A new report by Disability Rights New York (DRNY) found a popular rehabilitation program for prisoners in solitary confinement, who suffer from intellectual, developmental, and mental health disabilities, is marred by abuse and mismanagement.

The legally-mandated watchdog investigated the Sullivan Correctional Facility in Fallsburg, New York, where some prisoners with disabilities who are punished with over 30 days in solitary confinement may participate in a program called the Correctional Alternative Rehabilitation Program (CAR). In CAR, individuals “complete their punitive segregation sanction, but receive up to four hours of out-of-cell, therapeutic programming a day.”

CAR was designed to “serve as a rehabilitative alternative to punitive isolation in the Special Housing Unit (SHU),” pursuant to the agreement reached in the lawsuit Peoples v. Fischer. Indeed, DRNY found the CAR program space to be “clean and bright,” and CAR participants consistently stated the program had “helped them manage anger, respond appropriately to conflict, and handle social situations effectively,” as well as improve their reading, writing, and math skills.

However, DRNY also uncovered numerous complaints of misconduct by corrections and mental health staff tasked with carrying out the desperately needed treatment program. CAR participants say staff engage in punitive, abusive, and counterproductive behavior that makes rehabilitation difficult if not impossible.

Some participants confided to investigators that CAR felt like “nothing more than a ‘slightly modified box.'”

Altogether, the evidence presented in this report casts doubt as to whether programs for prisoners in isolation are enough to foster the trust and safety necessary for rehabilitation, and whether prisons can ever adequately provide medical treatment.

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Promoting rehabilitation and opportunity for people with intellectual and developmental disabilities before, during, and after their contact with the criminal justice system is crucial because of their comparatively high vulnerability to harm and abuse.

According to the nonprofit disability rights organization The Arc, disabled incarcerated individuals may “unintentionally give misunderstood responses to officers, which increase their vulnerability to arrest, incarceration, and possibly execution, even if they committed no crime.” They note that once disabled people are in the system, they “are less likely to receive probation or parole and tend to serve longer sentences due to an inability to understand or adapt to prison rules.”

Additionally, incarcerated people with disabilities may try to hide their disabilities; not understand or pretend to understand their rights or commands given to them; be easily overwhelmed and upset; and tell officers what they think they want to hear, even if it is not true.

The CAR program—in multiple ways—disregards these key concerns.

First, the eligibility process for admission to CAR relies almost exclusively on IQ testing, which is a narrow metric that excludes people who could benefit from the programming. DRNY notes “IQ scores [are] approximations and may be invalid or unreliable,” because they may fail to reveal an individual’s issues with verbal comprehension, working memory, perceptual reasoning, quantitative reasoning, abstract thought, or cognitive efficiency.

“As long as DOCCS [Department of Corrections and Community Services] uses IQ score as the sole quantitative method of eligibility,” the report states, “it will screen out those who, based on adaptive deficits or some combination of intellectual functioning and adaptive deficits, should be in CAR.”

For participants who do make it into the program, it is unclear how they can advance through it, due to “ill-defined benchmarks” based on “behavioral standards that do not adequately accommodate disability.”

Participants complained the program holds them to “unreasonably difficult standards” and punishes them when they fail to live up to those standards. The CAR manual does not specify what constitutes “inappropriate behavior,” even though such behavior may result in discipline.

DRNY found the corrections department readily demoted program participants and took away incentives when they misbehaved. Staff gave out excessive “negatives” and misbehavior reports for “imperfect adherence to the rules.” Such demerits were used to transfer participants out of the program, and sometimes back into solitary confinement.

Over nineteen program participants told DRNY the department placed them in isolation for a “cooling off” period after a misbehavior report, with one participant saying it “happens with such regularity that ‘[participants] are the only people in the box.'” They complain the department “curtails their progress…by placing them in SHU and [uses] SHU placement far too frequently as punishment for misbehavior.”

These practices violate “the stated objectives of CAR as a rehabilitative alternative to SHU,” which “exposes people with [intellectual and developmental disorders] to psychological harm and runs directly against the rehabilitative goals of CAR.”

“Many CAR program participants do not yet understand how to avoid infractions,” DRNY explains, “and require assistance in developing enhanced coping skills necessary to manage their behavior and conform to the rules.”

Corrections staff use force in the housing area that “is unnecessary for the situations or infractions at issue.” Staff are “verbally disrespectful” toward participants and lack the training required to serve them.

DRNY received a “shocking number” of complaints from CAR participants about excessive force, which impeded full participation in the program. In one instance, a prisoner was attacked by guards for leaving his cell after staff in the control booth accidentally opened his door. He suffered a bloody nose and other injuries, and was later “so anxious about his personal safety that he refused to leave his SHU cell, foregoing all CAR programming, until his maximum release date from prison.”

All but one participant interviewed by DRNY “expressed fears of discipline in CAR that is disproportionate to the offense.” DOCCS policies and practices are therefore “antithetical to the goals of CAR and sets up some program participants for failure.”

Meanwhile, mental health staff put participants in harm’s way by disclosing their personal health information to officers, who could use it to abuse and insult them. Mental health rounds are “infrequent and inconsistent,” and even when they happen, “there is no meaningful opportunity to engage with staff, as cell-side conversations are just minutes-long.”

Participants must submit written requests for mental health services, despite how their disability might affect their ability to write. Staff refuse to assist such inmates, which “precludes some participants from accessing services.”

DRNY identified a particularly troubling “pattern of complaints,” in which staff decided prisoners were malingering, or faking their symptoms to seek treatment or avoid discipline, “even when records indicate past treatment history and even when patients supply a reason for mental distress, such as neglect of medical needs, trauma, or abuse.”

Some mental health staff treat behavioral incidents as “volitional and manipulative, rather than as a manifestation of disability or a response to environmental factors.”

In one example that reveals the general posture mental health staff take toward their patients, a nurse documented one participant’s behavior thusly: “Feces smeared on all walls. P[atient] got up from from cot and said he was going thru something when I asked him why he was smearing.”

The next day, however, a clinical social worker misrepresented that nurses report and framed the behavior as “aggressive and volitional,” writing:

Patient is still unhygienic, with feces in his cell, smeared on walls. He is not hygienic to come out for interview. Per Nursing last night, he was saying he was going to throw something. This morning per Nursing, he was mute to Nurse. He is eating and drinking. No acts of self-harm. He is not psychotic. He does not want to go to CAR or SHU and he is apparently willing to remain in fecal matter to avoid everything.

“When [mental health staff] evaluate patients without any exploration of what their complaints indicate about mental health status or capacity for tolerating their environment,” DRNY writes, “staff place patients at risk of neglect.”

DRNY acknowledges that, in prison, “timely, person-centered care, coupled with the provision of a safe environment, would reduce the need for crisis services and free up mental health resources for ongoing treatment”

“When mental health staff fail to establish or implement an appropriate treatment plan, or provide a safe environment, staff place individuals at risk of injury or death.”

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This is not simply an issue of prisons needing to be brought into modern times. New York has been aware of the complex treatment needs of developmentally and intellectually disabled incarcerated people for decades [PDF]. Yet despite this reality, and the fact that the state has been compelled by a court to take action, it is still an open question whether officers and their powerful union will change their harsh methods and authority.

In prisons, the common refrain among guards is “our house, our rules.” Guards see punitive responses to disobedience, such as solitary confinement, as legitimate tools for enforcing order among criminals—even if such measures consistently fail to produce the results they desire.

The New York Times reported in December of last year that officials say their policies had “evolved over decades of experience, and it is simply wrong to unilaterally take the tools away from law enforcement officers who face dangerous situations on a daily basis.”

DRNY submitted detailed recommendations for each program deficiency they found. Each one should be seriously considered to ensure the program improves and achieves its full potential. But lost in this is a larger and more important discussion focused on whether the rigid and isolated environment cultivated by law enforcement is fundamentally at odds with rehabilitation.

Can, and more importantly, should we experiment with reforming a punitive environment to be more therapeutic, or is it time to look beyond prison walls for treatment answers?

It’s likely that some CAR participants give the program such glowing praise in the face of abuse and mismanagement out of desperation for treatment and human connection.

With few meaningful opportunities available to prisoners, even something as dysfunctional as CAR can seem like a godsend. In this context, it is a disservice to answer their call by constraining our imagined solutions to what can exist within the prison. Treatment options outside of prison should be considered. Otherwise, we are just treating disabled prisoners as social waste.