Inmates in the federal prison system who suffer from mental illness are routinely kept in solitary confinement for extensive periods without proper treatment, according to the first-ever audit of the Bureau of Prison's (BOP) segregation policies.

The 250-page-plus report, completed in December, but not made public until now, detailed numerous areas in which the BOP was failing its mentally ill inmates, but did not offer concrete solutions on how to alleviate the use of solitary confinement.

“This is a very troubling report,” said Dr. Jeffrey Metzner, a professor of psychiatry at the University of Colorado Anschutz Medical Campus, who has been assessing correctional mental health systems for over 30 years.

“It shows the BOP haven't been doing a very good job at establishing a mental health system on their own,” added Metzner, who is currently serving as an expert for the plaintiff in a case which accuses the bureau of not providing mental health treatment in maximum security (ADX) units. The lawsuit alleges that the BOP fails to properly diagnosis and treat mental illness in its high security units.

A copy of the audit was obtained by The Crime Report. Among the most disturbing findings were:

A large number of inmates in solitary confinement need mental health treatment, but aren't receiving it;

No protocol exists to identify inmates with mental illness who should be kept out of solitary confinement;

Inmates often receive a mental health diagnosis by medical students or interns who are not trained in psychiatry. Once diagnosed, they rarely receive follow-up reassessments or proper medication;

No reentry programs or means of tracking for inmates coming out of segregation exist.

The audit was conducted over a period of two years after Sen. Dick Durbin (D-IL) chaired the first ever hearing on segregation in the nation's jails and prisons before the Senate Judiciary Committee's Subcommittee on the Constitution, Civil Rights and Human Rights in 2012.

Rapid Growth of Solitary Population

Alarmed by the rapid growth of the population in solitary confinement throughout the federal system, BOP director Charles Samuels agreed at the hearing to Senator Durbin's request for an independent assessment of federal prisons' solitary confinement policies and practices.

The researchers were overseen by the National Institute of Corrections. Teams, which included state correction directors, psychologists and psychiatrists, visited prisons around the country to assess conditions.

There were 209,489 inmates as of March, 2015 in the federal prison system, but scant watchdog groups exist to monitor conditions within its walls. This is in sharp contrast to state prison systems, where a correctional association or a not-for profit group is usually mandated to assess facilities.

Editor's Note: For another perspective on the use of solitary for inmates with mental illness, see the Viewpoint column by Dr. Joseph Galanek, “Why Do We Place Our Most Vulnerable Prisoners in Solitary,” published in The Crime Report, Feb 12, 2015.

The lack of such oversight has contributed to a culture of impunity within the federal system, according to advocacy groups.

“The BOP is huge and diffuse, without a natural constituency,” said Deborah Golden, staff attorney at the DC Prisoners Project at the Washington Lawyers' Committee for Civil Rights and Urban Affairs, which monitors DC prisoners in the federal system.

“For a long time, the bureau traded on its reputation as being more professional and better than the states, but there is nobody to figure out that is the case.”

In January 2014 Congress formed the Charles Colson Task Force on Federal Corrections to address challenges in the federal corrections system (including population issues, which may include solitary).

The judiciary subcommittee convened in 2014 to hear some of the preliminary findings from the review, in which Samuels detailed the challenges faced by the federal system. Among them: repeated clashes between gangs within the prisons.

“We confine a significant number of dangerous people,” Samuels testified. “More than 40 percent of the inmate population is housed in medium and high security facilities,”

Overcrowding is one of the contributing factors to prison violence.

According to the Colson task force, high security facilities are 52 percent over rated capacity, and are among the most volatile sources of gang conflict. Medium security facilities are 39 percent over their rated In 2009, in an effort to control the violence and stop gangs from controlling other inmates, federal officials created Special Management Units (SMUs).

'Inadequate' Mental Care

Advocates have said the federal system's response to violence and overcrowding has been to place more inmates in solitary confinement, where they are not provided with adequate mental health care. Their assertion was corroborated by the audit and by a 2013 GAO report, which found that BOP officials have not studied whether or not solitary confinement is an effective safety measure for the approximately 15,000 prisoners held in segregation daily.

There are three different types of segregation in the federal system: Special Housing Units (SHU), Special Management Units (SMU), and the United States Penitentiary and Administrative Maximum (ADX) in Florence, Colorado.

SHUs are secure units in the prisons, where inmates are separated from the general population but can be kept alone or with another inmate. Inmates are placed in SMUs for disciplinary infractions and are required to participate in a18-24 month socialization program. In the ADX inmates are placed in extreme isolation only

In each type of unit, the report detailed disturbing conditions. Some highlights:

At USP Florence, an ADX facility, no medical provider saw an inmate regarding his medications since 2012;

USP Florence and USP Atlanta had no psychiatrists on staff. All mental health review was done through telemedicine;

At the SMU program, an inmate was punished for overdosing on his antidepressant.

The bureau did not respond to requests for comment from The Crime Report, but they did release a statement in which they concurred with many findings of the report. At the same time, they said some of the programs criticized in the report are used outside prisons as well.

The statement said: “We note that even in the community, the majority of psychiatric medications are prescribed by general practitioners, not psychiatrists or psychiatric nurse practitioners.

The BOP also defended its use of telemedicine as a “technology to provide quality mental health care to federal inmates around the country,” noting it is supported by teaching universities, insurance companies and the federal government, including the U.S. Veterans Administration.

The reply did not hide the Bureau's opinion that it was being unfairly singled out.

“The purpose of this document is to explain some concerns we have with particular recommendations, and make a few important points that we believe were omitted,” the statement said.

Critics, however, found the statement overly defensive.

“The findings of this report are so disturbing that I question the bureau's ability to reform itself,” said Amy Fettig, senior staff counsel at the ACLU's prison project.

The federal prison system has recorded some improvements since the congressional hearings. Inmates in the SHU units have dropped from 10,262 in 2013, spread over 100 facilities, to 8,939 in June 2014.

And, as the BOP noted, “The rate of serious assaults (particularly at high security institutions) and lockdowns declined, [as] did the populations of the SMUs and Special Housing Units (SHUs) around the country.

“In fact, over the past two fiscal years (2012-2014), the SMU population decreased by 37 percent and the SHU population decreased by 21 percent. From 2009, when we made the changes described above, to the present, we have seen an 86 percent decrease in serious assaults on staff and a 60 percent decline in serious assaults on inmates.”

Additionally, the bureau developed a mental health unit in Atlanta to house inmates who didn't belong in the SHU, ADX or SMU. However, the new unit only uses telemedicine to diagnosis and treat its inmates, there are no psychiatrists present at the facility.

Cara Tabachnick is managing editor of The Crime Report. She welcomes comments from readers.