RIDGEVILLE - Dozens of eyes peered through cloudy panes of reinforced glass as a trio of corrections officers, encased in protective vests and face shields, shuffled along the cell block's concrete floor.
One inmate pressed his face against a spider web of cracked glass and pounded furiously on the metal door, his voice echoing off the concrete walls.
"You got to get me out of here!" Rage built in his voice. "They've been experimenting on me and planting things in my head. The FBI and the CIA know about it, and the GPA too. You've got to help me!"
The man is one of 132 inmates locked up in Lieber state prison's Special Management Unit, an institutional term for solitary confinement. Like 53 others in the unit, he is mentally ill. Like most on his floor, he spends 23 hours a day locked in his cell, getting his meals through a slot in the door, nearly devoid of contact with the outside world as the voices howl in his head.
The tactic of locking away mentally ill inmates in solitary - often for months or years at a time - has been standard practice in Lieber and other South Carolina prisons for decades.
It's how prisons here, and in many states across the nation, have dealt with unruly - and potentially dangerous - inmates who lash out, try to hurt themselves or others, make threats or otherwise rail against efforts to control their behavior.
But nationally, the tide has been turning against this tactic, with states from Mississippi to Maine taking steps to reduce the number of prisoners housed in isolation, driven by a mix of humanitarian, legal and budgetary concerns. Critics contend solitary confinement has been overused, locking away inmates for nuisance offenses in an environment that can be psychologically crippling.
The practice has come under scrutiny in South Carolina as well after Circuit Judge Michael Baxley blistered the state Department of Corrections in a January ruling that condemned the prison system's treatment of mentally ill prisoners. The ruling has prompted state corrections officials to re-evaluate their use of solitary and reach out for guidance to other states further along in this process.
Among other things, Baxley noted that mentally ill prisoners were locked in solitary at twice the rate of other inmates and provided with a "grossly inadequate" level of care.
At maximum-security Lieber, for instance, mentally ill inmates comprised 20 percent of the prison's population, but they accounted for 42 percent of the inmates in the segregation unit, the judge noted. System-wide, nearly 1,700 prisoners were held in segregation units as of last week, including 473 classified as mentally ill.
Mentally ill inmates also spent longer in lock-up because they kept racking up violations, often for nuisance behaviors, with one man piling up 19 years worth of disciplinary sentences, Baxley found.
Some didn't survive the experience.
James Bell took an overdose of anti-depressant medication at Perry state prison in 2008 after six years in solitary. He had a history of cutting himself and previously had been hospitalized for psychiatric care.
On Feb. 9, 2008, Bell's aunt contacted a prison chaplain after receiving a "goodbye letter" from him in the mail. Two days passed before a counselor checked on Bell and found he had killed himself. A coroner determined he'd been dead at least 12 hours by that point.
Another known "cutter," 36-year-old Lorenzo Rouse, hanged himself with a sheet tied to an air-conditioning vent in his solitary cell in Lieber four months later. Rouse, in prison for multiple assault convictions, sliced his arm open with broken glass after being placed in solitary four days before his death. Just two hours before he died, he had been released from a restraint chair after threatening to harm himself further.
Mentally ill inmates told a paralegal with the law firm of Nelson Mullins Riley & Scarborough, whose suit led to Baxley's ruling, that it wasn't uncommon for prisoners in solitary to have limited access to mental health care they desperately needed.
Inmate Jonathan Roe told the paralegal "it's almost impossible to get a counselor to come see you when you're on lockup." Roe, who cuts himself to relieve stress when he gets manic, said being thrown in a room alone leads to dwelling on a problem until there's nothing to do but act out.
"And then when you do something drastic to get a release or to try to get somebody down there to talk to you, nine out of 10 times you get punished for doing it," he said. "They love spraying that gas. If you get to acting up, the first they'll do is pull that gas and put it in your face."
Roe, 29, was in for attempted robbery and assault when he spoke those words in 2010. After his release from prison, he got married and then killed his new bride, slashing her with a straight razor and shooting her in the chest and face. He is now back behind bars.
A necessary tool?
No one expects solitary confinement to disappear completely. Many officials see it as a necessary tool in a prison system where more than 400 correctional officers were assaulted by inmates between 2008 and 2011. The "worst of the worst," they argue, will always need to be separated from the rest of the pack for safety reasons.
Former state Corrections Director Jon Ozmint, who ran the state prison system from 2003 to 2011, said it is unfair for the courts to send people to prison to protect society and then criticize corrections officials for taking steps to protect people on the inside from the same dangers.
"Is it wrong for prisons to segregate the mentally ill when they threaten the safety of the public, staff or inmates?" he asked. "If so, perhaps it was wrong for those mentally ill criminals to be segregated to prison in the first place."
Still, state corrections officials said they are working to reduce the number of offenders in solitary and find alternatives to segregation for inmates with severe mental illnesses, including additional therapy.
They have reached out to their counterparts in Mississippi, considered a leader in this movement, for guidance in reforming South Carolina's approach to prison segregation. Mississippi's Deputy Corrections Commissioner Emmitt Sparkman visited the Palmetto State last week to meet with officials and offer advice.
Facing a lawsuit and an outbreak of violence in its "super-max" segregation unit in Parchman, Miss., changed course in 2007 and eased restrictions on those in solitary, provided more recreation and rehabilitation programs and began channeling inmates back into the general population. The end result: The state was eventually able to close its entire super-max unit, saving $5.6 million, while serious incidents of violence at the prison dropped 70 percent, officials said.
"It succeeded beyond anything we ever expected," Sparkman said.
The number of inmates in long-term segregation in Mississippi has dropped from more than 1,300 to about 350, and those who remain are given more opportunities to interact with others and earn more privileges through good behavior, Sparkman said. The prison system also has worked to make sure that those placed in segregation are there for a good reason, not just because someone was mad at them for back-talking the staff or acting up, he said.
If those in question are mentally ill, that must be taken into account in drafting a plan for them to improve their behavior and work toward their release from segregation, Sparkman said.
South Carolina Corrections Director Bryan Stirling said his agency has already begun to employ some of these methods. Mentally ill inmates in solitary are now working more closely with mental health counselors. The agency now also requires that mental health counselors review all disciplinary sanctions taken against prisoners with psychiatric issues, he said.
Since January, the number of mentally ill prisoners in special management units has dropped by 59, or about 10 percent, as a result of this new approach.
A history of isolation
The use of long-term solitary confinement in the United States dates to the late 18th century in Pennsylvania, where Quaker reformers posited that offenders would see the error of their ways and repent if left in extended isolation with a Bible to reflect and pray. Instead, however, many were said to have gone insane as a result.
The practice fell out of favor by the late 1800s, with the U.S. Supreme Court noting in an 1890 opinion that solitary had a tendency to render prisoners incoherent or violently insane.
But solitary confinement came back into vogue in the 20th century, with prisons such as Alcatraz in California and the federal penitentiary in Marion, Ill., adopting the tactic to deal with unruly and dangerous inmates. Other prisons followed suit, and by 1999, some 30 states were operating super-max facilities where inmates were kept in virtual isolation, locked up for 23 hours a day.
A 2011 study by researchers with the New York-based Vera Institute of Justice determined an estimated 80,000 prisoners - more people than live in Mount Pleasant - were being held in solitary confinement nationwide. Others put the figure closer to 25,000.
Experts contend that the mentally ill, who comprise an estimated 20 percent of the overall prison population, are disproportionately represented among the inmates held in solitary. A 2003 report from Human Rights Watch concluded that as many as half of the prisoners found in special management units had some form of mental illness.
Mental health advocates and humanitarian groups have argued for years that long periods of forced isolation is psychologically damaging for prisoners, particularly for those already battling mental illness.
Craig W. Haney, a University of California psychology professor who has spent years studying the effects of solitary confinement, told a U.S. Senate Judiciary subcommittee in 2012 that forced isolation can drive prisoners to question their own existence, mutilate themselves and commit suicide.
Haney described how one psychotic prisoner in a New Mexico solitary unit sewed his mouth shut with thread he pulled from his pillowcase. He told of another who remained in lockup in a federal facility after amputating his pinkie, chewing off another finger and slicing off other body parts with a sharpened piece of metal.
"The emptiness and idleness that pervade most solitary confinement units are profound and enveloping," Haney stated.
Some, however, point to the dearth of empirical studies on the psychological effects of long-term segregation. One such study, published last year, looked at inmates in Colorado's segregation units and found no evidence of significant psychological decline over a 12-month period.
South Carolina prison officials cited the study in their defense, but Baxley in his recent ruling considered the findings unpersuasive because many mentally ill inmates here stay in segregation much longer than a year and under much harsher conditions than in Colorado.
Moving toward change
In recent years, a desire to change course has been shared by some in the national corrections field as well.
At the annual Guggenheim crime symposium at New York's John Jay College of Criminal Justice in February, Colorado Corrections Director Rick Raemisch told an audience that misuse of segregation - what he called "the steel door solution" to nuisance offenders - had resulted in an approach "that multiplies and manufactures mental illness."
Raemisch, a former cop, drew national attention in January when he spent 20 hours in solitary lock-up to understand what it was like. He detailed the experience, which left him unsettled, "twitchy and paranoid," in an opinion piece that ran in The New York Times.
"We are social animals, that's what human beings are," Raemisch said at the conference. "If we cut that off, nothing good will come of it."
Raemisch noted that the vast majority of offenders in solitary confinement will be released at some point - some, straight into the community from isolation cells - creating potential public safety risks.
He knows from his experience. His predecessor, Tom Clements, was assassinated at his Denver home in March 2013, gunned down by a former prisoner who had been released into the community from solitary lock-up. Clements had worked to reduce the number of Colorado offenders held in solitary, and Raemisch has taken up the cause since assuming the helm.
Illinois, California, New York, Maine and other states also have joined the movement.
Between 2010 and 2012, Maine State Prison reduced the number of prisoners in its solitary units by about half, to 46, by opening an intensive mental health unit, employing alternative forms of discipline and using solitary as a punishment of last resort. The commissioner's approval is now needed before an inmate can be placed in solitary for more than 72 hours.
"Locking down the mentally ill for extended periods of time is not in their best interest," Joseph Fitzpatrick, a clinical psychologist who is acting director of Maine Department of Corrections, said. "It only exacerbates their illness."