As a psychiatrist I have long consulted to various kinds of correctional facilities including local county jails, state prisons both low or “minimum” security facilities and “maximum” or “high management” units, a federal correctional evaluation center of some past fame and notoriety because of its infamous inmate-patient referrals especially in the turbulent 1980’s, juvenile correction detention centers in regional settings in the Southwest and one of the country’s largest adolescent detention center in a very large urban city. I also served as a forensic examiner at a state level maximum security state hospital based forensic correctional inpatient unit.

I have long been acutely aware that 1) a substantial percentage, at least one third in the old days, to now a growing majority these days with the last ten years of shifting of the chronically mentally ill from public psychiatric hospital beds to the jails at all levels in this country,  have been mentally ill, and that, 2) the mental health treatment services in all correctional settings have always been and still are, woefully inadequate, and that 3) there is inadequate training for correctional personnel, that 4) management of the mentally ill offender has become consequently, and understandably necessarily more and more reliant on coercive, physical control measures in settings at all levels. This has been a disaster long in the making and obvious to any student and practitioner of correctional facility mental health services delivery who has had a long enough career to see it worsening in the last 10-15 years.

As the old proverbial saying warns us, “the chickens have come home to roost.” The conditions have, like so many other social crises in this country, and many others, reached the bursting point in jails. Now with at least a quarter to over half of inmates in all settings being grossly mentally ill, suicides and assaults are exploding. The recent issues at New York City’s Rikers Island jail facility, with deaths of inmates under untoward and unfortunate circumstances are a typical example.

The degree to which the most highly controlled prison environments have come to resemble the stark repressive and in a sense, inhumane conditions at the federal Guantanamo prison for terrorists on the southern coast of Cuba, hit me when I read a recent article on the Supermax Prison in Florence Colorado. Inside America’s Toughest Federal Prison appeared originally in the Sunday magazine section of the New York Times. It was lengthy and gave a first-hand, inside description of the conditions and control measures that the “APX” Supermax prisons employ to control the most dangerous of federal prisoners. Even given the notoriety and degree of true dangerousness of those inmates, the conditions were still breathtaking and beyond what my naive impressions of federal prison life were. The article and reporter derived a good deal of material from a paroled ex-inmate resident of that prison, as well as interviews with the warden, and impressions from on site visits by the  reporter within that prison.

Its control measures set a new extreme in the 23 hour a day, one hour a day out of your solo solitary single cell that I had first seen in a maximum security regional state prison facility nearly 30 years ago.

In that first introduction to anything beyond the local county jail where I did a psychiatric training rotation, seeing county jail inmates for psychiatric evaluation and then very routine and very available psychiatric medication intervention, I was terrified by my introduction. The clinic nurse corrections sergeant took me on a tour of the facility. I am sure that part of its overly dramatic shock value was intentional to make me very careful in observing prison safety and security procedures. At the gate when I first presented myself and my ID, a guard in the tower immediately above me, trained his 12 gauge pump shotgun on me. It was so close I could tell the make of the gun, Remington. The nurse sergeant pointed out to me as he ushered through the gate, a section of fence that had what looked like charcoal grill burnt drippings in the wire mesh. He informed me it was the not yet scraped off burnt residue of an inmate who had tried to scale the fence and was “fried” by the periodic pulse of many thousand volts of electricity in the fence. He noted to me grimly though with smile that they had left the burnt residues on the fence to remind other inmates of the futility of trying to escape. After that later in the tour, he showed me a rusty colored portion of hard terrazzo floor in the prison library. He explained to a puzzled, naive me that these were the blood stains of a “snitch,” who had been butchered in an assassination by other inmates; that he was so carved up that when the body was removed the head, and spinal column almost were detached surgically from the torso and body. He explained that this stain was not left on purpose, that it simply could not be scrubbed out.

The article in the New York Times described conditions that were to say the least oppressive. The cells were very small about 8′ by 8′ without only a narrow vertical slot-like window that showed only the sky and not the nearby beautiful Rocky mountains, a concrete slab of a bed with a thin mattress, stainless steel toilet and sink. The door is soundproof, and almost no outside noises come in. Inmates mostly communicate through their sink drains yelling to another room after they blow the water out of the sink drain trap. Their once a day 1 hour exercize time takes place at whatever hour of the day assigned to them, even if it is 3 A.M. [I must add this and some of the other circumstances I have witnessed before.] But their setting for walking, strolling, airing themselves or calisthenics, is another small sealed room with no window and only a chinning bar. Inmates are placed in total isolation for disciplinary measures, which means they are not allowed any respite from their cells for apparently as long as judged needed, even months, and are not allowed any verbal interactions from even the guards who never speak to them during those periods of punishment.

The most riveting portion of the article detailed the descent into psychosis of one inmate. He had apparently not had any history of mental health issues prior to his assignment to the Florence Supermax “APX” facility. It appeared that his referral there was prompted by his recidivist history. He was apparently fairly bright and accomplished in his somewhat short intervals outside of prison. But with a few years of repeated isolation at Florence, he began to deteriorate alarmingly into a very atypical psychosis. The article had a picture of him after his noticed deterioration, and to refrain from a “spoiler” revelation, I can only say that his appearance was truly bizarre and confirmed the article’s description and assertion of his deterioration.

I was left with many troubling thoughts. The United States has evolved into as harsh a prison system as perhaps in some ways as any in the world. Our numbers and proportions of citizens of any racial/ethnic background is one of the highest in the world. There appear to be reall reasons for the public relations bad grades we have been receiving internationally for the severity of our prisons. And lastly we have relied more and more on inhumane ways of treating prisoners to control them. This is all the more disturbing when other countries systems such as in the Scandinavian countries apparently have more humans systems that appear to work at least as well or better without the harshness that has become routinely practiced and accepted here. I now not only am ever grateful I have not been relegated somehow through bad behavior to these systems but have a more tempered view of the situation of the inmate in this country. I have no answers for our predicament but the deep down sentiment that this is perhaps not necessary for at least some of our inmates, that much of the need for control could be appreciably better if we treated their psychiatrically issues up to the standards of care that existed at the start of my psychiatric career nearly four decades ago.

We have arrived at this now almost incomprehensible state of affairs from huge budget cutbacks in the approaches, services and treatment capabilities once afforded the inmate population, an enormous change in the ideology regarding “rehabilitation,” largely heaving it out the social window, and the belief in universal application the harshest of measures not involving overt physical torture, nonetheless harming beyond civilized credulity. I think again of the old personal standard, would I want anyone I knew treated this way, any relative of mine, my father, brother, sister, cousin etc? Does anyone truly deserve this? Is this to be applied so pervasively? Should there be more open review standards that temper the application of such measures? In spite of my knowing incredibly dangerous sociopathic routinely murderous persons who likely only respond to such levels of controls, I cannot believe that this is needed for perhaps 80,000 persons or more currently.