1 in 10 prisoners in solitary confinement have a serious mental illness. A new bill seeks treatment.

Nearly 10% of all Wisconsin prisoners in solitary confinement today have a serious mental illness.

And just over 1,800 prisoners in Wisconsin have been diagnosed with a serious mental illness such as schizophrenia, bipolar disorder, personality disorder and severe depression, according to the most recent data from the Wisconsin Department of Corrections.

This demographic represents just 8% of the prison population. But for the 10% of incarcerated people with mental illness currently in isolation, symptoms of their illness may have landed them in confinement.

Between February 2019 and September 2023, prisoners spent an average 59.7 days sentenced to solitary confinement, according to the DOC. That extensive time in isolation deeply amplifies symptoms of serious mental illness, which is part of why state Sen. Rachael Cabral-Guevara, R-Appleton, along with Rep. Michael Schraa, R-Oshkosh, have introduced a new bill focused on treating prisoners struggling with serious mental illness, one that aims at an alternative to solitary confinement for Wisconsin prisons' sickest inmates.

"With the shortage of mental health professionals in prisons, it’s important to care for those who may be a danger to others in places where help can be sought," the co-sponsorship memorandum released Nov. 8 reads. "Additionally, with staffing shortages across the board in prisons, transferring these inmates to the proper facility can reduce the burden on correctional institutions themselves."

The bill, Cabral-Guevara told USA TODAY NETWORK-Wisconsin, would require training for correctional staff on how they identify and report symptoms of psychosis and the transfer of inmates in active psychosis to a mental health treatment facility or the Wisconsin Resource Center, based on the opinion of a health care professional of the jail, prison or DOC.

Cabral-Guevara, a health care provider who also serves as vice chair of the Committee on Mental Health, Substance Abuse Prevention, Children and Families, said that for people actively experiencing psychosis, the last place they should be sent is solitary confinement.

"The bill is trying to find a way to get people treated (for psychosis) in a humane manner, rather than putting them in an environment that can actually exacerbate the act of psychosis that they are in," Cabral-Guevara said.

Although the bill is in its early stages, it comes on the heels of Democratic Gov. Tony Evers and DOC Secretary Kevin Carr announcing plans to lift restrictions at two of the state's oldest prisons, Waupun Correctional Institution and Green Bay Correctional Institution.

That plan includes limiting the use of solitary confinement as punishment for people with a serious mental health diagnosis and requires correctional staff to make security rounds every 30 minutes. It's part of a larger effort to quickly respond to prisoners in distress.

But Cabral-Guevara and Schraa's bill would, potentially, arm correctional staff with additional mental health training to ensure their response is appropriate to the circumstances.

Kevin Hoffman, deputy director of communications for the DOC, said in an email to USA TODAY NETWORK-Wisconsin that he's had conversations with the bill's authors, noting that "many aspects of this proposal are already in place, including referrals to Wisconsin Resource Center for persons in our care with mental health needs."

Following these conversations, Hoffman said, he was "pleased" that Cabral-Guevara and Schraa added Wisconsin Resource Center to the bill and looks forward to its final product.

The bill would require training correctional staff in identifying active psychosis

Active psychosis might look like paranoia or suspicion of others, trouble thinking clearly, unusual or overly intense ideas, difficulty differentiating reality from fantasy, a decline in personal hygiene, and other symptoms, according to the National Institute of Mental Health.

Left untreated, somebody experiencing active psychosis runs a higher risk of attempting suicide and behaving in confusing and unpredictable ways, which increases the threat of violence in themselves and others, prisoners and staff alike.

Training correctional staff could, theoretically, make them more vigilant about how they identify and respond to these symptoms. The correctional staff with whom Cabral-Guevara spoke expressed a desire for training that goes beyond sitting in front of a computer screen and clicking through slides.

"They want engagement from mental health providers to give them real-life examples," Cabral-Guevara said. "There's also great simulation packages that are available and other opportunities besides just sitting in front of a computer screen, clicking a button and reading."

That's something Sara Williams, community organizer for JOSHUA, an interfaith justice advocacy organization that is the Green Bay affiliate of WISDOM, said she appreciates about the bill, as she and her organization have always advocated for more training of correctional officers.

Trainings like this, Williams added, could potentially serve as a preventive measure against active psychosis. Some of the staff see incarcerated people every day, she said, and they'd be able to pay attention to the growing signs of psychosis, potentially intervening before it begins.

"These folks deal with the population and the people that they deal with can be difficult," Williams said. "They don't have the training required to be able to actively assess serious psychosis in somebody. And I absolutely think that added training is necessary."

As it stands, correctional staff don't typically have the expertise or training to differentiate these behaviors and make such calls, although Hoffman, from DOC, emphasized that security staff does have such training and, as part of its current practices, submits referrals to the facility’s psychological services unit.

"We would be open to any additional training that could be implemented into our existing practices," Hoffman said in an email.

But historically high community corrections vacancies — at a rate of nearly 25% in 2022, according to a report released from Wisconsin Policy Forum in June — compounded by prisoner overcrowding, may make this additional training requirement more cumbersome to enforce.

Vacancy rates are even worse at Wisconsin's oldest prisons, Green Bay Correctional Institution and Waupun Correctional Institution. For the Oct. 22 through Nov. 4 pay period, the vacancy rates at Waupun stood at nearly 55% for correctional officers and sergeants, and 40.9% at Green Bay, according to Evers' press release.

It can take weeks sometimes before correctional staff are able to truly assess and identify a serious mental health crisis, Cabral-Guevara said. To strengthen their judgment calls and expedite a situation, many correctional staff say they want to have this training in their toolbelt, she said.

Learning from mental health providers also may help correctional staff distinguish between symptoms of psychosis and those who are actively manipulating staff into transferring them to more ideal treatment facilities, Cabral-Guevara said.

That gray area, meanwhile, is leading to additional harm. Cabral-Guevara said she has spoken to people who spent time in solitary confinement. They told her that for several weeks, and even months, they're subjected to neighboring prisoners in confinement who are actively in psychosis.

"They have to talk to people next to them, trying to calm them down, because their neighbors were so psychotic that they were hurting themselves," Cabral-Guevara said. "And they felt punished or tortured to be kept in solitary confinement."

Bill is part of ongoing attempt to improve those prisons struggling with mental illness

Multiple suicides and suicide attempts in Wisconsin prisons over the last year emphasize the need for more mental health services.

Those services, from mental health assistance, therapy appointments, medications and diagnoses, are "very, very lacking," at least at Green Bay Correctional Institution, said Williams.

That's been especially true since lockdowns began.

More on prison lockdowns: Here's what you need to know about the Waupun prison lockdown, now in its eighth month

More: Protesters advocate closing Green Bay Correctional Institution, ending lockdown

When someone has been experiencing a persistent mental health crisis, it's more appropriate to work with mental health treatment centers like Winnebago Mental Health Institute and the Wisconsin Resource Center in Oshkosh, Cabral-Guevara said, which both have locked units for state prison residents.

Cabral-Guevara emphasized that the bill is geared toward a handful of people in prison, the 8% in the state with serious mental illness. There are many capable physicians, psychiatrists, nurse practitioners and physicians' assistants treating patients within the DOC's Bureau of Health Services, she said, but some patients require extra attention and skillsets.

The bill would require prisoners experiencing psychosis to be transferred to an outside mental health facility. In cases where 48 hours have passed since the DOC authorized emergency transfer of a prisoner in active psychosis, a doctor, psychiatrist or specialist must see the patient every 24 hours and do a comprehensive assessment for active psychosis until they can be transferred.

Williams sees this alternative as a convenient "out" for DOC, though. Monitoring someone in solitary confinement every 24 hours doesn't address the problem at hand, she said, which is that solitary confinement exacerbates every aspect of someone's mental health.

"If they are supposed to be transferred to a state facility treatment within 48 hours, then they should have to figure that out, not keep them in solitary," Williams said. "If they don't have the professionals to send them over to another facility, how are they going to have the professionals actively check on them every 24 hours?"

More: Third death reported at Waupun prison in four months

Winnebago Mental Health Institute is one facility that Cabral-Guevara said is on board for the bill. But the state institution, under Wisconsin Department of Health Services, declined to comment on pending legislation.

The National Alliance on Mental Illness (NAMI) estimates that between 25% and 40% of all mentally ill Americans will be jailed or incarcerated at one point in their lives.

By contrast, just over 6% of the general population will be jailed or incarcerated at one point in their lives.

Mary Kay Battaglia, executive director of NAMI Wisconsin, said she supports increased mental health services in Wisconsin's prisons, but declined to comment on the bill being proposed by Cabral-Guevara and Schraa.

"We support and encourage increased mental health services in the prisons and would very much like to see improvements to allow those in Wisconsin prisons to no longer be under the current lockdowns that have limited movement, family connection, and physical activities," Battaglia wrote in an email to USA TODAY NETWORK-Wisconsin. She applauded the recent efforts of Evers and Carr to lift the lockdowns.

As of now, the bill has more co-sponsors in the Assembly than in the state Senate, Cabral-Guevara said, and it's slated to be heard by the Senate Committee on Health at an upcoming session, either December or January.

Cabral-Guevara hopes to hear people's perspectives and stories at an upcoming hearing. She's also aware that some advocacy groups wanted more from the bill, "but this is a step in the right direction."

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.

This article originally appeared on Green Bay Press-Gazette: New bill addresses Wisconsin prisoners with serious mental illness