There are several euphemisms for the practice of solitary confinement of individuals within our prison system: segregation, secure housing units, involuntary protective custody and — most relevant to legislation being considered by the Maryland General Assembly this session — “restrictive housing.”
The United Nations classifies prolonged isolation as a form of torture, yet on any given day, 8 percent of Maryland’s prisoners are in restrictive housing — double the national rate of 4-5 percent. People in restrictive housing spend 22 hours a day locked in a 6-by-9-foot cell. These individuals may be placed with one other person rather than alone; however, the deleterious effects of “solitary” confinement remain when two adults cohabit a room smaller than a parking spot.
As health care professionals and physicians-in-training in Baltimore, we see the harmful consequences of this practice on the patients and communities we serve. We provide care to formerly incarcerated people who face the myriad challenges of life after release, including housing instability and barriers to employment. For our patients who endured restrictive housing while incarcerated (along with an astonishing 53 percent of the Maryland prison population in 2018), the difficulties inherent in reentry are compounded by the devastating psychological impact of isolation.
Last year in Maryland prisons, the average length of stay in restrictive housing was over 46 days. Such prolonged stays have repeatedly been linked to higher rates of anxiety, depression, PTSD and suicide. Lights in restrictive housing cells are often kept on continuously, leading to chronic sleep deprivation and insomnia. These harmful effects are amplified among adolescents, who are in a critical neurodevelopmental window, placing them at risk of long-lasting cognitive and behavioral impairments.
The health consequences of restrictive housing do not end after incarceration. Decreased social interaction, as well as limited ability to engage in mental health services and vocational training prior to release make the reentry process far more difficult. Limited access to family, clergy and other stabilizing supports exacerbates the difficulties returning citizens encounter, while also punishing their families.
In our pediatric offices, we care for children harmed by limited access to an incarcerated parent. Given stark racial disparities in incarceration, with black individuals comprising approximately 70 percent of people behind bars in Maryland, communities of color disproportionately experience the harmful ripple effects of restrictive housing policies.
The additional staffing and security mandated by restrictive housing come at a high price: At $75,000 per year per person, restrictive housing is three times more costly than general prison housing. Several states have successfully reduced use of restrictive housing while investing the savings in alternate safety measures, health care, rehabilitation and education; they have achieved corresponding reductions in violence against prison staff and provide models for other states to follow.
Fortunately, the Maryland General Assembly can rectify several major issues with our state’s use of restrictive housing during the current legislative session. Senate Bill 809/House Bill 745 would prohibit the involuntary placement of pregnant and post-partum individuals into medical isolation. The current policy is to place all pregnant people in their third trimester into medical isolation without a clear medical rationale. Forced isolation during pregnancy confers significant mental and physical health risks, including preterm labor, miscarriage and postpartum depression.
Direct release from restrictive housing is an ongoing problem, with more than 750 individuals in the past three years being released directly from isolation in Maryland prisons into the community after spending an average of 60 days in restrictive housing. House Bill 1002 would limit this unsafe practice by disallowing placement in restrictive housing within six months of release (barring clearly delineated extenuating circumstances.) The bill would establish a transitional process for individuals in restrictive housing to begin 180 days prior to their anticipated release date, with re-entry planning services including housing and public benefit assistance.
House Bill 1029 caps the maximum time a person can spend in restrictive housing at 15 consecutive days (90 days total within a year) and establishes a graded approach to using restrictive housing as a disciplinary tool. It emphasizes the creation of step-down programs to prepare prisoners for return to the general population and eventual release.
Restrictive housing damages the health and safety of incarcerated people, prison staff and society. These bills take important steps toward addressing these human rights violations. For the health of our patients and our communities, we strongly urge our legislators to advance these bills.
Dylan Hardenbergh and Nivedha Kannapadi are medical students at the Johns Hopkins University School of Medicine and members of the Johns Hopkins Incarceration and Health Justice Collective. Natalie Spicyn (Twitter: @nataliespicyn) is a primary care physician and chief of adult medicine at Park West Health Systems. The views expressed in this piece are those of the authors and do not reflect the views of their respective institutions.