The following is from Mariposa McCall, MD Psychiatrist:

Dear Colleagues,

On February 8, 2018, I along with three other presenters (Dr Everett Allen, an internist who worked for several years at California Pelican Bay State Prison’s solitary confinement, a UCSF Public Health and Criminal Justice researcher Cyrus Ahalt, and Steven Czifra who was confined in solitary confinement for 8 years and is now is a U.C. Berkeley MSW intern) presented on the relevance of solitary confinement to community psychiatry to my colleagues at the California Contra Costa County Psychiatry and Psychology monthly meeting.  Solitary confinement is being held in a small cell for 22 to 24 hours a day with minimal property and minimal meaningful human contact. We reviewed the overwhelming evidence of the physical and psychological harms of solitary confinement. In addition, we discussed the ethical dilemmas for providers as they participate in this practice.

Another psychiatrist present suggested I write a petition…..

Canada declared solitary confinement unconstitutional in Jan 2018. A few months later India too acknowledged this preventable harm. When will this nation reach this decision? On any given day in USA, 100,000 are held in these extreme conditions, some unconscionably for years and decades.  50% of suicides occur in these restrictive segregation, and self injurious behaviors are rampant.  This is preventable.  We as providers will see these individuals as patients when released,  95% will be released.  As community members, we will walk, shop, eat, live with them. Do we want traumatized human beings or rehabilitated individuals? As providers, is it ethical to declare someone fit for this high risk containment? This is what is happening…we are witnesses and participants.

Some of you may feel this issue does not pertain to your field. Ethical guidelines of “first do no harm” and human rights concern us all.

I am hoping you will join me in signing this petition I wrote to end prolonged solitary confinement (greater than 15 days) in U.S.  jails, prisons, and detention centers.

If you are a medical provider of any specialty, a psychologist, a SW, a NP or a PA please consider signing and forwarding to other of our colleagues.

Mariposa McCall, MD

The petition is directed to the American Medical Association, American Psychiatric Association, American Psychology Association, American Academy of Psychiatry and the Law, American Association of Nurse Practitioners, American Association of Physician Assistants, and National Association of Social Workers. Here is an excerpt:

…. Lastly, we pledge that solitary confinement is in direct violation of our code of ethics as healers, knowing the risks of such placement. Rule 43 of the Mandela Rules of the United Nations Standard Minimum Rules on the Treatment of Prisoners prohibits both indefinite solitary confinement and prolonged solitary confinement (defined as lasting more than 15 days).

The World Health Organization (WHO) states health care staff “should not certify a prisoner as being fit for disciplinary isolation or any other form of punishment.” Similarly, the National Commission on Correctional Health Care (NCCHC) their April 2016 position statement write: “Health staff must not be involved in determining whether adults or juveniles are physically or psychologically able to be placed in isolation…in systems that do not conform to international standards, health care staff should advocate with correctional officials to establish policies prohibiting the use of solitary confinement for juveniles and mentally ill individuals, and limiting it use to less than 15 days for all others.” We are in solidarity with the Physicians for Human Rights (PHR) who agree with The United Nation (UN) Principles of Medical Ethics that “specifically hold that it is a contravention of medical ethics for a doctor to ‘participate in the certification of the fitness of prisoners or detainees of any form of treatment or punishment that may adversely affect their physical or mental health’” (PHR 2002).

Alternatives to solitary confinement exist that can maintain institutional security and offer rehabilitation while protecting human rights. In 2017, Colorado corrections ended the practice of solitary confinement beyond 15 days and any direct release to community from solitary confinement. On January 17, 2018, Canadian Supreme Court Judge Leask ruled “Prolonged segregation is both unnecessary for and, indeed, even inconsistent with, the objective of maintaining institutional security and personal safety…Based on the evidence, I find that segregation breaks down inmates’ ability to interact with other human beings; deprives them of rehabilitative and educational group programming; risks mentally healthy inmates descending into mental illness; and exacerbates symptoms for those with pre-existing mental illness.”

We the undersigned who made an oath to do no harm and serve our fellow citizens in their journeys to heal, call upon our respective organizations to recognize the harm solitary confinement brings to individuals, communities, and our country. There is a great need for agreement among individuals and organizations to uphold human rights and ethical principles but also to reduce reprisals against whistle-blowers. Individual practitioners need their organizations to use their authority and influence. ….

Read, sign, and share the full petition: https://www.change.org/p/helping-professional-organizations-end-prolonged-solitary-confinement


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