The Pennsylvania Department of Corrections has reached a settlement with the Disability Rights Network of Pennsylvania requiring sweeping reforms in the care of inmates with serious mental illness in the state's prison system.

Inmates with serious mental illness or intellectual disabilities no longer will be subject to solitary confinement, according to the terms of the settlement, reached late Monday. The agreement, which is effective immediately, resolves a March 2013 lawsuit.

"The idea here is to keep people with serious mental illness out of the very harsh conditions of the Restricted Housing Unit," said Robert Meek, an attorney for Disability Rights Network. "Solitary for everyone has been criticized by the United Nations Special Rapporteur and many other people as torture, but it's especially torturous for people with disabilities."

According to the settlement, new inmates will be screened for mental illness. Those with mental illness who must be taken out of general population will be housed in one of two new types of housing units: 14 short-term Diversionary Treatment Units and six longer-term Secure Residential Treatment Units.

In each, those inmates would receive 20 hours out of cell per week for treatment and nontreatment activities.

Any inmate kept in solitary confinement for a year or more also would receive an annual psychiatric evaluation.

The settlement indicates that inmates may not be disciplined for self-harm, and that restraint chairs and psychiatric observation cells may not be used as means of punishment. It also mandates that all staff be trained in suicide prevention and mental-health first aid.

Department of Corrections spokeswoman Susan McNaughton said the reforms are expected to protect about 4,000 inmates. That's out of around 10,000 on the prisons' mental health roster.

Changes implemented

The department has implemented many of the changes already. So far, it has reduced the number of people with serious mental illness in solitary from 900 a year ago to 135, McNaughton said. The agreement defines serious mental illness as schizophrenia, bipolar disorder and major depression, among other conditions.

In December, The Inquirer wrote about the case of Khasiem Carr, an inmate with schizoaffective disorder who spent months in solitary confinement in the state prison system before being transferred to a Secure Residential Treatment Unit.

While in solitary in state and county institutions, he became disoriented and stopped eating and drinking for long stretches, until he was hospitalized. He described the Secure Residential Treatment Unit as a significant improvement.

Diversionary Treatment Units, on the other hand, may not feel all that different to inmates from Restricted Housing; in fact, they may be co-located, McNaughton said. But, she emphasized, all individuals with serious mental illness are getting 20 hours per week out of their cells.

"Our goal is to stabilize all of these individuals and get them back into general population as soon as possible," McNaughton said.

Angus Love of the Pennsylvania Institutional Law Project said that, ultimately, the success of the reforms will come down to implementation.

"They changed the names of a variety of units and added some new ones. I won't say I'm skeptical, but we'll be very careful in monitoring compliance . . . to be sure that it lives up to the spirit of that agreement."

The prison system in Pennsylvania will be subject to oversight by an independent monitor for two to five years, depending on how quickly it brings its practices in line with the terms of the settlement.

McNaughton said that the reforms will continue after the monitoring period ends.

Cost is unclear

It's not clear what the annual cost of the reforms will be, but the department has requested $30 million in additional state funding over the last two budget cycles to pay for the extra staffing required, she said.

It also created a new central office for administering mental health care, created suicide-prevention committees at each prison, and revised its contracts with mental-health-care providers.

The agreement puts Pennsylvania among states leading the way on protecting people with mental illness in the prison system, Meek said. Massachusetts, New York, and Arizona have all entered into similar agreements in the last few years.

In New Jersey, State Sen. Raymond Lesniak (D., Union) introduced legislation late last year to ban solitary confinement for juveniles and those with mental illness, and limit the amount of time an inmate can be kept in such conditions. The bill is awaiting action.

"We share a common goal with the Disability Rights Network," said McNaughton, the state corrections spokeswoman, "and that's to ensure that individuals with serious mental illness receive safe and appropriate delivery of mental-health services, so this is something that will continue from this point on."

A first step

Ann Schwartzman, executive director of the Pennsylvania Prison Society, called the reforms an important step.

"Unfortunately, this doesn't go far enough," she said. "But at least it's a start. For years we haven't been able to move on this issue. So at least this way people in dire need will be able to get some assistance."

The settlement also cannot address the root of the problem, she said; that lies outside the prison system.

"We decided a couple decades ago that we didn't want to fund mental-health treatment in mental-health facilities, and that there would be more support in the community. That never happened. So prisons have become mental health facilities by default, and they're not equipped to do that. So you end up with a system where people are in solitary for years and years," she said.