By Christie Thompson, ProPublica.
This story was co-produced with WNYC.
When Amir Hall entered New York state prison for a parole violation in November 2009, he came with a long list of psychological problems. Hall arrived at the prison from a state psychiatric hospital, after he had tried to suffocate himself. Hospital staff diagnosed Hall with serious depression.
In Mid-State prison, Hall was in and out of solitary confinement for fighting with other inmates and other rule violations. After throwing Kool-Aid at an officer, he was sentenced to seven months in solitary at Great Meadow Correctional Facility, a maximum-security prison in upstate New York.
Hall did not want to be moved. When his mother and grandmother visited him that spring, Hall warned them: If he didn't get out of prison soon, he would not be coming home.
A grainy tape of Hall's transfer on June 18, 2010, shows prison guards spraying chemicals into his cell, forcing him to come out. He barely says a word as he is made to strip, shower, bend over and cough. His head drops, his shoulders slump. His face is blank and expressionless. He stares at his hands, except for a few furtive glances at the silent guards wearing gas masks and riot gear.
"There was somebody who looked defeated, like the life was beat out of him," said his sister Shaleah Hall. "I don't know who that person was. The person in that video was not my brother."
Multiple studies have shown that isolation can damage inmates' minds, particularly those already struggling with mental illness. In recent years, New York state has led the way in implementing policies to protect troubled inmates from the trauma of solitary confinement.
A 2007 federal court order required New York to provide inmates with "serious" mental illness more treatment while in solitary. And a follow-up law enacted in 2011 all but bans such inmates from being put there altogether.
But something odd has happened: Since protections were first added, the number of inmates diagnosed with severe mental illness has dropped. The number of inmates diagnosed with "serious" mental illness is down 33 percent since 2007, compared to a 13 percent decrease in the state's prison population.
A larger portion of inmates flagged for mental issues are now being given more modest diagnoses, such as adjustment disorders or minor mood disorders.
It's unclear what exactly is driving the drop in "serious" diagnoses. But "whenever you draw a magic line, and somebody gets all these rights above it and none below it," said Jack Beck, director of the Prison Visiting Project for the nonprofit Correctional Association of New York, "you create an incentive to push people below." The association was one of a coalition of organizations that called for the change in policy.
The New York Office of Mental Health says the decrease reflects improvements to the screening process. Efforts to base diagnoses on firmer evidence "has resulted in somewhat fewer, but better-substantiated diagnoses" of serious mental illness, said a spokesman for the office in an emailed statement.
In Hall's case, prison mental health staff never labeled his problems as "serious."
Instead, they repeatedly downgraded his diagnosis. After three months in solitary — during which Hall was put on suicide watch twice — they changed his status to a level for inmates who have experienced "at least six months of psychiatric stability."
Two weeks after his diagnosis was downgraded, and two days after he was transferred to solitary at Great Meadow, guards found Hall in his cell hanging from a bed sheet.
As part of a report issued on every inmate death, the Corrections Department's Medical Review Board found no documented reason behind the change in Hall's diagnosis.
A 2011 Poughkeepsie Journal investigation detailed a spike in inmate suicides in 2010, which disproportionately took place in solitary confinement. Death reports from the state's oversight committee obtained by the Journal suggest several inmates who have committed suicide in recent years may have been under-diagnosed.
Hall's family is suing the Corrections Department and the Office of Mental Health, among other defendants, for failing to treat his mental illness and instead locking him in solitary.
"If someone knew anything, had any inkling that there was that going on, why was he put there?" asked his aunt Sonya Hall.
New York State's Office of Mental Health, which is in charge of inmates' mental health care, declined to comment on Hall's case, citing the litigation.
Amir Hall (or Mir, as his family calls him) was originally arrested in October 2007, for the unarmed robbery of a Verizon store. He made off with $86. Released on parole, he lived with his sister Shaleah Hall and her two sons while working at a local Holiday Inn and studying to become a nurse.
"Sometimes I sit there thinking that he's going to walk through the door and make everybody laugh," said Shaleah, who has "In Loving Memory of Amir" tattooed in a curling ribbon on her right bicep. "He was the life of the party. If you met him, you would just love him."
But Hall's mood could shift in an instant, Shaleah said. He was often paranoid, worried that people judged him for being gay. He would snap, then apologize repeatedly for it afterward.
"You had to walk on eggshells sometimes, because you never knew if he was going to be happy or sad that day," Shaleah said. "It was like this ever since we were kids."
One of those outbursts landed Hall back in prison for violating parole, after he got into a fight with Shaleah's friend.
Knowing her brother's history of mental illness, Shaleah said solitary confinement must have "drove him crazy."
"I feel like they treated him like an animal," she said. "They just locked him away and forgot about him."
The lawsuit over Hall's death claims mental health and prison staff ignored recommendations that he receive more treatment, and that staff members failed to properly assess his mental health when he arrived at Great Meadow.
In a response to the state oversight committee's assessment of Hall's case, the Office of Mental Health said they were retraining staff on screening for suicide risk. The Corrections Department said they were working to improve communication when inmates are transferred to new facilities.
Sarah Kerr, a staff attorney with the Prisoners' Rights Project of the Legal Aid Society, noted Hall's case during a Senate hearing on solitary confinement. "The repeated punitive responses to [Hall] as he psychiatrically deteriorated in solitary confinement exemplify the importance of vigilance and monitoring, and the need for diversion from harmful solitary confinement," she wrote.
Kerr points out that significant improvements have been made for inmates diagnosed above the "serious" mental illness line. The new mental health units provide at least four hours of out-of-cell treatment a day, and speed up an inmate's return to the general population.
"I don't think those improvements should be taken lightly," said Kerr. "In terms of mental health policy, we're way ahead of the country."
But when it comes to solitary confinement, "New York is among the worst states," said Taylor Pendergrass of the New York Civil Liberties Union, which is suing the state over its use of isolation. "Even if you're totally sane and you go into solitary, it's incredibly hard to deal with the psychological toll of that," he said.
Solitary confinement is used in jails and prisons across the country, though there's no reliable data to compare its prevalence among states. Experts say New York stands out for sentencing inmates to solitary for infractions as minor as having too many postage stamps or a messy cell. A report from the NYCLU found that five out of six solitary sentences in New York prisons were for "non-violent misbehavior."
Under the state's new law, all inmates housed in solitary — known in New York as Special Housing Units, or SHU — receive regular check-ins from mental health staff. The screenings are meant to catch inmates not originally diagnosed with a disorder who develop problems in isolation.
But Jennifer Parish, director of criminal justice advocacy at the Urban Justice Center, said she thinks many staff members still view inmates' symptoms as attempts to avoid punishment. "If you don't believe that being in solitary can have detrimental effects to a person's mental health, you're going to see someone who just says, 'I want to get out of here,'" she said.
Beck has seen the same skepticism in conversations with some prison staff. "There's a bias in the system that looks at the incarcerated population as anti-social, malingerers, manipulators," Beck said. "I hear that all the time."
When inmates ask to see mental health staff, "we have found far too often that it appears security staff really resent people asking for these interventions," Beck said. "We have in a few facilities what I think are credible stories of individuals being beaten up when they want to go to the crisis center."
As Sarah Kerr sees it, "if mental health staff are overly concerned that people are feigning illness, that they're conning their way out of special housing ... that will lead to tragedies."
The Corrections Department says any unusual behavior by inmates or attempts to hurt themselves are reported to mental health staff. A spokesman for the Office of Mental Health said "inmates reporting psychiatric symptoms are taken seriously and assessed carefully."
Donna Currao said prison staff ignored her and her husband, Tommy Currao, when he attempted suicide at least 10 times over the course of 10 months in solitary confinement. According to his wife, Currao had been sent to solitary after testing positive for heroin.
Currao's first suicide attempt in solitary was in July 2012, when he tried to overdose on heroin. That October, guards found him attempting to hang himself in his cell. While on suicide watch after he tried again to overdose, Currao broke open his hearing aid and used the metal inside to cut his wrists. (He received a bill of $500 for "destruction of state property," Donna said.)
Both the Corrections Department and the Office of Mental Health declined to comment on Currao's case.
According to the Corrections Department, an inmate can be returned to solitary confinement after being on suicide watch if they're cleared by the Office of Mental Health. In 2011, 14 percent of the 8,242 inmates released from New York's mental health crisis units were sent to solitary confinement.
After just three weeks in isolation, Donna noticed a dramatic change in her husband. He "was withdrawn, all he would do is apologize," Donna said. He was no longer laughing with her, playing cards or chatting with other inmates. She watched him drop from 240 pounds to 160.
Currao stopped writing the almost daily letters he'd sent for 13 years. When Donna persuaded him to start again, as a way to escape, he talked of an overwhelming sadness.
Donna says she repeatedly called the prison. She faxed them copies of Currao's suicidal letters. But he remained in isolation.
"I don't know if they don't want to spend the money, or think it's a joke," she said. "They still thought he wanted out of solitary. He wanted out of the picture is what he wanted."
A survey by the state's independent oversight committee found many family members who said prison officials didn't listen to concerns about inmates' psychological wellbeing. None of the mental health files reviewed by the oversight committee contained information from family members about a prisoner's psychiatric history.
The Office of Mental Health says it's working on creating new procedures to "insure that the call is responded to promptly and in a manner that addresses the family member's concern as best as possible."
Prisoner rights advocates are also working on a new legislative proposal to ensure that mentally ill inmates get the treatment they need. A coalition of groups is drafting a new bill, which would expand protections from solitary for inmates with mental illness, and put a limit on solitary confinement sentences for any prisoner, whether or not they're diagnosed with a disorder.
"Even though there's a law that says you can't do this for people with serious mental illness, it hasn't stopped [Corrections] from using solitary," said Parish. "I think they just replaced it with lower-level tickets instead of some of the most serious ones."
In May, Donna's persistence in trying to get her husband treatment finally saw results. Currao met with a psychologist, and was diagnosed with "serious" anti-social personality disorder and dysthymic disorder. He was moved out of solitary confinement and into one of the 170 Residential Mental Health Treatment beds created under the recent law.
Currao "seems to be 1,000 times better" since entering treatment, Donna said. He talks about wanting to become a counselor when he's released.
But Donna wonders why it took so many suicide attempts and nearly a year of pressure to get her husband a proper diagnosis and the treatment he was legally owed. "They are not enforcing this law," she said. "Why do we have to fight so hard to get them evaluated?"
Hall's family is left with the same questions as they search for answers about his death. "How many more people have to die?" Shaleah asked. "They need help. Locking them away is hurting them more."