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Mentally ill individuals should be excluded from solitary confinement of any duration.
National Commission on Correctional Health Care (NCCHC)

The definition in Massachusetts also includes several other disorders: those commonly characterized by breaks with reality or perceptions of reality; developmental disability, dementia, or other cognitive disorders; or personality disorders manifested by episodes of psychosis or depression, when those disorders lead to significant functional impairment involving acts of self-harm or other behaviors that have a seriously adverse effect on life or on mental or physical health.

We also designed two treatment units as alternatives to long-term segregation for people with SMI: a Secure Treatment Program (STP) for the “traditionally” mentally ill (those with schizophrenia, bipolar disorder, etc.), and a smaller Behavior Management Unit (BMU) for patients who are psychopathic or have a severe personality disorder. Those populations have different issues and different needs; therefore, the units employ different interventions. (I provide a detailed description of how to implement such a program for psychopathic people in a correctional setting in “Psychopathy: Assessment, treatment, and risk management,” Handbook of Violence Risk Assessment and Treatment: New Approaches for Mental Health Professionals.)

For the mentally ill patients, the STP emphasizes supportive therapy, medication, insight into mental illness, and relationships with staff and other offenders. For the psychopathic patients, the BMU utilizes behavior management, clearly defined incentives and consequences, strict adherence to rules, and staff consistency.

Both units employ multidisciplinary treatment teams to address mental health needs. Progress requires programming; therefore, each patient is scheduled for at least 15 hours of structured out-of-cell programming and 10 hours of unstructured out-of-cell activity each week. Both units operate under a point-based incentive system, using a stepwise plan for increasing incentives based on behavioral stability. Each week, patients can select incentives from a menu of options based on points earned for pro-social behavior.

In the nine years since we created these units in Massachusetts, we have shown that providing quality mental health treatment to SMI patients as an alternative to segregation in a safe and secure setting is possible. We have realized significant reductions in the number of assaults on staff, assaults on other incarcerated people, days on suicide precautions, and days in an inpatient psychiatric setting. These findings illustrate how such an approach improves patient outcomes, decreases negative clinical and legal outcomes, creates safer institutions, and is cost effective. Furthermore, it is the right thing to do!

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