement for administrative segregation. Non-segregation options must be created within correctional facilities, with adequate resources and correctional staff.18 19 20
  2. Abolish solitary confinement for youth. Due to the more fragile brains, the negative effects of solitary confinement will have a greater impact on youth.21
  3. Solitary confinement for medical reasons (including cardiovascular disease, respiratory disease, cancer, infectious disease, liver disease, and/or diabetes) is inappropriate. These persons require care that will address the medical health needs rather than exacerbate them in solitary confinement.
  4. Solitary confinement for mental illness (including those with post-traumatic stress disorder) is inappropriate. These persons require care in a specialized setting that will address the mental health needs rather than exacerbate them in solitary confinement.
  5. Solitary confinement for discipline is not recommended. The evidence shows that it is not effective and that better options exist.16
  6. Until solitary confinement is abolished, correctional facilities should develop and implement independent review procedures of all those in solitary confinement, to address both legality of the confinement and also to ensure the health (mental and medical) of persons in solitary confinement.
  7. Until solitary confinement is abolished, correctional facilities should assure that the health care needs of persons in segregation are met. Persons in solitary confinement should be assessed in person by medical and nursing staff at least daily, in addition to regular assessment by correctional staff. If the person requires health care, then the patient should be seen in a health care setting that maintains confidentiality and dignity.22

References

1 Shalev S. A Sourcebook on Solitary Confinement. London, UK: Mannheim Centre for Criminology, London School of Economics; 2008.

2 General Assembly resolution 70/175, United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), A/RES/70/175 (8 January 2016), available from http://undocs.org/A/RES/70/175. Accessed 2017 Jan.

3 General Assembly resolution 66/150, Torture and other cruel, inhuman or degrading treatment or punishment, A/RES/66/150 (19 December 2011), available from http://undocs.org/A/RES/66/150. Accessed 2017 January.

4 Shalev S. Solitary Confinement and Supermax Prisons: A Human Rights and Ethical Analysis. J Forensic Psychol Pract 2011;2-3(11):151-183. doi: 10.1080/15228932.2011.537582

5 Haney C. Mental Health Issues in Long-Term Solitary and “Supermax” Confinement. Crime & Delinquency 2003;49(1):124-156.

6 Kaba F, Lewis A, Glowa-Kollisch S, Hadler J, Lee D, Alper H, et al. Solitary confinement and risk of self-harm among jail inmates. Am J Public Health 2014;104(3):442-7. doi: 10.2105/AJPH.2013.301742

7 Kupers T. What To Do With the Survivors? Coping With the Long-Term Effects of Isolated Confinement. Crim Justice Behav 2008;35(8):1005-1016.

8 Tannenbaum D, Konkin J, Parsons E, Saucier D, Shaw L, Walsh A, et al. CanMEDS – Family Medicine: Working Group on Curriculum Review October 2009. Mississauga, ON: The College of Family Physicians of Canada; 2009.

9 Buchman S, Woollard R, Meili R, Goel R. Practising social accountability: From theory to action. Can Fam Physician 2016;62(1):15-18.

10 The College of Family Physicians of Canada. The CFPC Social Justice Lens Worksheet. Mississauga, ON: The College of Family Physicians of Canada; 2015.

11 Wilkinson R, Marmot M, eds. Determinants of Health: The Solid Facts, 2nd ed. Copenhagen, Denmark: World Health Organization; 2008.

12 Canadian Nurses Association. Social Justice … a means to an end, an end in itself. Ottawa, ON: Canadian Nurses Association; 2010.

13 The College of Family Physicians of Canada. Prison Health Program Committee. Available from: www.cfpc.ca/Prison_Health_Who_We_Are. Accessed: 2017 January.

14 Appelbaum KL. American Psychiatry Should Join the Call to Abolish Solitary Confinement. J Am Acad Psychiatry Law 2015;43(4):406-15.

15 Webster P. Controls over solitary confinement needed. CMAJ 2015;187(1):E3-E4.

16 Ahalt C, Williams B. Reforming Solitary-Confinement Policy – Heeding a Presidential Call to Action. N Engl J Med 2016;374(18):1704-1706.

17 American Public Health Association policy statement, Solitary Confinement as a Public Health Issue, Policy number 201310 (5 November 2013).

18 National Association of State Mental Health Program Directors (NASMHPD). Six Core Strategies for Reducing Seclusion and Restraint Use (c). Available from: www.nasmhpd.org/sites/default/files/Consolidated%20Six%20Core%20Strategies%20Document.pdf. Accessed 2017 January.

19 Colton D, Xiong H. Reducing seclusion and restraint: questionnaire for organizational assessment. J Psychiatr Pract 2010;16(5):358-62. doi: 10.1097/01.pra.0000388632.74899.86.

20 Colton D. Leadership’s and program’s role in organizational and cultural change to reduce seclusions and restraints. In: For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Nunno M, Bullard L, Day D, eds. Washington, D.C.: Child Welfare League of America; 2008, p. 143-166.

21 Burke AS. Under construction: Brain formation, culpability, and the criminal justice system. Int J Law Psychiatry 2011;34(6):381-5. doi: 10.1016/j.ijlp.2011.10.001

22 Enggist S, Møller L, Galea G, Udesen C, eds. Prisons and Health. Copenhagen, Denmark: World Health Organization, 2014.

Dr. Ruth Elwood Martin speaks with Georgia Straight about solitary confinement

Interview with CCPHE Director Dr. Ruth Martin in a 2014 Georgia Straight article “Correctional Service Canada ignores repeated calls for reform on solitary confinement,” the third and final article in a 3-part series: