Out of Mind, Out of Sight: Report on Confinement of Mentally Ill Prisoners in Ireland
Editor's note: Following are the first few pages of this report released on
April 19 by the Irish Penal Reform Trust. Copies of the complete report are
available from the Trust or via email from Frank Mulcahy: fmulcahy@iol.ie
Introduction
This IPRT report reveals that mentally ill prisoners are put into solitary confinement (strip cells) as a substitute for appropriate treatment.
But first, a few words on solitary confinement and strip cells.
Solitary confinement:
During the early days of space travel, it was normal to put trainees into isolation chambers to see how long they would last. They were on their own in silence, without any means of knowing the time. Many men cracked. One cosmonaut, Andrian Nikolayev, lasted the longest. He spent 4 days in the isolation chamber and he was then called 'The iron man'. An important difference between the solitary confinement of prisoners and the isolation chamber is that the trainee in the isolation chamber could press the buzzer and come out at any time. Neither, obviously, was any trainee mentally ill.
IPRT is particularly concerned with mentally ill/disturbed prisoners who are put in solitary confinement for a lot longer than Andrian Nikolayev. Not only are mentally ill prisoners not receiving proper treatment but being locked up for 23-24 hours a day for any significant period can cause a very specific kind of psychiatric syndrome. Dr Stuart Grassian, psychiatrist, member of Harvard Medical School faculty and an expert in the area of solitary confinement says,
the restriction[s] of environmental stimulation and [the] social isolation associated with confinement in solitary are strikingly toxic to mental functioning . . . the harm caused by such confinement may result in prolonged or permanent psychiatric disability, including impairments which may seriously reduce the inmates capacity to reintegrate into the broader community upon release from prisons
In a separate interview Grassian pointed out,
The [US] courts have recognised that solitary confinement itself can cause a very specific kind of psychiatric syndrome often involving random violence and self mutilation, suicidal behaviour, a lot of real agitated, fearful and confusional kind of symptoms'
Dr Stuart Grassian, also says that the most shocking thing is that those who end up in padded cells
all tend to be ill in very similar kinds of ways and they are so frightened of what was happening to them that they do not exaggerate their illness. They tend to minimize it, to deny it. They are scared of it.
IPRT believes that the prison system tends to respond to the disruptive behaviour of mentally ill prisoners with further punishment. But the punishment often makes things worse and people tend to get into vicious cycles of disruptive behaviour and punishment.
The inhumanity of strip cells:
A strip cell (known also as padded or isolation cell) is a place of solitary confinement. It is an empty cell -furnished only with a thin mattress on the ground and a blanket. In Irish prisons a few of these cells have walls that are padded in order to protect the prisoner from self-damage, others do not. The latter cells are called strip cells, i.e. the walls are usually concrete and thus potentially dangerous. A few cells within the Irish prison system do not even have a call-button. IPRT found that in one prison mentally ill prisoners have to 'shout through the heating vent to their mates who then call an officer'. In another IPRT was told that a prisoner would 'have to hammer on the door' if he wanted help etc. In one prison new, very hard but easy washable material covered the walls. It appears that ease of washability was given priority over softer and more protective wall material because mentally ill prisons can defecate the cells. The windows are always sealed, thus the cells are inevitably stuffy. Many of the padded cells are dark and dank. If there is a slopping out buckets in the cell it is very smelly. In the words of an expert who examined one prison on behalf of IPRT these cells are 'dreary smelly single cells'. While in a strip cell a prisoner is allowed to wear only underpants or night dress. No books, radio or any personal belongings are ever permitted. People in strip cells are usually locked up for 23 hours a day. Though prison rules state that every prisoner must be allowed out to exercise for one hour a day this rarely seems to happen. This means that some prisoners will be locked up for 24 hours a day. Prison rules also state that a doctor must see each strip cell occupant daily. At least some of these visits appear to be somewhat cursory.
In theory the rules about solitary confinement to the above type of cell is strict. Rule 78 of the Rules for the Government of Prisons (Department of Justice, 1947) states: "The Governor may order any refractory or violent prisoner or prisoner of suicidal tendencies to be temporarily confined in a special padded cell, but a prisoner shall not be confined in such a cell as a punishment nor for a longer period than is absolutely necessary." Reality, as shown in fig. 1 and 2 and tables 1 and 2 tell a different story.
Standards of treatment of the mentally ill prisoner:
'No-one shall be subjected to torture or to cruel, inhuman or degrading treatment'.
This is a basic human right enshrined in United Nations Universal Declaration of Human Rights (Article 5) that Ireland has signed but not implemented. So far we have not ratified the Covenant against Torture, Degrading and Inhumane Treatment (CAT). This means that Ireland can avoid its international AND LEGAL obligations to adhere to basic human rights standards. The government's delay in ratifying CAT is inexcusable. The use of solitary confinement as a way of dealing with mentally ill prisoners is totally rejected by the IPRT.
IPRT Findings
(summary)
This IPRT Report examined 224 entries into strip cells - places of solitary confinement - in 3 Irish prisons. IPRT found that:
- solitary confinement (strip cells) is used as a regular substitute for medical care.
- 78% of prisoners put into strip cells were found to be mentally ill (Fig 1, p 9).
- some mentally ill prisoners are repeatedly put into strip cells. For example one person spent 25 out of 30 days in solitary confinement (Table 2).
- the longest stay in a strip cell at any one given time was 18 days (p 11).
- solitary confinement makes sick people sicker. Yet even those who are certified insane are put in strip cells (Table 1, p 11)).
- some prisoners are kept naked while in solitary confinement (p 13)
- some cells have no call button; prisoners have no means to call for help and
- some cells have slopping out buckets (p 4).
- IPRT believe these figures to be conservative: 40% of entry/exit dates to and from these strip cells are missing (p 10)).
- reliable sources have witnessed mentally ill prisoners eating paint off walls and defecating in strip cells (pp 4 & 11)
IPRT Recommendations
(Summary)
IPRT calls for the:
- immediate ratification of the United Nations Covenant against Torture, Degrading and Inhumane Treatment (CAT)
- immediate implementation of all recommendations from the European Committee for the Prevention of Torture (CPT)
- radical overhaul of the entire prison health system including
- immediate refurbishment of 40 rooms in the Central Mental Hospital for the Criminally Insane.
- immediate setting up of suitable in-service psychiatric clinics, at least three appropriately placed geographically
- immediate replacement of the use of strip cells for mentally ill and suicidal prisoners by well-lit observation wards
- full time inspector of prisons
- an ombudsman for prisoners
- consideration of the idea of mental health courts (see policy paper no 2)
IPRT report: introduction:
The abysmal failure to build adequate and appropriate community psychiatric and psychological services for mentally ill and unwell people has resulted in mental illness becoming hugely criminalised in this country. People who urgently need medical attention go unnoticed in society and are left unattended for years on end. Many become homeless. Some commit suicide. Many become lawless and end up in prison. The Irish Penal Reform Trust estimates that almost 40% of the prison population may be suffering from some level of psychiatric or psychological illness or disturbances. The mentally ill prisoner should be treated in an appropriately secure psychiatric/psychological setting. The prison environment is detrimental to their mental health. As currently structured, prisons do not allow for adequate observation, medical or otherwise, of mentally ill prisoners. Many are locked up for as long as 23 hours a day in solitary confinement in strip cells.
The internationally respected psychiatrist Professor Anthony Clare of St Patrick's Hospital, Dublin stated,
the mentally ill are now the most systematically stigmatised group in our society. They . . . are the true lepers of today.
This stigmatisation, combined with the lack of appropriate care while in detention, means that mentally ill prisoners are the most discriminated against in Irish society. Their human rights are denied on an ongoing basis - by the state.
John Gunn, Professor of Forensic Psychiatry at the Institute of Psychiatry, London, writes,
Not only do prisons generate psychiatric problems but they also collect them inappropriately and act as unofficial mental hospitals for individuals who should be in health care.
That observation summarises the challenge facing the Irish Government in relation to their failure to recognise and respect the human rights of mentally ill prisoners.
What type of individual ends up in a padded cell? Prison records (summarised below) clearly show that those who end up in solitary confinement in padded cells are not ruthless offenders. This is because the most ruthless of prisoners are usually the most calculating. They tend not to commit the kinds of infractions that would result in them being confined to padded/strip cells.
In reality, the people who end up in padded/strip cells are there as a result of impulsive or chaotic types of behaviour. They may have some type of psychiatric disturbance such as attention deficit disorder, mood instability or affective instability. In short, most people who end up in padded cells are mentally ill, illiterate or cognitively impaired - people who at times cannot manage to contain their behaviour. This view is supported both by research and by the governors and relevant staff interviewed by IPRT for this project. The most common comment went like this: 'most prisoners who are in these cells are really very depressed' or 'they ought not to be in prison in the first place'.
The facts about solitary confinement and the mentally ill:
IPRT visited three prisons, Mountjoy, Cork and Limerick between 20th February - 20 March 2001. IPRT wishes to sincerely thank the Governors and staff of all three prisons for their co-operation. IPRT would also like to acknowledge that in all three prisons individual efforts by staff to act consistently in a humane way to those mentally ill was more than evident. Our criticisms here are of the prison system and in particular, the lack of political will to demonstrate humanity.
In total 224 official entries into strip cells were examined. Although the dates of entry ranged from November 1999 to March 2001, the majority of recorded entries fall in the later half of the above time period. The last date of entry recorded was March 6th 2001. The data was used with two main purposes in mind. Firstly, to establish a link between use of strip cells and mentally illness. Secondly, to highlight the inexcusable length of time certain prisoners are detained in these cells, the majority of whom are can be generally defined as having mental health problems. This report concentrates on those reasons for entry that are explicitly psychiatrically/pscyhologically sourced only.
Reasons for detention:
It is recognised that the data available citing the 'reasons' for the detention of an individual in a padded/strip cell, firstly, is not comprehensive, (rarely does the 'reason' cited exceed a few words) and secondly, is reliant on the subjective opinion of prison staff. However despite this, it does allow us to determine the general reason or reasons for detention and, in most cases, a distinction can be made between prisoners with mental health problems and those without (Fig. 1). For example, it is clear that a prisoner detained for reasons such as 'suicidal' or 'self-inflicted wound' can be classified as having problems related to mental health (Tables 1& 2). IPRT conclude that the information available goes a long way toward establishing a relationship between the use of padded cells and the mentally ill.
Figure 1 highlights the reasons for detention in strip cells. 78% of those detained in a strip cell suffer from some form of mental illness/disturbance (actual categories of mental illness: tables 1 & 2). 5% are put into strip cells for substance related (drugs usually) reasons, 13%are put in for punishment reasons and 4% for reasons that do not fall into categories above.
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