Better Off Podcast: How can we protect the health of incarcerated people?

As COVID-19 swept through American prisons and jails in 2020, wardens scrambled to keep prisoners and corrections officers from getting sick. One strategy was to increase solitary confinement. Health experts warn that solitary confinement increases the risk of mental illness and suicide, but the practice continues. Today, about 2 million people are incarcerated in the U.S. In this episode of the Better Off podcast, we’ll ask: Is it possible to build a corrections system that accounts for their health and safety?  



Jasmine D Graves, Ph.D. student (Harvard Graduate School of Arts and Sciences) in the Population Health Sciences program, Harvard T.H. Chan School of Public Health

Monik Jimenez, Assistant Professor in the Department of Epidemiology, Harvard T.H. Chan School of Public Health


Host/producer: Anna Fisher-Pinkert

The Better Off team: Kristen Dweck, Elizabeth Gunner, Pamela Reynoso, Stephanie Simon, and Ben Wallace

Audio engineering and sound design: Kevin O’Connell

Additional research: Kate Becker

Full Transcript

Anna Fisher-Pinkert: From the Harvard, T.H. Chan School of Public Health, this is Better Off, a podcast about the biggest public health problems we face today. . .

Jasmine D. Graves: Across this country, there are people who spend years, decades in solitary confinement.

Anna Fisher-Pinkert: And the people innovating to create public health solutions.

Monik Jimenez: Do we want to have a thriving society that lifts us all up, or do we want to continue to support this variation of slavery that we have currently?

Anna Fisher-Pinkert: I’m your host, Anna Fisher-Pinkert.

Anna Fisher-Pinkert: When we think about housing, we rarely talk about our carceral system. But while there are 1.2 million households living in public housing in the U.S., there are almost 2 million people in America who will go to sleep tonight locked inside a jail or prison.

Anna Fisher-Pinkert: So, I wanted to understand how living in prison or jail impacts people’s physical and mental health. Particularly those people in solitary confinement or restrictive housing. A quick note to our listeners, this episode will discuss suicide and self-harm.

Anna Fisher-Pinkert: I started getting curious about housing behind bars in the early phases of the COVID-19 pandemic when the virus was sweeping through crowded jails and prisons. I had the option to hunker down with my family at home, but the situation in correctional facilities was very very different.

Monik Jimenez: In the free world, the primary mitigation strategy for COVID transmission has been social or physical distancing, right? Carceral spaces are physically designed to not allow for physical distancing because they are specifically designed with an eye towards perceived security.

Anna Fisher-Pinkert: This is Monique Jimenez, an assistant professor of medicine at Brigham and Women’s Hospital and the Harvard, T.H. Chan School of Public Health. She says that when COVID hit prisons, most went into lockdown in an attempt to mitigate the spread of the virus.

Monik Jimenez: And so, when a facility goes into lockdown, which is what most facilities instigated during the pandemic, they lock people into their cells or into their dorms. So basically, locking people into their housing units. And for some people that may be being locked up to 23 hours a day with one other person, maybe by themselves, maybe with four or six other people, or maybe with a hundred people or more.

Anna Fisher-Pinkert: A dorm with over 100 people is not safe for COVID transmission. But, being locked in alone, unable to access common areas or the yard. . . that’s a lot like solitary confinement, a practice that public health experts say leads to all sorts of mental and physical distress. In order to get a sense of what was going on inside carceral facilities at this time, Monik and her colleagues surveyed the family, friends, doctors, and attorneys who remained in contact with incarcerated people. What they learned was disturbing.

Monik Jimenez: People were getting about a half hour, an hour to come out of their cells, to maybe take a shower, call their family members. In many places, people were only let out for that amount of time, maybe every three days.

Anna Fisher-Pinkert: On top of that programming and visitations stopped.

Monik Jimenez: And now you have groups of people in this particular setting, many of which have very complex health and mental health needs that are not receiving the types of stimulation necessary to maintain some sort of mental health balance. People who didn’t have mental health issues now really starting to feel the pressure of being locked inside. It’s not just being locked inside your house or your, your room, or even your studio apartment, right? We’re talking about very, very small, confined spaces and very limited access to basic necessities of life.

Anna Fisher-Pinkert: There are regulations around how people are confined and the UN standard minimum rules for the treatment of prisoners, also known as the Mandela rules, call for UN member states to prohibit solitary confinement for more than 15 consecutive days. But the U.S. has never held strictly to that limit. There are big variations in the rules and the enforcement of those roles in state, local, and federal facilities. And during the pandemic, wardens had a lot of leeway to do what they felt was necessary to maintain safety, including prolonged lockdowns and expanded solitary confinement.

Anna Fisher-Pinkert: This strategy didn’t work. In 2020, according to UCLA’s COVID-19 behind bars project, people in prisons were five times more likely to get COVID than people in the general population, and three times more likely to die from it.

Monik Jimenez: There’s pretty robust evidence really coming from CDC data, that a fair amount of the transmission within facilities, was due to correctional officers coming in and out of facilities.

Anna Fisher-Pinkert: Corrections officers or the people who can move between housing units during a lockdown. And they leave after their shifts to go back to the community. It’s important to say that the spread of COVID-19 had a horrific impact on people who work in prisons and jails, the COVID prison project reports that nationally there have been 287 COVID-19-related deaths of prison staff.

Monik Jimenez: And so, we have to think about these spaces not as incarcerated people and correctional officers as separate entities, but it’s an ecosystem and everyone in that ecosystem is impacted, deleteriously, when we don’t have robust public health measures that are implemented across all members of that ecosystem.

Anna Fisher-Pinkert: The pandemic revealed a lot of weaknesses in the U.S. public health system, but Monique says that those weaknesses are especially apparent in our prisons and jails.

Monik Jimenez: Carceral systems have varying levels of robustness with respect to their emergency preparedness. And they also very often do not have people on their payroll who are well-versed in managing an epidemic within a facility. Infectious disease outbreaks within facilities are not new. These things happen, you know, these are locations that are primed for infectious disease transmission.

Anna Fisher-Pinkert: One change that Monik wants to see is more collecting and sharing of data on disease outbreaks and transmission. Another is to give public health authorities the ability to intervene in what happens in those dorms and housing units.

Monik Jimenez: And it’s not just they need the support to allow somebody to have somebody to come in. They also need to be required to allow those people to come in, right? And the teeth behind the public health measures needs to be there so that as public health authorities, we have jurisdiction to make those recommendations and those policies and those guidelines regardless of whether they are in custody or in the free world.

Anna Fisher-Pinkert: Public health experts like Monik aren’t just worried about the next infectious disease outbreak. They’re worried about what our carceral system is doing to the mental and physical health of people who are locked up. While the lockdown restrictions at the peak of the COVID pandemic were extreme, lockdowns are not unusual in prisons, nor is solitary confinement or restrictive housing unusual. Before the pandemic, between 60,000 and 80,000 incarcerated people were being held in solitary confinement in the U.S. on any given day. That number ballooned to over 300,000 when the pandemic hit the U.S.

Jasmine D. Graves: Across this country, there are people who spend years, decades in solitary confinement.

Anna Fisher-Pinkert: That’s Jasmine Dominique Graves, a Ph.D. student at Harvard University in the population health sciences program at Harvard Chan School. Before she came to Harvard, Jasmine worked in New York City government for ten years. And, between 2012 and 2014, she had a really unique job. She worked for New York City Bureau of correctional health services analyzing data from electronic health records and interviewing incarcerated people on Rikers Island to understand the big picture of prisoner health. The team was led by Dr. Homer Venters and one of the projects she worked on was a quantitative study, exploring the relationship between self-harm and solitary confinement.

Jasmine D. Graves: And what we found was that people who were placed in solitary confinement were almost seven times more likely to engage in self-harm and six times more likely to engage in fatal forms of self-harm, including suicide.

Anna Fisher-Pinkert: This is something that Jasmine also found in her interviews with people who had been in solitary confinement.

Jasmine D. Graves: So, people, and this is kind of some of the themes that were emerging when I did the qualitative work with people who engage in self-harm and solitary, understood that this was one of the only ways that I could get out the box. The only way I could get out of solitary confinement is if I engage in an act of self-harm.

Anna Fisher-Pinkert: When Jasmine describes the conditions inside a solitary housing unit in Rikers, it’s easy to understand why people are desperate to get out, even if it just means getting moved to a mental health unit.

Jasmine D. Graves: People are fed or provided food through a locked slot. Officers would have like an old-school, big key, open the slot, put food in. It’s also the slots that were used to handcuff people because the rules are such that, any time a person who’s placed in solitary confinement is outta their cell or coming out of their cell, they have to be shackled at all times. So even if you are coming out for therapy, you were shackled to the wall. You were shackled to a desk, shackled to the floor. There’s not an instance where anytime you’re out of a cell, you are not shackled.

Jasmine D. Graves: You might also see someone smeared in feces, or the cell smeared in feces. You might also see an instance where someone’s cell is on fire. You might also walk in and see someone who’s died of suicide or who’s engaging in an act of self-harm. There’s a lot of terrible things that people see.

Anna Fisher-Pinkert: Jasmine told me the story of one man who died by suicide while in solitary confinement on Rikers Island in 2012. His name was Jason Echevarria he was 25 and housed in the MAUI which at the time was a unit specifically for people with mental health needs.

Jasmine D. Graves: And he had a history of self-harm. He, in August, swallowed a packet of industrial soap that is sometimes was at the time given to people incarcerated to clean their cells. Our understanding is that as one of our pharmacists was rounding to disperse medication, because again, people are locked in 23 hours a day. She saw him vomiting uncontrollably in his cell and she said to the officer who she was with, he needs medical attention. And he insisted like, Okay, we’ll get him medical attention, but you need to keep going. So, she finished her round, she let the officer, who was at the table, at the bottom of the tier knows, hey, like, that person’s not doing well. He needs medical attention. And they said we’ll take care of it. I want to say, this is now like in the evening and at 8:00 AM the next morning he was dead.

Anna Fisher-Pinkert: One of the major arguments made by proponents of solitary confinement, is that it keeps corrections officers safe by isolating dangerous members of a prison’s population. But as we saw during the COVID-19 pandemic, prisoners can be isolated for medical reasons. They can also land there because of non-violent and fractions.

Anna Fisher-Pinkert: And even though they’re not supposed to, they can land there because of mental health issues. But as Monik said, prison is an ecosystem, and the trauma of solitary confinement doesn’t only impact prisoners.

Jasmine D. Graves: I’m a big proponent of obviously holding correctional officers accountable for the harms that they cause. On the island and in many other, and every other correctional setting for that matter. I will say in my time there, interestingly, a number of officers also started to talk to me. And share their kind of trauma and processing of what it means to come to work and see the person who you were talking to yesterday didn’t make it through the night. And I also think it’s important to note that no person, I mean, no human being most importantly, the people incarcerated, including also the officers, the health staff, no person leaves these places unscathed.

Anna Fisher-Pinkert: There is quantitative data showing that the impacts of solitary confinement follow incarcerated people long after they leave prison.

Monik Jimenez: One study that I reference very often is work by Laura Brinkley Rubenstein, who analyzed data from the North Carolina Department of Corrections and basically, this data demonstrated that exposure to solitary confinement was associated with increased risk of mortality upon release.

Monik Jimenez: And, being placed in restrictive housing even once over the term of your incarceration was associated with a 17% increased risk of mortality. Just one year after release, any exposure to restrictive housing, a 24% increased risk of mortality within a year. And more than one placement was associated with a 38% increased risk of mortality.

Anna Fisher-Pinkert: The risk of suicide after release was 78% higher for those who had been placed in restrictive housing. And yet the practice persists. And solitary confinement affected Monique personally.

Monik Jimenez: My father was incarcerated for a large portion of my life. And one thing that I will say is that his experiences in solitary confinement didn’t stay with him in prison. They came home with him. And his experiences of solitary confinement when he was living through them, impacted me as a young girl, who was wondering how my dad was doing, recognizing that he wasn’t calling. I knew generally what that meant, that he was in the hole. So those have impacts on the people on the outside. It has impacts on the people who are inside who are going to be coming home.

Anna Fisher-Pinkert: Monique thinks that public health experts need to get engaged in the issue of how we treat people in our jails and prisons.

Monik Jimenez: So, if we, for example, were to say, let’s say we have somebody who has a wound. As public health practitioners and medical care providers, do we go to that wound and say, you know what? Let me just hit on that wound some more. Let me throw some dirt in there, make sure there’s lots of live bacteria, and let’s make it fester. And then we’ll deal with it after it festers. No. What do we do? We heal it. We take care of it, we address it, we clean it, we support that person so that they can take care of their wound.

Monik Jimenez: And in most cases what we’re doing is taking young men, in particular young Black men, and brown men who maybe have, who need support, who need mentorship, who need to maybe learn that they have value. Learn how to emotionally regulate, learn from other people, understand that what their options are, things like that. We have people in a highly toxic, violent space where they’re on top of each other, people who need severe mental health care in the general population. And then when somebody acts out, or very often when they don’t act out, we place them in solitary confinement. And so, we’re gonna take whatever kind of humanity is there and strengths, and we’re gonna push that to the limit. That is sick. I feel that that is contrary to how we build safe communities.

Anna Fisher-Pinkert: So, what’s the alternative? When Jasmine was working at Rikers, correctional health services leadership and staff developed a program to try to keep people out of solitary confinement. A program called clinical alternatives to punitive segregation. The idea was to take people with severe mental illness who might’ve otherwise ended up in solitary for minor rules violations and offer a supportive housing unit.

Jasmine D. Graves: Those units were designed and offered a full range of therapeutic activities and interventions including individual, group therapy, art therapy, medication counseling. There was what they would call community meetings, but really when I visited the unit people had their cell doors open. People could come freely in and out of their cells, which was actually not even common practice in the general population.

Anna Fisher-Pinkert: The team of researchers compared health outcomes for the people in this housing unit, nicknamed CAPS, against outcomes for people in regular restrictive housing units or RHUs.

Jasmine D. Graves: And so, what we found was that looking at rates of self-harm, for example, for patients who were placed in CAPS, their rates of self-harm and injury were significantly lower than people who were in those RHU units. So, it demonstrated that there were better outcomes for the people who were incarcerated, but there were also rarely instances of jail rule violations. So, both from like a security management perspective and a health perspective, these units have pretty good outcomes.

Anna Fisher-Pinkert: But before you get too excited about CAPS-like programming in every jail and prison across the country, remember that these outcomes are better compared to a solitary housing unit, not compared to life outside of prison.

Jasmine D. Graves: Folks can run with that and be like, well we just design a bunch of CAPS units. What I believe to be the truth, and this is coming from my perspective as an abolitionist, we cannot reform these issues away.

Anna Fisher-Pinkert: But Monique says that it’s possible to aim for abolition in the future while still addressing the reforms that are needed now.

Monik Jimenez: I do think we have to be thinking about supporting individuals who are there right now, because conditions are horrendous, and people are hurting. And we also need to dismantle our system and really ask ourselves, as a society, do we want to have a thriving society that lifts us all up, or do we want to continue to support this variation of slavery that we have currently?

Anna Fisher-Pinkert: Monique says that there was one bright spot during the COVID-19 pandemic. In order to reduce populations in jails and prisons, some state and local agencies enacted forms of decarceration. Either accelerating the release of some people who were in the system or diverting others from incarceration.

Monik Jimenez: You know, before people would talk about decarceration and people would look at you like you have three heads. That’s not possible, that’ll never happen. But the pandemic showed us that it can happen, and it can happen very quickly. Did it happen to the extent that it should have No. But can it happen? Yes. And so, I think that what that brings up for me is that decarceration is a viable public health tool, and we need, as a public health profession, we need to understand that this is our lane. This is not outside of our purview, calling for decarceration, abolition of carceral spaces is exactly our lane because this is a public health emergency and it’s not going away.

Anna Fisher-Pinkert: This year New York city council is expected to pass a bill ending solitary confinement at Rikers Island. It’s not a solution to the ills of mass incarceration. But it represents a change in how many think about crime and incarceration in America. And that shift if it leads to meaningful policy changes, could have an impact on the health and well-being of 2 million people in prisons and jails in the U.S.

Anna Fisher-Pinkert: Thanks for listening to Better Off. We’re better off with our team. Kristen Dweck, Elizabeth Gunner, Stephanie Simon, Pamela Reynoso, and Ben Wallace. Audio engineering and sound designed by Kevin O’Connell. Additional research from Kate Becker. I’m host and producer Anna Fisher-Pinkert.

Anna Fisher-Pinkert: Thanks to our guests today, Monique Jimenez and Jasmine Dominique Graves.

Anna Fisher-Pinkert: If you liked this episode, please visit our website We’ll have more information about Monique and Jasmine’s work. And links to other episodes you might like to listen to. Also, please rate and review us on your favorite podcast app and tell your friends about the podcast too. That’s it for this week. Thanks for listening.