The Treatment of the Mentally Ill in Supermax Facilities

Abstract

As a criminal justice policy, researchers have encountered numerous problems attempting to evaluate whether supermax confinement achieves its desired goals. Among the many goals of supermax confinement is the incapacitation of the “worst of the worst” inmates. This type of custody, however, has been widely criticized for worsening inmate mental health. In an effort to better understand the treatment of the mentally ill in supermax confinement, we performed a content analysis on 42 state correctional policies. We found considerable variation exists regarding the treatment of the mentally ill as prescribed by official policies and that the majority of correctional policies dictate some level of treatment or intervention for supermax inmates. As criticism regarding the indefinite use of lockdown increases, we argue it is important correctional departments have a foundation that protects inmates and the agency itself, which begins with official policies.

Keywords

supermax mental health prisons correctional policies treatment

Super-maximum security facilities, referred to hereafter as “supermax,” are specialized prisons reserved for a unique class of the “worst of the worst” inmates. An inmate may be placed in a supermax facility for disrupting prison operations, such as disregarding rules or assaulting other inmates and staff (Riveland, 1999). Supermax facilities are highly restrictive and often technologically advanced (Kurki & Morris, 2001). Inmates in these facilities have starkly different experiences than those housed in lower-security prisons. For example, in supermax confinement, inmates routinely sit idle in their cells for 23 hours-a-day with few programming opportunities and/or chances to socialize with others (Haney, 2003).

Researchers investigating the effects of supermax confinement, such as how inmates are treated or how prolonged confinement influences inmate mental health, have found varied results (King, 1999; Lovell, 2008; Naday, Freilich, & Mellow, 2008; O’Keefe et al., 2013; Smith, 2006). Differences often occur because state correctional agencies use various admission characteristics and multiple names are used to define these institutions, such as administrative segregation or close security units, which inhibit the generalizability of studies (Butler, Griffin, & Johnson, 2013; Naday et al., 2008). These problems have also prevented nationwide studies of how correctional agencies manage and respond to mentally ill offenders housed in supermax confinement, which is a growing concern for many correctional administrators (see Haney, 2003; Kupers et al., 2009; Lovell, 2008; Smith, 2006). State correctional policies, however, provide official directives for handling inmates that may require increased supervision or assistance.

In an effort to better understand how different states operate supermax facilities and the potential impact of these regulations on inmates, we conducted a content analysis of 42 supermax state correctional policies. We investigated policies and administrative techniques for managing inmates with mental illnesses to learn how correctional agencies identify, treat, and further prevent mental illness in a particularly harsh environment. In addition, any implementation evaluation of supermax confinement needs to identify how states prescribe the treatment of the mentally ill (Mears, 2008b, 2010, 2013; Pizarro & Narag, 2008). For example, states that admit inmates with mental illnesses or other nuisance inmates to supermax confinement may undermine the effectiveness of the unit to target the “worst of the worst,” and it may also bring forth litigation (Glidden & Rovner, 2012; Hafemeister & George, 2012; Kupers et al., 2009; Kurki & Morris, 2001). State supermax policies also offer insight regarding official standards for the management and release of inmates with mental illnesses, and these policies may have implications for the well-being of inmates generally. These policies dictate and guide responses by correctional staff and administrators while supervising and segregating inmates. According to the state policies reviewed in this study, many departments indicate the need to protect this vulnerable class of inmates; however, more thorough descriptions of inmate reviews are needed to understand how custodial and treatment decisions are made. Such considerations and reviews are crucial to inmate, staff, and community safety considering the majority of supermax inmates will reenter society (Haney, 2003).

Supermax Prisons as Criminal Justice Policy

Criminal justice policies have changed over the past 30 years, relying more on “get tough” crime control strategies, increased government accountability, evidence-based practices, and more cost-efficient decision-making (Mears, 2010, 2013; Simon, 2007). In regard to supermax confinement, there is a considerable gap in research as to whether this new paradigm is followed (Mears, 2008b, 2013). For example, proponents of supermax confinement believe it deters future misbehavior because conditions of confinement are harsh (Mears & Castro, 2006), but studies have shown that supermax confinement may not have a lasting deterrent effect on post-release behaviors compared with non-supermax inmates (Lovell, Johnson, & Cain, 2007; Mears & Bales, 2009). In addition, researchers have found that the supermax population may consist of nuisance inmates, such as the seriously mentally ill, instead of the “worst of the worst” (Haney, 2003; Kupers et al., 2009; Kurki & Morris, 2001). In regard to cost-efficiency, supermax confinement is expensive, with the costs of construction and inmate housing being higher than maximum-security prisons (Kurki & Morris, 2001; O’Keefe, 2008; Pizarro & Stenius, 2004; Ross, 2007). In Colorado, housing an inmate in supermax confinement costs approximately US$32,000 a year compared with US$18,500 for an inmate in maximum-security housing (Pizarro & Stenius, 2004; Rosten, 1999). Therefore, researchers suggest that more attempts to empirically examine the need, theoretical rationale, causal logic, implementation, impact, and cost-efficiency of supermax confinement would provide much needed insight as to whether such restrictive confinement is a “sound” policy (Mears, 2010, 2013; Pizarro & Stenius, 2004).

Among the five recommendations to evaluate supermax confinement as a policy (Mears, 2008b, 2010, 2013), implementation is one component that is the focus of this study. Specifically, implementation refers to how a policy or program is put into effect (Mears, 2010; Patton, 2008). For example, evaluations of implementation strategies focus on “finding out if the program has all its parts, if the parts are functional, and if the program is operating as it’s supposed to be operating” (Patton, 2008, p. 308). According to Mears (2010, 2013), the implementation of supermax confinement as a policy requires the targeting of the correct population for confinement. Numerous scholars, legal experts, and correctional administrators have argued that supermax confinement is not suitable for inmates with severe mental illnesses (Goode, 2012; Haney, 2003; Lovell, 2008; Smith, 2006). The treatment and management of this class of inmates can lessen the likelihood that an implementation strategy and evaluation is performed properly.

Mental Health Factors that May Influence the Implementation of Supermax Confinement

Correctional agencies that use supermax confinement face two critical issues: preventing the development of mental illness and managing inmates who already possess identified mental illnesses. These two problems may lessen the likelihood that a program or policy is implemented as designed (Mears, 2010, 2013; Patton, 2008). Critics argue that prolonged supermax confinement leads to the neglect and deterioration of inmates’ mental health (Haney, 2003; Mears & Castro, 2006; Naday et al., 2008; Slate & Johnson, 2008). For example, Arrigo and Bullock (2008) found a positive correlation between mental health issues and the length of supermax confinement. Related to the issue of agency response to mentally ill inmates, many states admit mentally ill offenders into supermax custody to ensure these inmates receive medical treatment and to protect other inmates and staff (Lanes, 2011; Mears & Watson, 2006). Mentally ill inmates, in the general population of correctional facilities, may not receive the increased supervision or protections that shield them from predatory inmates (Mears & Watson, 2006; Rhodes, 2004). In addition, discrepancies exist among correctional jurisdictions regarding the admission or exclusion of inmates with mental illnesses from supermax custody. For example, Riveland (1999) observed that the detrimental effects of prolonged supermax confinement outweighed the benefit of treatment programs and concluded that inmates with mental illnesses should not be admitted to supermax confinement. These initial findings indicate the importance of assessing the number of states that view supermax placement as a method to control and treat inmates with mental illnesses.

Inmates with mental illnesses are susceptible to supermax placement because prison adjustment and misconduct are affected by mental health problems or disorders (Felson, Silver, & Remster, 2012; Slate & Johnson, 2008). Specifically, inmates with mental disorders may be more likely than non-mentally-ill inmates to engage in misconduct (Felson et al., 2012). Immediate reviews or screenings, however, reduce the likelihood that individuals unable to handle supermax confinement are selected for placement. Few studies have examined decisions to place inmates in supermax confinement. O’Keefe (2008) found approximately 89% of classification reviews for supermax placement were confirmed by classification or reviewing committees. Also, after providing written notice of a request for supermax placement, correctional staff must present evidence to the classification or reviewing committees that warrants placement. Every placement decision must be approved by the warden of the respective facility (O’Keefe, 2008).

Although immediate and preliminary mental health assessments provide insight into an inmate’s well-being (see Cloyes, Lovell, Allen, & Rhodes, 2006), daily staff visits are an additional method to help identify at-risk inmates. The primary purpose of daily staff visits is to answer inmate requests for medical assistance in addition to visiting offenders as requested by correctional officers. In a study of Colorado’s administrative segregation (supermax) population, O’Keefe (2008) found a disproportionate number of supermax inmates are in greater need of psychiatric services than the general population. Another study by Hartman (2008) assessed California’s Pelican Bay Prison and evaluated the operation of supermax facilities from various administrative functions, including the treatment of mentally ill offenders. O’Keefe and Hartman discuss the necessity of increasing treatment options for inmates with mental disabilities. However, in a 1-year longitudinal study conducted by O’Keefe et al. (2013), the researchers found that, overall, inmates in administrative segregation Colorado did not suffer significant deterioration in mental stability. The researchers noted that this seemed contrary to what most supermax literature stated, however; they believed further studies were needed. Regardless, routine visits by health staff allows health professionals to intervene when symptoms of mental illness are present within supermax units.

Some states use preventative strategies to divert inmates at risk of a worsening mental state from entering supermax confinement, though there have been cases where facilities failed to relocate inmates or placed inmates into supermax arbitrarily (Kurki & Morris, 2001; Kupers et al., 2009). Kupers and colleagues (2009) discussed problems the Mississippi Department of Corrections (MDOC) encountered by failing to relocate inmates with mental illnesses from supermax custody. Specifically, the American Civil Liberties Union (ACLU) filed suit against MDOC for violations of the Eighth Amendment due to inhumane conditions and the arbitrary placement of inmates into supermax custody. Furthermore, The United States Supreme Court has intervened in states’ operations of supermax prisons with their decision in Madrid v. Gomez (1995). In this case, the Court ruled the administrative practice of knowingly admitting inmates with mental illnesses to supermax units is unconstitutional. Correctional agencies may minimize the development of mental illnesses in inmates by adopting a number of strategies that identify and remove inmates expressing mental health symptoms from supermax confinement (Glidden & Rovner, 2012; Hafemeister & George, 2012). One set of tactics include reactionary strategies, such as removing an inmate from solitary confinement or offering additional medical services (Haney, 2003; Kupers et al., 2009). In addition, states may rely on classification reviews, though critics argue these reviews are typically “rubberstamped” approvals of continued supermax confinement (Kurki & Morris, 2001). Classification reviews, however, require administrators to at least review an inmate’s case file and progress while isolated, which may reveal issues with mental health.

Study Summary

Correctional administrators are aware of the problems associated with managing inmates with mental illnesses, such as the rising costs of treatment, untrained correctional staff, and lack of appropriate screening tools, which contribute to limited treatment opportunities for inmates (Slate & Johnson, 2008). Within supermax facilities, not only do correctional administrators encounter these problems, but they also have to deal with problematic inmates and make decisions regarding supermax confinement. Any attempt to evaluate the utility of supermax confinement as a policy needs to first identify how the rules and regulations of correctional departments prescribe the directives that correctional staff will follow (Butler et al., 2013). One of the most widely discussed concerns is the treatment of the mentally ill inmate in supermax confinement (Haney, 2003; Kupers et al., 2009; Lovell, 2008; Smith, 2006). Although researchers, inmate advocacy groups, and various courts have identified the treatment of the mentally ill in supermax as a concern, little is known about the formal procedures correctional agencies use to treat this vulnerable class of inmates. Furthermore, a comprehensive examination of supermax policies’ directives for handling mentally ill inmates has not been conducted. An investigation into these state correctional policies will provide a foundation for an implementation evaluation (Mears, 2010, 2013).

In this analysis, state correctional department’s directives were examined for the delivery and application of mental health services to inmates in supermax custody. Following a thorough examination of the research literature on supermax and an analysis of each state’s supermax policy, five mental health guidelines were identified and assessed. Each of the guidelines represents a treatment requirement or protocol designed to assist or identify inmates experiencing symptoms of a mental illness.

Method

Research Questions

In the current study, we examined the treatment of mentally ill inmates, as prescribed by state correctional supermax policies. Specifically, we investigated whether state correctional policies address the treatment of mentally ill inmates in supermax facilities. Based upon the literature, we developed five research questions.

Research Question 1: How many policies allow mentally ill inmates to enter supermax custody?

Research Question 2: How many policies prescribe preliminary or immediate evaluations of an inmate’s mental health?

Research Question 3: How prevalent are routine mental health evaluations within supermax custody?

Research Question 4: How many policies prescribe reactionary strategies for removing mentally ill inmates from segregation?

Research Question 5: How many policies prescribe precautionary strategies, such as observing or assisting inmates with symptoms of mental illness?

Analytic Strategy

We used a content analysis¹ to answer each of the five research questions. Interrater reliability was obtained by each author examining the contents of the policies and determining the directives that apply to the management of mentally ill inmates in supermax confinement. After a thorough analysis of the policies, we established the parameters for each mental health guideline through the use of peer debriefing (Creswell & Miller, 2000).² An additional check for interrater reliability was obtained by providing two graduate students with directions for coding eight randomly selected policies. The two graduate students had 90% agreement with the coding of policies, providing support that the coding scheme used in this analysis is reliable (Neuendorf, 2002). Specifically, a percent agreement of .90 is considered “acceptable to all,” a percent agreement of .80 is “acceptable in most situations,” and a percent agreement of .79 or less indicates “great disagreement” (Neuendorf, 2002, p. 143).

Previous supermax research served as a guide to operationalize the following variables: supermax custody placement, preliminary or immediate health evaluations, routine mental health evaluations, and precautionary strategies. Specifically, we identified common themes across the policies to establish variables that represent the treatment of mentally ill inmates in supermax confinement. Due to the nature of policymaking and writing, the types of treatment and methods to treat inmates varied drastically across states. We established central themes from the content analysis to operationalize our variables and used prior research to help identify what treatment or correctional responses are included.

Data Collection

Policies were obtained by accessing each state correctional department’s website in the summer of 2010. Only policies pertaining to long-term administrative segregation are included in this study. Twenty-five correctional agencies offered public access to their departmental policies on their websites. When policies were unobtainable from a website, correctional departments were contacted by telephone and e-mail to request the policies. We contacted the policy manager or public information officer and notified him or her of the purpose of the study. Follow-up e-mails and telephone calls were used to remind policy managers of the purpose of the study and to once again request the policies. Special care was taken to avoid the word “supermax” when requesting the policies, because some administrators associate the word with the mismanagement and mistreatment of inmates and states do not actually use the word “supermax” to define this type of custody (Naday et al., 2008; Richards, 2008). Specifically, we requested policies pertaining to the management of problematic inmates in long-term segregation who posed a threat to the security or stability of the institution.

Seventeen state correctional agencies complied with our request to obtain supermax incarceration policies resulting in a data set of 42 states (25 were obtained online and 17 were collected through personal e-mail or telephone conversations). Attempts were made to collect policies from all 50 states, but due to the perceived sensitive nature of supermax facilities, some departments refused to release their state policies because administrators believed the release of policies may threaten institutional security at prison facilities. Specifically, Maryland and Utah declined to disseminate their policies citing possible threats to security. North Dakota was unable to provide their policy regarding long-term segregation because the state was currently in the process of revising rules and regulations. The remaining five states, Hawaii, Texas, Delaware, Iowa, and Wisconsin, did not reply to the researchers’ repeated requests for such policies. Some states have separate and distinct mental health policies for inmates in supermax custody, such as Alabama, Alaska, Arkansas, Florida, Michigan, and New York. The remaining mental health directives are found within the correctional agencies’ supermax policy.

Supermax Custody Placement

State supermax placement policies were reviewed to determine if policies allowed mentally ill inmates to be placed in supermax custody.³ Specifically, each policy was examined for statements that prescribed the placement of mentally ill offenders in supermax custody. For example, Oregon’s supermax policy allows mentally ill offenders to serve time in a mental health infirmary rather than intensive management units, which was coded as not allowing the mentally ill in supermax confinement. Another example is Idaho’s segregation policy, which requires mental health staff to visit inmates diagnosed with mental illnesses within one day of segregation placement.

Preliminary or Immediate Evaluations

Preliminary or immediate evaluations of inmates could occur in many forms. Any examination of an inmate’s mental health that occurs prior to placement was defined as preliminary. Correctional agencies use different strategies to determine whether an inmate is suitable for supermax placement. Some agencies use a classification committee to examine whether supermax placement is warranted and if an inmate is mentally capable of prolonged supermax confinement. Other institutions have specific mental health committees that examine whether supermax confinement will worsen preexisting illnesses. Therefore, any preliminary evaluation of the inmate prior to or immediately after placement was included in this analysis.

Mental Health Evaluations

We operationalized formal mental health evaluations as procedures that provide supermax inmates with routine checks from mental health professionals. Typically, these evaluations are formal and result in written recommendations from treatment staff if an inmate should have a treatment intervention. An important part of the evaluations is determining whether evaluations occur in a routine fashion. For example, many state policies prescribe a mental health review within the first 30 days and every 90 days after supermax placement. Missouri’s supermax policy, however, mandates a mental health professional review of inmates in administrative segregation on a yearly basis, which constitutes the longest wait for mental health reviews in this data.

Reactionary Strategies

For the purposes of this study, a reactionary behavior represented administrator action following the determination that an inmate may be developing mental health issues. Reactionary strategies always occur after an inmate’s well-being has been brought to the attention of administrators or correctional staff. For example, Mississippi’s administrative segregation policy mandates correctional officers observe supermax inmate behavior in 30-min intervals, though observations may be more frequent if an inmate is acting strangely or causing disruptions. Also, Oregon’s policy describes the types of treatment that are available to inmates by clinical staff, which include crisis intervention, behavioral contracts, anger management, and other services that aid in complying with established mental health treatment plans for inmates exhibiting mental health problems. Each of these responses occurs after an inmate’s behavior, well-being, or adjustment has been formally reported to an administrator or staff.

Precautionary Strategies

Precautionary strategies, like reactionary strategies, can take many forms. Some states use daily visits by clinical staff to assess whether inmates are in need of medical help. Other state policies, such as Florida and Washington, prescribe the use of treatment plans to ensure mental states do not worsen. The individual service plans help ensure inmates receive appropriate mental health treatment.

It is important to note there may be conceptual overlap with certain variables. For instance, preventative techniques that correctional agencies utilized, such as the removal of mentally ill inmates from supermax placement, can also be considered a precautionary strategy. When necessary, tables reflect the codes that are included in each health guideline. For example, California’s policy permits inmates requiring psychiatric services to be placed in a psychiatric service unit instead of a segregated housing unit. Alternatively, Alabama’s correctional policy requires mental health professionals to determine if an inmate’s mental health status is “contraindicated” or worsened by supermax placement, which assists administrators in determining whether to remove an inmate from administrative segregation.

Results

The results of the content analysis revealed many state correctional departments have official mental health guidelines for supermax prisons. Table 1 provides an overview of each state policy’s mental health guidelines. Approximately 90% of the policies included two or more mental health guidelines. For example, Florida provides preliminary or immediate evaluations, precautionary strategies, and routine mental health evaluations. Furthermore, when we excluded the guideline that permits mentally ill inmates to enter supermax confinement, we found that every state’s policy except Illinois’s provided directions for handling the mentally ill in some capacity. Similarly, 26% of state policies provided directives for all four guidelines that influence the management of mentally ill inmates in supermax custody. The four guidelines are preliminary or immediate evaluations, precautionary strategies, reactionary strategies, and routine mental health evaluations. Only 12% of the policies lacked a precautionary or reactionary strategy for managing mentally ill offenders. The most common mental health guideline to be prescribed by state policy would be precautionary strategies, which were found within approximately 79% of the state supermax policies. Routine mental health evaluations and reactionary strategies were the next most common mental health guidelines to be included in the policies with each included in approximately 74% of state policies.

Table 1:

Individual State Mental Health Guidelines

State	Admit Mentally Ill Inmates	Preliminary or Immediate Evaluations	Reactionary Strategies	Precautionary Strategies	Routine Mental Health Evaluations
Alabama			X	X	X
Alaska	X		X	X
Arizona			X
Arkansas		X	X
California		X	X	X
Colorado		X			X
Connecticut					X
Florida		X		X	X
Georgia		X	X	X
Idaho	X	X	X	X	X
Illinois	X
Indiana	X	X	X	X	X
Kansas	X	X		X	X
Kentucky	X		X	X	X
Louisiana					X
Maine		X	X	X	X
Massachusetts		X		X	X
Michigan		X	X	X	X
Minnesota		X	X		X
Mississippi				X	X
Missouri			X	X	X
Montana			X	X
Nebraska				X	X
Nevada				X	X
New Hampshire			X	X	X
New Jersey			X	X
New Mexico		X	X	X	X
New York		X		X	X
North Carolina		X	X	X
Ohio			X	X
Oklahoma		X	X	X	X
Oregon	X		X	X	X
Pennsylvania			X	X	X
Rhode Island			X		X
South Carolina		X	X	X	X
South Dakota		X	X	X	X
Tennessee		X			X
Vermont		X	X	X	X
Virginia		X	X	X	X
Washington		X	X	X	X
West Virginia			X	X	X
Wyoming	X	X	X	X
Total (N = 42)	8	23	30	33	31
Total (N = 42)	19%	55%	71%	79%	74%

Note. Each state that had a mental health guideline is dummy-coded with an “X.”

Research Question 1 was answered by reviewing the extent to which state policies provide directives for admitting mentally ill inmates to supermax confinement. Only 19% of the states in the data set provided directives that allow mentally ill offenders to enter supermax confinement. In most of the state policies that prescribe mentally ill inmates can be placed in supermax confinement, it is for the safety, security, and health needs of the inmate in addition to the security and orderly operations of the correctional facility. For example, Oregon’s policy allows mentally ill inmates to be placed in intensive management units for their mental health needs. It is important to note, however, that numerous state policies prohibit the admittance of mentally ill inmates into supermax custody. For example, Indiana prohibits any inmate with an AXIS I mental illness from entering the Security Confinement Units. Michigan’s policy cautions against admitting mentally ill inmates into administrative segregation, but it is permissible when the inmate requires treatment and may threaten the security of an institution. The majority of states did not provide directions in their policies regarding the placement of mentally ill offenders in supermax confinement.

Research Question 2 examined how many policies prescribe preliminary or immediate evaluations of an inmate’s mental health prior to placement in supermax custody. Overall, approximately 55% of state policies prescribe some type of preliminary or immediate mental health evaluation. In regards to Research Question 3, a similar evaluation is used to examine an inmate’s mental health once placed in supermax confinement, which is referred to as a routine (e.g., week, month, triannual, biannual, or annual) mental health evaluation. Approximately 31 states (74% of the data set) prescribe some type of routine mental health evaluation. Routine mental health evaluations vary considerably in length of time between evaluations. For example, Missouri’s state policy prescribes the formal review and examination of inmate mental health on an annual schedule whereas 22 other states examine inmate mental health every 3 months. In regard to any type of mental health evaluation that occurs prior to admission or after placement in supermax confinement, approximately 43% of the state policies prescribe preliminary or immediate evaluations in addition to routine mental health evaluations. State policies are less likely to prescribe preliminary or immediate evaluations than they are to prescribe routine mental health evaluations. Although few states provide preliminary or immediate mental health evaluations and routine mental health evaluations, approximately 86% of state policies prescribe either a preliminary or immediate mental health evaluation or a routine mental health evaluation for inmates. Therefore, the majority of state policies prescribe some evaluation for inmate mental health while in supermax confinement.

Research Questions 4 and 5 are examined in Table 2, which illustrates the unique approaches correctional departments use to handle mentally ill inmates. The frequencies of each of the codes included in the content analysis that were operationalized as precautionary and reactionary mental health guidelines are listed. In regard to examples of precautionary strategies, the majority of state policies prescribe daily, weekly, or monthly visits with inmates to help prevent a worsening mental state. Some policies also mandate that evaluation or classification committees will consist of mental health professionals, but this accounts for approximately 17% of state policies. Few state policies prescribe the use of psychological assessments to determine whether supermax placement is warranted among classification committees or administrative segregation hearing boards. Also, few policies specifically mandate that officers should receive more training to manage mentally ill inmates in supermax confinement.

Table 2:

Precautionary and Reactionary Strategies Included in the Content Analysis (N = 42)

Examples of Precautionary Strategies	Frequency	Examples of Reactionary Strategies	Frequency
Mental health staff will conduct daily, weekly, or monthly visits with segregated inmates	2355%	Mental health watches are used when an inmate begins to display early symptoms of a serious mental health disorder	1024%
Evaluation or classification committees will consist of mental health professionals	717%	Health professionals are available upon request	921%
Special needs units are designed to house inmates with mental illnesses as an alternative to supermax placement	37%	Inmates displaying symptoms of mental illnesses can be transferred to mental health units	614%
Inmates will be given mental health treatment plans	37%	A mental health professional will monitor inmates with diagnosed mental illnesses	410%
Administrative segregation hearing boards may include a psychological assessment of inmates to determine if supermax placement is warranted	12%	Mental health issues will be considered by reviewing committees to determine whether an inmate should be released from supermax confinement	12%
Specific training for correctional officers managing mentally ill inmates	12%	Mental health services, such as crisis intervention for inmates	12%

Note. Some state policies have multiple precautionary or reactionary strategies. Therefore, the number of precautionary or reactionary strategies can exceed the number of policies in the data set.

Reactionary strategies, however, are more likely to include changes in supervision protocol, such as after an officer observes abnormal behavior or symptoms of a mental illness from inmates. Unlike precautionary strategies, states use different reactionary strategies to respond to inmates with mental illnesses. Approximately 14% of state policies mandate transfers for inmates displaying symptoms of a mental illness out of supermax confinement. Few state policies explicitly outline the influence mental illnesses have on classification decisions. In addition, most state policies do not prescribe the services that are available to inmates experiencing mental illnesses within supermax confinement.

Discussion

In response to the challenges of managing large correctional populations over the last 35 years and intense legal review of virtually every aspect of prison operations, states now provide very detailed policies that attempt to standardize how prisoners should be managed. This shift in prison administration required strategies grounded in the management of aggregates. While policies will always be subject to interpretation, these policies are the “backbone” for managing prisons. Policies are critical to the training process and are used to evaluate staff and inmate compliance. The management of unruly inmates requires clearly articulated rules.

While previous studies examined correctional staff perceptions and eye-witness accounts of the management and control of mentally ill offenders, our analysis provides a new approach by examining how states have attempted to standardize their policies to manage inmates with mental illnesses in supermax confinement. In this study, we examined the operational procedures of 42 state correctional agencies’ management of supermax inmates. While the quality of treatment offered to inmates in supermax custody is difficult to assess, our results reveal state policies require some treatments and protections of the mentally ill.

Our research also provides a foundation for an implementation evaluation of supermax confinement in regard to the treatment of mentally ill inmates. Specifically, a majority of correctional agencies in our data use some form of inmate evaluation and either reactive or precautionary strategies as dictated by departmental policy. In a time of heightened scrutiny over the management of supermax prisons, correctional administrators may be heeding the call to provide more services and assistance to inmates, but it is important to emphasize that this study did not examine how these departmental policies are actually implemented. Regardless, over half of the policies in our data set prescribed a reactionary or preventative strategy for managing supermax inmates. Some critics may view this as not enough and that all states should include strategies to handle and react to the needs of inmates in supermax confinement.

While many correctional agencies require inmate evaluations and strategies for responding to mentally ill inmates, more can be done to ensure the constitutional rights of inmates are protected while also maintaining institutional security. Madrid v. Gomez (1995), which occurred over a decade ago, ruled in favor of protecting a vulnerable class of inmates from further psychological damage (i.e., inmates with known mental disorders or illnesses are not to be admitted to supermax confinement). Yet, approximately 55% of the correctional agencies we surveyed prescribe immediate or preliminary mental health screens for inmates entering supermax placement. States may benefit by adopting and enacting policies that protect mentally ill inmates without being forced by the threat or success of litigation. Approximately 55% of the state policies require mental health staff visit inmates regularly in supermax custody. The policies, however, do not detail the manner in which the daily visits occur. Haney (2003) and O’Keefe (2008) argue staffing and correctional funding play a tremendous role in the quality of daily visits by mental health staff. Although we are not able to determine the quality, frequency, or actual implementation of these policies, the results do offer insight into how many states proactively conduct routine checks on supermax inmates.

Limitations and Recommendations for Future Research

As with any research, our study has limitations that warrant discussion. The current study does not enable us to determine how the policies are followed in practice. For example, we cannot state with certainty that precautionary strategies are used as prescribed by state policy. Future studies should examine the extent that these policies are carried out in daily operations. This will bring researchers a step closer to investigating how supermax confinement is actually implemented rather than examining rules and regulations. Attempts to identify how, in practice, inmates are diagnosed as having mental illnesses stemming from prolonged supermax confinement and what happens to these offenders will provide a more detailed assessment of these enigmatic institutions (Butler et al., 2013). In addition, some states have separate policies for prescribing the management of special-custody inmates, such as those with severe diagnosed mental illnesses. These states are Alabama, Alaska, Arkansas, Florida, Michigan, and New York. It is important to note, however, that other states may have similar policies that were not included in the current study. In an effort to control for this limitation, policy reference numbers were used to determine whether other states used separate policies to discuss the handling of mentally ill inmates in supermax custody. We also asked for each departmental policy or rule and regulation when collecting the rules and regulations, which would ideally include all policies regarding the use and prescription of supermax confinement. Also, we did not receive eight departmental rules and regulations for the maintenance of supermax confinement, which may provide further insight into how states prescribe the treatment of the mentally ill. Specifically, Texas, one of the most notoriously punitive states, is not included in the current data. Texas has encountered problems with its use of administrative segregation, and the revised policies may have provided additional insight into the management of inmates.

In regard to recommendations for future research, this study provides a foundation to evaluate whether supermax confinement is implemented as prescribed by departmental rules and regulations. Our study provides insight into how correctional departments prioritize, according to departmental rules and regulations, the treatment of the mentally ill in restrictive confinement. What is not known, however, is how these policies are implemented in practice. Although numerous researchers have found that mentally ill inmates are placed in supermax confinement, and that the quality of treatment services can be poor (Haney, 2003; Kupers et al., 2009), we recommend researchers examine why discrepancies exist between official rules and regulations and implementation. For example, are inmates that exhibit behaviors of mental instability or symptoms of mental illness removed from supermax confinement? If so, what procedures are taken to treat the illness? Answers to these questions will help determine what exists in the “black box” of supermax confinement, which includes questions researchers have regarding the necessity, efficiency, accountability, and impacts this policy has on correctional populations (Mears, 2008a, 2010, 2013). The “black box” of supermax confinement can also be examined by using policy dissemination to determine how departmental rules and regulations are influenced by Supreme Court and federal court rulings. For example, how did Madrid v. Gomez (1995) and other landmark cases regarding the use of administrative segregation influence nationwide procedures regarding supermax confinement? Studies of policy dissemination may help address this question, and provide insight as to how, over time, rules and regulations reflect federal and Supreme Court rulings. More importantly, differences in how states amend rules and regulations to be in accordance with federal and Supreme Court rulings will also provide insight into the management strategies of correctional systems.

Conclusion

The quality of mental health services is one of the most controversial issues in corrections (Goode, 2012; Matthews, 2010; Slate & Johnson, 2008). Even more problematic are concerns for the treatment of the mentally ill in supermax confinement (Haney, 2003; Matthews, 2010). Any implementation evaluation will examine whether the “worst of the worst” or nuisance inmates (e.g., mentally ill) are admitted to supermax confinement (Mears, 2013), and how correctional departments respond to inmates with mental illnesses. Prior to an implementation evaluation, however, it is important to identify how correctional departments manage supermax facilities and the inmates in confinement. This study provides one of the first nationwide evaluations of the official guidelines for treatment of mentally ill inmates in supermax confinement. It is important to remember that although courts have upheld the constitutionality of supermax facilities, its operations are being closely monitored. O’Keefe (2008) states,

As demonstrated in Ruiz v. Johnson (1999), clearly written policies and procedures are not nearly enough; a court of law will examine actual practices. In fact, even accreditation by the American Correctional Association did little to assist the corrections officials’ position in the Texas lawsuit when a paper review was deemed an inadequate substitute for a thorough on-site evaluation. (p. 140)

Therefore, correctional administrators must not only rewrite policies to reflect compliance with the Constitution, but they also must ensure the rights of all supermax inmates are protected.

Beyond merely cataloging which protections and safeguards different states provide to inmates in supermax custody, we provided added perspective to a larger issue in criminal justice. Although the primary purpose of the correctional system seems to be the punishment of lawbreakers, the very fact that we discuss the “correctional system” or “corrections” generally is indicative of the hope of a rehabilitative ideal within the criminal justice system (Cullen & Jonson, 2011). Although this goal might be illusory, perhaps criminal justice could be guided by the Hippocratic Oath of the medical profession that physicians “do no harm.” Before we get to the issue of rehabilitating prisoners, we need to first make sure that we do not make them worse (Rothman, 1980). The analysis of supermax confinement provides a good opportunity for this line of inquiry as the prison experience itself can have a criminogenic effect notwithstanding the added strains of supermax custody (Nagin, Cullen, & Jonson, 2009).

Footnotes

Acknowledgements

The authors would like to thank the four anonymous reviewers for their insightful comments. They also thank Amy Anderson, Jonathan Brauer, Robert Lytle, and Karyn Sporer for their suggestions, comments, and assistance with coding.

Notes

H. Daniel Butler, MA, is a doctoral student in the School of Criminology and Criminal Justice at the University of Nebraska at Omaha. He holds an MA from The University of Southern Mississippi.

W. Wesley Johnson, PhD, completed his doctorate of criminology at Florida State University in 1992. Prior to his employment as doctoral program director in the School of Criminal Justice at The University of Southern Mississippi, he served as associate dean in the College of Criminal Justice at Sam Houston State University. He has published in a variety of journals, is past president of the Academy of Criminal Justice Sciences, and currently serves on the board of the National Alliance on Mental Illness−Mississippi. He helped establish the first mental health court in Mississippi and is currently working with various agencies to improve their interactions with mentally ill offenders and staff.

O. Hayden Griffin III, JD, PhD, is an assistant professor in the Department of Justice Studies at the University of Alabama at Birmingham. His research interests are drug policy, law & society, and corrections. His research has been published in Deviant Behavior, Journal of Research in Crime and Delinquency, and Journal of Criminal Justice.

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