On a sweltering summer afternoon, I stood with our mental health team, waiting while a guard unlocked the door to a solitary confinement cell on Rikers Island. When the door swung open, a young Black man with a sweat-stained face beseeched us, “Help me! Please! I’ve been in this cell for three months now. I can’t take it anymore. I’m telling you, I can’t. Please get me out of here. Help me, help me!”
As I took in the cuts on his arms and the blood-smeared cinderblock walls, I could feel his desperation with every fiber of my being. I wanted to cry out, Yes, of course I will help you!
But instead, after a few useless words aimed at comforting him, we stepped to the side of the cell to review our tiny array of options. We could adjust his medication or try a new medication. Apart from throwing out a few more words of encouragement, that was it.
I was a monitor of human suffering—a well-intentioned cog in the wheel of the New York City Department of Correction.
The real answer, of course, was to get him out. But that was complicated. We had the authority to issue a temporary reprieve—a few days or so, just long enough till he’d caught his breath so to speak, before being returned to solitary. But we were under fierce pressure not to do so, if for no other reason than his release would trigger scores of additional suicide threats and gestures. When I first began working on this 500-cell solitary confinement unit, I was given a word of advice by my clinical supervisor: “If you authorize the release of every person who threatens or attempts suicide, you’ll have 500 empty cells.” Of course, we were also to be sure no one actually died.
There were many moments when these daily cell-door huddles turned surreal and my mind would veer off to images of myself on graduation day so many years earlier, tossing my mortarboard cap into the air. I was an MSW! I was going out into the world to help people, to right wrongs, to seek justice, to make the world a better place!
But now, I had a sickening awareness that I was a monitor of human suffering—a well-intentioned cog in the wheel of the New York City Department of Correction. How had I become entwined in all of this?
Despite the highest of ideals and the best of intentions, social workers often find themselves in workplaces that bring ethical challenges. Mary Gamble, a colleague with whom I have spoken, was a behavioral social worker in a Maryland jail where the warden routinely placed people with serious mental illnesses into solitary confinement cells, refusing to release them until they’d demonstrated an improved mental state.
As anyone with even the slightest knowledge of solitary confinement knows, isolation only exacerbates existing mental illness, and may induce it where it did not previously exist.
Seeking guidance in 2016, Gamble turned to the National Association of Social Workers (NASW) for their stance on solitary, only to learn that while they acknowledge solitary confinement settings can be ethically challenging, they do not have a position on the practice itself—which, according to the United Nations Nelson Mandela Rules, can constitute torture if prolonged for more than 15 days. When pressed by Social Workers & Allies against Solitary Confinement, NASW’s response was that they do not take positions on specific matters, but instead expect individual social workers to practice in accordance with the profession’s Code of Ethics.
This code states that “Social workers respect the inherent dignity and worth of the person.”
For Gamble, reconciling her commitment to uphold the dignity of human life with the practices of her workplace left her in a quandary, often referred to as dual loyalty—the responsibility to employer, versus ethical responsibility to clients.
The Code of Ethics also addresses this dual loyalty dilemma, stating that “Social workers should not allow an employing organization’s policies, procedures, regulations, or administrative orders to interfere with their ethical practice of social work. Social workers should take reasonable steps to ensure that their employing organizations’ practices are consistent with the NASW’s Code of Ethics.”
“I was mocked, bullied, and had my clinical judgement called into question.”
To this end, Gamble spoke up, objecting to this jailhouse cruelty, advocating for the people inside these solitary cells.
Did her objections result in institutional policy changes, as neatly suggested in the Code of Ethics? Hardly. Instead, Gamble recalled, “I was mocked, bullied, and had my clinical judgement called into question. I utilized supervision and sought out support from my profession, but found that little support was available…”
Traumatized, Gamble resigned and left the profession.
Mary Gamble’s experience points to the powerlessness of the individual in effecting ethical changes within a host facility. This reality must be taken very seriously, especially amidst recent calls to more closely align social workers with law enforcement.
With the all-too-often brutal handling of people with mental illness by police, a solution gaining in popularity is to include social workers on these crisis calls. After all, social workers are well equipped to deescalate tense situations and handle people humanely. In a July letter to the Wall Street Journal, NASW CEO Angelo McClain endorsed this idea, stating that “… strengthening social worker and police partnerships can be an effective strategy in addressing behavioral health, mental health, substance use, homelessness, family disputes and other similar calls to 911.”
But not everyone agrees. When the mayor of Buffalo, New York, publicly endorsed this plan, he was met with swift opposition from social workers, mental health professionals and members of an organization called Agents of Change. They pointed to the clashing ideologies of the police—whose tools are handcuffs and tasers—and social workers, whose tools are empathy, compassion and listening. Nationwide, other social workers, such as Social Service Workers United-Chicago, and Alan Dettlaff, dean of the Graduate College of Social Work at the University of Houston, have expressed similar concerns.
This is a critical point, and raises many telling questions. If social workers and police officers worked together and a difference of opinion arose during a crisis, which is easily foreseeable, whose tactics would prevail? And would social workers be on the police department payroll? If so, this would be problematic.
When I worked on Rikers Island, I was not an employee of the Department of Correction, but of an outside hospital that contracted with the city to provide health services. Even so, working in the jails, I was still a “guest in their house,” and the implications of that were huge. The core problem was exactly what the Buffalo contingent outlined: fundamentally incompatible ideologies.
Our mental health team was continually being told we were too soft. Daily barbs from jail employees included that we were being “played.” He’s not going to kill himself, we were continually told. He’s not hearing voices. He’s faking it. Attempts to thwart our decisions were made at every turn. How would this dynamic be any different for social workers sitting in patrol cars?
It might be argued that our presence in carceral settings is valuable in providing skilled and compassionate care, and this much is true. For the person existing inside a solitary confinement cell, cut off from meaningful human contact for weeks, months and even years on end, we are their lifeline. We are caring faces at the cell door, assessing for depression and suicide risk. We also provide frontline information in the form of books and articles exposing the brutality behind prison walls to a world that otherwise, would never know.
But whether or not this is enough to offset complicity with this ethically objectionable system is questionable. Furthermore, an en masse refusal of all healthcare providers to be complicit with the system could bring rapid change.
The recent national recognition of social workers and their valuable skillset is well deserved. But how and where these skills should be used are profound questions for our profession. This unprecedented moment of awareness of social and racial injustice brings with it the possibility for transformation. Instead of serving as convenient pawns in a miserably failed response to people with mental illnesses, isn’t our real place to instead demand appropriate, compassionate care for our most vulnerable citizens? If such care were in place to begin with, there would be few crisis calls and far less trauma.
It is not enough to point to the Code of Ethics and walk away.
Prisons, jails and law enforcement situations are far from the only settings that pose ethical challenges. There are many others that demean people, such as punitive drug “treatment” programs, methadone clinics and the child protective system.
At a time when old systems are being exposed as racist, cruel and unjust, social workers must think hard about where we choose to be aligned. While our presence in solitary confinement units reduces suffering, the ethical dilemma of working in these units demands a far more robust response from our profession’s leadership. It is not enough to point to the Code of Ethics and walk away.
Leadership must squarely acknowledge the gravity of solitary confinement. They must make a good-faith effort to grapple with an admittedly complex issue, and become a meaningful resource for thousands of workers who try to provide good patient care inside the nation’s jails and prisons. With real guidelines in place, such as solid timelines limiting social work care in these units to weeks—instead of months and years—we might actually force changes to this practice from within, and bring relief to countless suffering people inside.
As frontline workers, we have the skills, the knowledge and the power to effect change. We are at a critical societal juncture—a golden moment for social workers to reject the crumbling systems of the status quo and leverage our skills toward humane, compassionate alternatives to complex problems, and in the process, to reaffirm our true ideals.