1. PSYCHOLOGICAL EFFECTS OF SOLITARY CONFINEMENT AND SECLUSION Associate Professor Donald Grant Forensic Psychiatrist

2. SOLITARY CONFINEMENT CONFINEMENT OF A PRISONER ALONE IN A CELL FOR ALL, OR NEARLY ALL, OF THE DAY, WITH MINIMAL ENVIRONMENTAL STIMULATION AND MINIMAL OPPORTUNITY FOR SOCIAL INTERACTION

3. SECLUSION THE CONFINEMENT IN A CLINICAL SETTING OF A PATIENT IN A ROOM WITH THE DOOR CLOSED OR LOCKED WITH NO ABILITY TO LEAVE. OFTEN PRECEEDED BY FORCIBLE “TAKE DOWN” AND INVOLUNTARY MEDICATION.

4. WHAT MAKES SOLITARY CONFINEMENT HARMFUL?  SOCIAL ISOLATION - deprivation of meaningful, sympathetic social interaction and physical contact. Can lead to further withdrawal, with ongoing discomfort in social situations after release.  REDUCED ACTIVITY AND STIMULATION - boredom, monotony, sensory deprivation, detachment from the outside world. Brain activity slows.  LACK OF CONTROL – Others control everything, no personal autonomy, complete dependency, If prolonged may lead to loss of self-reliance, subsequent dysfunction in society.

5. FACTORS RELEVANT TO THE EFFECTS OF CONFINEMENT  The individual prisoner or patient (resilience, attitudes).  The background of the person (unstable, deprived, dislocated).  Intellectual or psychological vulnerabilities (low intelligence, mental illness, personality disorder, history of abuse, PTSD).  Substance abuse history (drug/alcohol dependence, withdrawal, craving).  The context of the confinement (punishment, containment, safety).  The duration of the confinement and the knowledge of the prospective duration (more than 10 days, indeterminate length)  The conditions of the confinement (size, facilities, light).  The meaning of the experience to the person confined (Political prisoner / Maximum secure prisoner /Patient).

6. EFFECTS OF CONFINEMENT  Effects can arise from confinement alone, but are exaggerated by poor hygienic conditions, abuse or torture.  Effects are worse with increased individual vulnerability and increased duration.  Psychological effects compounded by possible physical effects – pain, GIT issues, urinary problems, headache etc.  Some individuals report no effects, the majority have some negative effects.  Short term, long term and permanent effects possible.

7. PSYCHOLOGICAL EFFECTS OF CONFINEMENT  ANXIETY DISORDERS - stress, anxiety, irritability, fear of impending death, panic attacks, PTSD  DEPRESSION - Emotional flatness, loss of feeling, mood swings, hopelessness, withdrawal, apathy, lethargy, Major Depression.  ANGER - irritability, hostility, poor impulse control, verbal and physical outbursts towards others and/or self, unprovoked rage.  COGNITIVE DISTORTIONS – short attention span, poor concentration, poor memory, confusion, disorientation in time and space.  PERCEPTUAL DISTORTIONS – hypersensitivity to noise and smells, visual distortions, depersonalisation/derealisation, hallucinations (auditory, visual, touch, smell, or taste).  PARANOIA and PSYCHOSIS – obsessional ruminations, vengeful and violent thoughts, persecutory ideas, paranoid states (eg, being poisoned), psychotic episodes, psychotic depression.  SELF HARM and SUICIDE – self mutilation, head banging, self-starvation, suicides more common than in general prison population.

8. What to do?  Be aware of the effects of seclusion  Be aware of person’s vulnerabilities  Provide explanations and be humane  Use seclusion for the right reasons only  Use seclusion as a last resort, for shortest time possible  Provide therapy for patients affected by seclusion  Use alternatives (time out, quiet room, medication, anger management)  Train staff in de-escalation and management of aggression  Provide extra resources and better facilities  Recruit younger, capable staff