Day or night, the lights inside cell 135C of central New Mexico's Valencia County Detention Center were always on.
Locked inside, alone, for months, Jan Green — a 52-year-old computer technician with schizophrenia and bipolar disorder — rocked on a bench for hours, confiding in an imaginary companion.
"I would talk and hold conversations just in my little crazy world, I guess you would say, just to keep me company," Green says.
Though isolated, Green was, in a sense, far from alone. In jails around the country, inmates with serious mental illnesses are kept isolated in small cells for 23 hours a day or more, often with minimal treatment or human interaction.
Some states have moved to curb long-term "solitary confinement" in prisons, where research shows it can drive those with mental illnesses further over the edge. But there has been little attention to the use of isolation in the country's 3,300 local jails, the biggest mental health facilities in many communities.
Unlike prisons, jails hold those awaiting trial or serving shorter sentences, limiting time in lockdown. But inmates with serious mental illnesses are more likely to break rules and stay jailed longer, increasing the chances of weeks or months in isolation that risks inflicting additional psychological damage.
A report obtained by The Associated Press found mentally ill inmates in New York City's jails were disproportionately put in lockdown, some for thousands of days. Inmates who spent time in isolation were far more likely to harm themselves, according to a second report by staff of the city's health department.
"At many jails and prisons around the country, solitary confinement has become kind of the default placement for the mentally ill," says Dr. James Gilligan, a New York University psychiatrist and lead author of the first study.
Jails use isolation to punish inmates, but also to separate those with serious mental illnesses because they may be victimized by fellow inmates or are considered dangerous. Many end up in lockdown because of behavior linked to mental illnesses, experts say.
"If they can't follow the rules outside the facility, how in the world do you expect a mentally ill person to be able to function as an inmate?" says Mitch Lucas, assistant sheriff of Charleston County, South Carolina, and president-elect of the American Jail Association. "So you end up having to deal with whatever tools you have at hand and, in many jails, the tool is restrictive housing and that's it."
The number of inmates with mental illnesses has been rising since the 1970s, when states began closing psychiatric hospitals without creating and sustaining comprehensive community treatment programs.
Jail operators say critics mischaracterize treatment of inmates in isolation, but acknowledge growing debate over lockdown.
—In New Mexico, three counties have been sued since 2008 for holding inmates with serious mental illnesses in lockdown for between eight months and two years.
Green won a $1.5 million settlement in January after suing Valencia County. Since her release, she has been treated for post-traumatic stress disorder, triggered by the sounds of doors locking or the sight of people in uniform.
—In Tennessee, a 2011 Justice Department investigation of the Robertson County Jail, north of Nashville, found that officials denied treatment to seriously mentally ill inmates, instead isolating them in long-term "therapeutic lockdown," where they were denied any interaction with staff, including health providers.
—In Ventura County, California, when inmate Daniel Hernandez committed suicide in 2009, it had been more than three months since he'd seen a jail psychologist, a lawsuit by his family alleged. He was locked in a segregation cell where the opening in the door was covered with a piece of paper.
Officials isolated Hernandez "despite indications that segregation housing was adverse to his mental health condition," a judge wrote. The county settled the suit by agreeing to pay the family $775,000.
—In Dane County, Wisconsin, jail inmates with serious mental illnesses are routinely kept in isolation cells about 6 feet wide. Deputies attempt to get inmates out daily to shower, but the most mentally unstable inmates often refuse to leave their cells, Sheriff David Mahoney said.
"They can't be housed in general population because they could be victims themselves, so we're forced to house them in solitary confinement because it's the only housing we have," Mahoney said.
Mahoney said he is concerned that isolation makes mental illness worse. Research bears that out.
In prison, healthy inmates isolated for months show disordered thinking which becomes paranoia, despair that can lead to suicidal thinking and depression, said Dr. Terry Kupers, a psychiatrist who, as an expert witness, has investigated numerous correctional facilities. It's worse for mentally ill inmates.
"You put them in solitary and they break down," Kupers says.
One of the few studies in jails, examining 244,000 incarcerations in New York City, found inmates who inflicted life-threatening injuries were 10 times as likely to be both seriously mentally ill and have spent time in isolation. New York officials have moved recently to reduce isolation of mentally ill inmates. But that comes after years of expanding lockdown.
Green says jail left her with deep psychological scars. She was arrested twice in 2009, charged with assaulting her husband. For much of 2010 and 2011 she was held alone in a small segregation cell near the jail's booking area.
"The reason she was moved into administrative segregation was for her own safety and the safety of others," says Brandon Huss, an attorney who represented Valencia County in the case. Other inmates would "wake up and find her face in their face."
Nearly three years later, Green, now living in Minnesota, flashed back recently when she entered a restaurant and saw a waitress whose uniform reminded her of a jail guard's.
"She's definitely not the same woman she was going in," daughter Jessalyn Middendorf says. "She's not the mother that I knew, that I grew up with."
Adam Geller can be reached at firstname.lastname@example.org. Follow him on Twitter at https://twitter.com/adgeller