physicians have concluded that for those inmates who enter the prison already diagnosed with a mental illness, the punishment of solitary confinement is extremely dangerous in that the inmates are more susceptible to exacerbating the symptoms. professional organizations, like the national commission on correctional health care (ncchc), the american college of correctional physicians, and american psychiatric association (apa), work to improve the mental health services, however, the systems within the prisons "remain woefully inadequate." "psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis." these studies suggest that a main issue with isolating prisoners who are known to have mental illnesses is that it prevents the inmates from ever possibly recovering. instead, many "mentally ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization." it is also noted that if a prisoner is restrained from interacting with the individuals they wish to have contact with they exhibit similar effects.