Philadelphia jail offers out-of-cell therapy for inmates in solitary confinement

At any given time, there are roughly 300 people in solitary confinement at the Philadelphia Department of Prisons. For those inmates, that means 23 hours a day in a cell.

Now, the Prisons Department is spending $2 million over the course of the year to offer an out-of-cell therapy program for inmates in segregation.

“We were concerned about the effect of segregation on the mental health of people with mental illness,” said the jail’s medical director, Bruce Herdman, “and of course there is the possibility of creating mental illness through segregation.”

Inmates end up in segregation for a variety of disciplinary infractions. Someone might have been found with a cell phone, drugs, or a handmade weapon. He or she might have gotten in a fight, or assaulted an officer.

Under normal conditions, those confined to segregation are in their single-occupancy cells for 23 hours a day. They are allowed one hour to shower, have access to the television and the exercise equipment, make phone calls, and use the yard outside.

With the new program, those in segregation get an extra two hours out of cell Monday through Friday. The first hour is a group therapy session focused on what psychologist Dana Killingsworth of Centurion Health described as criminal thinking, relationship skills, communication skills, and critical thinking.

“Things targeted to help them to not come back to jail,” she said. “Or if they do come back, not to go to segregation.” The second hour is devoted to an activity that is designed to reinforce some of the skills that came from first hour.

Killingsworth said the curriculum for the therapy sessions was built off of D.A. Andrews and James Bonta’s risk needs and responsivity research, which addresses eight behavioral and social factors that lead to recidivism.

The program has been up and running for six months. The full course of therapy runs 5 ½ weeks, but the average length of time in segregation in the city’s jails is 13 days, so most people are not completing the program uninterrupted. Some who end up back in segregation can pick up with a group where they left off. Groups consist of no more than eight people.

Herdman acknowledged that group therapy for two hours a day would not solve the mental health issues of many of the inmates.

“Most of them, we don’t know when they’re going to leave,” he said of the largely unsentenced population. “So the kind of in-depth psychotherapy that you would want  to do with someone who’s got a significant trauma history is not ethical for the most part, unfortunately.”

But, he added, because all other mental health intervention at the jail is crisis-based, this is the only real proactive mental health care inmates are getting while incarcerated.

“What we do primarily is self-injury prevention and psychopharmacology with the exception of this new program,” he said. “We don’t do individual therapy.”

Deirdre Reynolds, the medical director for Centurion Health, which contracts with jails and prisons across the country to run mental health services in correctional facilities, said programs like these offered an opportunity to treat mental illness among a high-risk population.

“With the idea that the correctional system is becoming the new state hospital, it would be nice to be able to enhance the services for the seriously mentally ill in our population,” she said.

Killingsworth, the psychologist, said that the program had been received favorably among inmates, and that she had even heard anecdotal reports of people who had returned to general population wanting to do something that would land them back in segregation so they could have access to the services.

The administrators haven’t figured out yet exactly how to measure the success of the program. They’ve thought about looking at a drop in negative incidents on the segregation unit, or lower rates of recidivism to segregation, but haven’t analyzed data yet.

Herdman said the program’s $2.1 million price tag will come out of savings generated from a decline in the prison population and will pose no additional cost to taxpayers.

The negative psychological impact of solitary confinement has been well documented.

Richard Smeyne is a professor of neuroscience at Thomas Jefferson University who studies the effects of isolation on the brain. His research found that after one month of isolation, neurons in the cerebral cortex of mice shrunk by 20%. How long it would take for a similar effect to take hold on humans is not exactly clear, and neither is whether the size reduction is permanent.

Smeyne said the majority of the psychological damage done to the brain is a result of a lack of human contact, so if a program like this afforded real social interaction, it could help ease the psychological burden of isolation.

“Trying to mitigate the isolation and have a true social interaction — that seems to be the importance, not the hours you’re spending in a physical place,” said Smeyne. But he said there are other interventions that the jail could take to mitigate the psychological effects of solitary confinement, like turning off the lights at night to prevent the body from losing its natural circadian rhythm. Many correctional facilities resist turning off the lights in segregation units for security reasons.

Many state prison systems are moving away from segregation, or solitary confinement. The state of Colorado has all but eradicated the practice, and Oregon has significantly reduced its population in isolation.

Smeyne said programs like Philadelphia’s don’t seem to be taking steps in the direction of reducing the number of people in isolation — instead, they focus on simply cutting down the hours per day spent in a cell.