AT JUST 5 FEET TALL, Christopher Carroll could barely see out of the two narrow window slats of his cell door in San Diego’s Central Jail, where he ended up on June 14, 2014, for disorderly conduct and being drunk in public.

Four days after his arrest, Carroll committed suicide. Because of his small stature and age — he was 51 — he’d been placed in protective custody, a classification reserved for inmates deemed too vulnerable to be housed in the jail’s general population. According to the medical examiner’s report, he was also classified as “Keep Separate All,” a status that further isolated him, because during a previous jail stay, he didn’t get along with other inmates.

The report notes that every 48 hours, he was allowed one hour of dayroom time, per jail policy. At 11:45 a.m. on June 18, Carroll asked via intercom whether it was time for his hour and was told no. Forty-five minutes later, during a routine security check, he was found hanging in his cell.

The medical examiner’s report describes blood on the wall of Carroll’s cell and abrasions on his forehead, suggesting he’d been hitting his head against the wall. There was urine on the cell floor and food and feces on the ceiling.

Carroll, who was homeless, had struggled with alcoholism and mental illness, according to his brother Ken. The family had tried repeatedly, and unsuccessfully, to help him. Ken wondered if solitary confinement had pushed Carroll to kill himself.

“He just didn’t like four walls,” Ken told me. “He couldn’t stand four walls.”

IN SEPTEMBER, California agreed to drastically reduce the use of solitary confinement in its prisons, the result of a 2012 lawsuit by the Center for Constitutional Rights, filed on behalf of inmates at Pelican Bay State Prison, a supermax facility located just south of the California-Oregon border. The lawsuit, Ashker v. Brown, argued that Pelican Bay’s reliance on prolonged, indefinite solitary confinement — one plaintiff had been in isolation for 43 years — was unconstitutional.

To settle the case, the California Department of Corrections and Rehabilitation (CDCR) agreed to system-wide changes, including limiting the use of solitary confinement to punishment for serious rule violations and not, as had been the practice, to house inmates with gang ties. The settlement also establishes procedures to prevent inmates from being held in a prison’s security housing unit, or SHU, indefinitely.

But the Ashker settlement has no bearing on California’s 123 jails and their roughly 73,000 inmates, which are under the control of county sheriffs’ departments.

The recreation area at San Diego’s Central Jail.

But while each jail system sets its own policies, those policies are guided by the state’s Minimum Standards for Local Detention Facilities, also known as Title 15. That’s where the policy that allowed Christopher Carroll only one hour of dayroom time every 48 hours comes from. Title 15 recommends that jails allow inmates a minimum of three hours of recreation time each week. “Recreation,” however, isn’t defined, and in urban jails that lack outdoor space, this could mean an hour in a concrete room with nothing but a pull-up bar, or, as watchdog group Prison Law Office found in one county facility, an hour to walk around an empty cell. And even though Title 15 says three hours of out-of-cell time is the minimum for all inmates, in secure housing in many facilities, it’s the standard.

“A lot of staff will say, ‘We meet the Title 15 requirements,’” said Anne Hadreas, a staff attorney at Disability Rights California (DRC), which recently found widespread use of solitary confinement during jail inspections in several California counties. “Our response is that doesn’t actually save you in terms of liability. Just because you have a state regulation doesn’t overcome your constitutional liability.”

The damaging effects of isolation are well-documented, though the focus, understandably, tends to be on prolonged solitary confinement, like that experienced by Pelican Bay inmates who, as social psychologist Craig Haney testified in the Ashker case, experience a “social death” — the loss of the ability to simply interact with people. But even short-term confinement can cause lasting harm. More than a century ago, in an 1890 opinion in a case challenging a Colorado inmate’s placement in solitary confinement, U.S. Supreme Court Justice Samuel Freeman Miller described a Philadelphia jail “experiment” that found that inmates placed in isolation for “even a short confinement” fell into “a semi-fatuous condition, from which it was next to impossible to arouse them, and others became violently insane; others still, committed suicide.”

The inmates who didn’t crack in isolation, Miller wrote, “were not generally reformed, and in most cases did not recover sufficient mental activity to be of any subsequent service to the community.”

Excerpts from Miller’s opinion are included in DRC’s recent report on conditions in Sacramento County’s two jails. DRC attorneys toured the jails in April — federal law gives them the right to enter and inspect any facility that houses people with disabilities. The report describes “widespread overuse of isolation,” sub-par mental health care, and inmates being placed in isolation due to mental illness or a physical disability. The jail’s “most generous” restrictive housing policies, the report says, keep inmates in their cells 21.5 hours a day, while in the jail’s “Total Separation” unit, inmates are locked up for all but 30 minutes a day — at least according to jail staff. Every inmate DRC spoke with described receiving far less out-of-cell time than reflected in policy. Some inmates said they’d sometimes go three days without leaving their cells, which also means no showers and no chance to make phone calls to family or attorneys.

Most troubling are descriptions of the main jail’s 18-bed inpatient psychiatric unit, where inmates, the report says, are allowed out of their cells “only once or twice per week.” Cells in the unit have no desks or chairs, and the dayroom, described as dirty and smelling of feces, was bare except for one bench. Clinical visits, the report says, take place through the cell-door food port, raising issues of confidentiality and therapeutic effectiveness. During the tour, an inmate in the unit tried to commit suicide by sticking his head in a toilet.

DRC submitted its report to the Sacramento County Sheriff’s Department in early August and received a written response in mid-September. Hadreas said it wasn’t what they were hoping for. While the department indicated it wanted to work with DRC, there had been no concrete steps to reduce isolation and improve mental health conditions, she said.

A sheriff’s department spokesperson did not respond to a request for comment.

Hadreas said DRC is considering whether to upgrade its monitoring of the jail to an investigation, and from there, if necessary, a lawsuit. But she hopes that won’t be necessary.

“These are their initial responses and the hope is that this is just the first step in working together to create a better system,” she said.

The Sacramento County Main Jail in California.

There’s no official count on how many California jail inmates are kept in isolation. But a recent Bureau of Justice Statistics survey found that, nationwide, nearly one out of five jail inmates spent part of 2011-12 in restrictive housing. Of those, roughly a quarter reported a mental illness diagnosis. Inmates in restrictive housing, the survey found, tend to be people of color, younger, less educated, and lesbian, gay, or bisexual.

Cat Sanchez, a transgender inmate, has been in solitary confinement in the Tulare County men’s jail in central California for nearly two years. Compared with other jails, her out-of-cell time is generous: She gets an hour in the dayroom each day and an hour outside every other day.

Sanchez said she’s struggled with mental illness, exacerbated by isolation. She’s threatened suicide multiple times. She understands that being transgender raises safety concerns, but she believes there are better options than keeping her locked in a cell for 23 hours a day. So, she repeatedly files grievances, asking to be moved to less restrictive housing. She’s been told her only other option is to be moved to an older part of the jail where the cells have bars and are considered more “open,” she said. Right now, she said, her cell door has a 6-inch square window.

“This has caused me to cut myself,” she said in a phone interview. “I’ve never done it ever before. You can’t just put somebody in a little room and leave them there and expect them to be fine.”

Jonathan Laba, a Contra Costa County public defender, said he’s seeing too many mentally ill inmates with behavior issues end up in isolation — allowed only an hour out of their cells every other day — instead of the jail’s designated mental health module.

“When you have a mentally ill inmate placed on lockdown in a small cell with almost no contact with the outside world, their mental illness inevitably gets worse,” he said.

Sanchez said she recently pleaded guilty to trying to kill her boyfriend. She’ll serve her sentence in a state prison where she hopes she’ll have a cellmate, someone she can talk to.

“Once I get back in [prison], if I had a bunkie, I could be making food right now, we could be talking about his family and mine, playing cards. Once you have somebody you get along with, it’s really nice.”

Kelly Knapp, a staff attorney with Prison Law Office, said she receives letters weekly from jail inmates throughout California who feel they’ve been wrongly placed in restrictive housing. Many have disabilities or only vague gang ties.

Earlier this year, she started hearing from inmates in Santa Clara County’s main jail, particularly from a group of inmates with gang-related charges who’d been moved, allegedly without explanation, from general-population cells to isolation.

In a June 25 letter to Santa Clara County Sheriff Laurie Smith, Don Specter, Prison Law Office’s executive director, noted that inmates in one section of the jail — including the group with the gang charges — reported being denied outdoor exercise for at least seven months.

“During that seven-month period,” Specter wrote, “their only ‘yard’ was a small, empty cell in their unit. In this ‘yard,’ they had no access to fresh air or natural light, and no room to exercise. This is in stark contrast to the SHU at Pelican Bay State Prison where convicted prisoners in the most restrictive setting receive 10 hours of outdoor yard time each week.”

These are pre-trial inmates who have not been convicted of anything, Specter points out, yet they’re kept in their cells 23 to 24 hours a day, have limited visit and phone privileges, are handcuffed and shackled when they leave their cells, and regularly subjected to body cavity searches, despite not coming into contact with other inmates.

“We have toured scores of jails and prisons throughout the nation,” Specter wrote in a subsequent letter, “and the conditions we observed in the Santa Clara Jail units were harsher and more punitive than most we have visited.”

Knapp said Prison Law Office plans to sue the county over jail conditions.

“We have offered and would prefer to work cooperatively with the sheriff, but we have no choice but to pursue litigation because she won’t come to the table with us.”

Sgt. James Jensen, the sheriff’s spokesperson, said Smith appreciates and takes seriously Prison Law Office’s input. Jensen said the sheriff is convening a Blue Ribbon Commission to examine jail conditions and encourages Prison Law Office to be part of that process.

A hallway in California’s maximum security Pelican Bay prison, May 1, 2000.

UP UNTIL A FEW YEARS AGO, jail sentences in California were limited to a year. Anything longer and you went to prison. But in 2011, after a federal court ordered the state to drastically reduce its prison population, the Legislature passed the Public Safety Realignment Act. Under the act, felony offenders who’ve committed low-level crimes — no violence and nothing of a sexual nature — now serve time in jail instead of prison, some upwards of five years in facilities designed for short-term stays. Parole violators — except those paroled from a life sentence — who in the past would have been sent back to prison are sent to jail, too.

This is all happening in older facilities that lack recreational and therapeutic space. According to a recent report by the Public Policy Institute of California, roughly half of California’s 123 jails were built before 1980. Since 2011, the state has issued three rounds of funding to address jail infrastructure needs, though initial spending focused mostly on alleviating overcrowding. Now sheriffs are thinking about ways to create more dayroom space and dedicated mental health care units, said Brandon Martin, a PPIC research associate focusing on corrections.

Martin’s been touring jails around the state. He said sheriffs know things need to change, and they’re concerned that if they don’t, they’ll be sued.

Knapp said overhauling Title 15 would be a first step to curbing isolation. She’s submitted recommendations to the Board of State and Community Corrections (BSCC), which is currently collecting input for a Title 15 update.

She wants to see the three hours minimum recreation time increased, especially for mentally ill inmates, and more flexibility in how inmates are classified. Inmates should be segregated only if they pose a threat and placed in the least restrictive setting possible, she said. But Knapp worries it will take too long to update Title 15 and, even then, jails aren’t required to follow the guidelines.

“Inmates can’t wait for that process to play out,” she said. “They are suffering from real harm now.”

BSCC Deputy Director Alison Ganter said the board is in the beginning stages of updating Title 15. She agrees isolation is a problem many jails aren’t equipped to address.

“There’s nobody out there that wants to keep people in their cells all the time,” Ganter said. “Mostly [isolation] is just for reasons of necessity. Jails aren’t designed properly to get certain inmates out for certain amounts of time.”

IN SAN DIEGO’S CENTRAL JAIL, where Christopher Carroll hung himself, there are no outside-facing windows. There had been windows when the facility was constructed in the mid-1990s, but over the years, inmates broke the windows, some intending to use the shards to cut themselves. Now all the windows are covered over. Inside the jail, the only fresh air and natural light come from a grate with large holes that’s roughly a dozen feet off the ground in each floor’s small recreation area.

Earlier this year, the sheriff’s department overhauled its suicide prevention policies and started looking for ways to provide inmates diagnosed with a mental illness with a more therapeutic environment and closer monitoring. As for inmates in secure housing, Jail Commander John Ingrassia said the goal is to get them out of their cells for at least an hour a day. The recreation yards at the county’s largest jail, the George Bailey Detention Facility, have been divided up to allow more inmates out at one time. And guards are figuring out which inmates get along best in order to allow groups out of their cells — as opposed to single inmates — for longer stretches.

There’s also an increasing realization that punitive measures are counterproductive, not only for mentally ill inmates, but also for inmates who end up in isolation for disciplinary reasons. Programming and activities keep inmates out of trouble, while idleness exacerbates underlying issues.

“Staff has started to realize that it makes their job easier the more these guys stay entertained,” Ingrassia said. “Anyone sentenced to our custody is going to return to the public. If you leave them locked up for 24 hours a day, or 46, 47 hours, what are they going to be like when they get out?”