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Solitary Confinement is a Catch-22 for Colorado Prisoners and a “Moral Injury” for Mental Health Workers

Responding to an open-records request, the Colorado Department of Corrections (DOC) revealed on April 11, 2023, that 1.7% of the state’s prison population was in solitary confinement for 22 hours a day or more.

A mentally ill woman held for DOC at the Delta County Jail (DCJ) was in that group. When she eats feces or attacks others at the jail, she is placed in solitary confinement, according to the Colorado Sun. “We have limited resources,” explained Joel Watts, a therapist at the jail. “If we don’t put them in isolation, they become a danger to themselves, to others and to staff.”

But throwing people like her in “the hole” presents a troubling ethical dilemma – “a Catch22,” Watts added. “In putting them in isolation, we know they’re going to get worse.”

Prisoners are sent to solitary confinement for several reasons: Acting violently towards the staff or other prisoners, being in a certain gang, receiving severe disciplinary infractions or needing to be placed in protective custody. Suffering from mental illness is another common reason, when a prisoner poses such a risk that he or she is sent to solitary confinement. However, the negative psychological and physical effects brought on by the isolation will almost always worsen the mental sickness.

Prisons and jails – not medical facilities – hold the largest share of the nation’s mentally ill. Unlike those in a hospital setting, a mentally ill patient who becomes disruptive in prison can be dealt with only by being locked away in solitary confinement to protect others. In “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics”, Jeffrey L. Metzner, MD and Jamie Fellner, Esq. note that “prison officials have increasingly turned to solitary confinement as a way to manage difficult or dangerous prisoners.”

“Many of the prisoners subjected to isolation, which can extend for years, have serious mental illness, and the conditions of solitary confinement can exacerbate their symptoms or provoke recurrence,” they add. “Prison rules for isolated prisoners, however, greatly restrict the nature and quantity of mental health services that they can receive.”

Moreover, the ethical dilemma that solitary confinement proposes to mental health workers such as Watts is an example of “moral injury,” a term coined by social justice and civil rights activist Staughton Lynd in his groundbreaking work, Moral Injury and Nonviolent Resistance: Breaking the Cycle of Violence in the Military and Behind Bars. It results when an individual is forced to violate his or her own personal principles or professional standards because of policy or law.

To reduce the moral injury clinicians like him face, Watts suggests a two-track approach when people are arrested: The first, incarceration, is solely for individuals who are not mentally ill and pose a public safety risk. The second is a restorative approach that focuses on rehab, inpatient and residential services, and dismissal of charges for mentally ill individuals who are in psychosis when they break the law. 

Additional sources: Colorado Sun, Solitary Watch