Randy Poindexter no longer hears the nagging voices in his head or feels the raw desire to carve bloody ruts in his arms and body.

But he hasn't forgotten the 16 years he spent locked in solitary confinement in South Carolina's prisons or the ravaging effects it had on his sanity. The memories are as clear as the scars that snake across his skin; as fresh as the screams that shake his fitful slumber at night.

For 3,092 days, the North Charleston man sat alone in a cell, nearly devoid of human contact as he stared at the walls for at least 23 hours at a stretch. Paranoia and depression set in, then hallucinations and self-mutilation. He cut himself to relieve stress. Others he knew took their own lives rather than endure the forced solitude.

"It's still hard, every day," Poindexter said, his head bowed, his voice a soft drawl. "You would think after being out for five years I wouldn't still be thinking about it. But I do. All the time. When I went into prison, I didn't have near the problems I had coming out."

Poindexter, 48, has watched with keen interest these past several months as lawyers, lawmakers and others have debated the impact of a landmark court ruling that blistered the state for its treatment of an estimated 3,500 inmates with severe mental illnesses.

He was among the inmates who shared their horror stories for the decade-long, class-action lawsuit that led to former Circuit Judge Michael Baxley's ruling in January. The order calls for a sweeping overhaul of prison practices, including a sharp reduction in the use of solitary to control the mentally ill behind bars.

Though the state Corrections Department plans to appeal, its new director, Bryan Stirling, has pledged to make reforms, nonetheless. The agency is hiring more mental health staff, boosting training and taking steps to make solitary an option of last resort, mirroring a national trend, officials said.

A number of states, from Maine to Mississippi, have been shifting away from the use of solitary confinement, embracing the argument that long periods of forced isolation is psychologically damaging for prisoners, particularly for those already battling mental illness. South Carolina corrections officials have been consulting with a key player in the prison reform movement in Mississippi, which has dramatically reduced the number of inmates in its long-term segregation units.

Since January, the number of South Carolina inmates in "special management units" has dropped from 1,705 to 1,663, Corrections spokeswoman Stephanie Givens said. "We are making changes and we are making progress."

Though change may come, it will be too late to help Poindexter. He did his time and he's back in the community, trying to put the damage behind him with the aid of counseling, his family and the nine medications he ingests daily to control his bipolar disorder and schizophrenia.

His story illustrates the challenges in providing therapeutic care in an underfunded, understaffed correctional system built more for punishment than redemption. It also shows the resiliency of the human spirit and its ability to bounce back from a time when painting the cell walls red with his own blood was the only thing that brought Poindexter peace.

Joy Jay, executive director of Mental Health America in Columbia, has seen many former inmates struggle to readjust to the outside world after spending years locked away alone. A good number end up back behind bars, unable to find a place to live, a job to support themselves or a way of coping in a world they no longer understand.

Consider the case of Jonathan Roe, another mentally ill inmate who spent years in solitary. He stabbed and shot his new bride to death last year in Anderson County just months after his release from prison. He's now back behind bars, serving 40 years.

"They really have so many barriers against them," Jay said. "Think about coming out of solitary after 16 years of being caged up. How do you adjust to open society at all?"

Losing his way

Poindexter grew up in North Charleston, the middle brother of three, and the one who seemed destined for trouble. He started drinking at 13 and doing drugs a couple years later. By the time he came of age, he already had a juvenile record with assault and car theft convictions.

Not long after getting out of prison for armed robbery and assault, Poindexter got busted again in early 1987 for breaking into a North Area home with another man. The elderly residents returned in the midst of the crime and Poindexter waved a gun at them while trying to escape, elevating the offense to first-degree burglary and armed robbery.

Prosecutors described Poindexter as a "very dangerous man," and a judge sentenced him to 20 years in prison. He was 21 years old.

Like a good number of mentally ill people who end up behind bars, Poindexter never received psychiatric care before entering the prison system, though he had been given medication commonly used to treat schizophrenia while staying at a juvenile group home. His initial diagnosis in prison revealed bipolar disorder, commonly known as manic depression, records reveal.

From the start, Poindexter said, he just couldn't conform to prison life.

At Lieber state prison in Ridgeville, Poindexter used a homemade shank to stab a fellow prisoner who had robbed his cellmate. That landed him in the prison's special management unit, where inmates are locked up alone nearly around the clock and fed through a slot in the door.

In solitary, Poindexter became even more defiant and hostile. He flooded his cell, cussed and assaulted prison staffers and caused other problems. That led to more punishment, more time stacked onto his stay in the segregation unit. Three months became six, which then became a year, and so on. In no time, this temporary punishment became a way of life.

Corrections officials defended long-term segregation for many years, saying it was the only way to keep unruly inmates from disrupting the general population and posing a risk to other inmates and staff. But Baxley found the practice had been overused, with mentally ill prisoners locked in solitary at twice the rate of other inmates - often for years at a time - and provided with a "grossly inadequate" level of care.

Poindexter said that's because corrections officers viewed mentally ill inmates simply as troublemakers, someone to be gassed, strapped in a restraining chair or tossed in a crisis cell naked with the air conditioning turned up.

"Rather than treat me for mental illness, they treated me as a behavioral problem," he said.

Corrections officials said records show Poindexter had ample access to medication and counseling, but Poindexter insists he often went long stretches without either - a condition also found by Judge Baxley to be widespread in the state prison system. When he did get medication, Poindexter said, the dosage was often too strong, particularly with the anti-psychotic drug Haldol.

"I would go to see him and he would be walking around like a zombie," his mother, Linda Barrs, said.

Unraveling

Poindexter said he didn't realize how bad it could get until he was punished for slashing a guard who he believed had set him up to be ambushed by other inmates in 1997.

Officials dispatched Poindexter to the "super max" unit at Kirkland prison in Columbia, a spot reserved for the most dangerous and high-risk prisoners. There, he was virtually cut off from the world and subject to punishment for even talking out of turn, he said.

In this near total isolation, he began seeing things and hearing voices in his head. "They would tell me I was going to die in there, that I wasn't no good and I deserved to die - all kinds of scary stuff," he said. "I never cut myself until they put me in there. I never even thought about it. But just sitting in that cell, staring at the walls every day, it will drive you nuts."

"Cutters," as they are known, are a distinct class in the prison system, routinely and ritually carving wounds in their bodies. Some do it for attention, some for a chance to escape their cells, if only for a trip to the infirmary. Many, like Poindexter, say the blood-letting and pain helps them relieve stress and gain some form of control over their lives.

Poindexter sliced his body from top to bottom with razor blades or whatever other sharp objects he could find or fashion. He caused serious injury to himself on several occasions and ended up hospitalized.

On one occasion, he refused medical help until he had finished painting his cell walls with his own blood. When he finished, he stood in the middle of the room, looked around, and felt, for the moment, at peace. "I felt like a weight had been lifted off my shoulders," he said.

Poindexter was sent to a prison psychiatric hospital several times for his cutting, but again and again he was returned to the super max unit at the end of his stay.

"I told the prison officials I was losing my mind," he said. "They did not care."

After 16 years in lockup, Poindexter was finally assigned to a special unit at Kirkland designed for mentally ill inmates. There, he said, he received consistent counseling and medication. Gradually, his symptoms began to subside and his behavior calmed, he said.

He was released from prison on June 1, 2009. A guard escorted Poindexter to the front gate, expressing little confidence that he would make it on the outside. "I'll see you back here in 30 days," the guard quipped.

Poindexter's mother handed him a new wallet, $100, a cellphone and a gold cross to wear around his neck - some things to help get him get a new start. He bought a Snickers bar and a Pepsi at a store, just because he could, and then returned to a world that had passed him by.

Life on the outside

Poindexter has kept out of trouble since that day. He mainly stays home, helps his mother and cares for his ailing stepfather, who has cancer. For the first couple years, on the anniversary of his release, he would call the guard who doubted him, just to say he was still a free man.

But it hasn't been easy returning from the isolation in which he was kept. He has no friends, no real social life outside his family. He can't find a job and subsists on disability payments. He has trouble trusting others and difficulty sleeping, his dreams often carrying him to the cell that defined his world.

His family has been his bedrock since leaving prison, along with regular counseling he receives at Charleston Dorchester Mental Health Center.

The case manager he sees, Bob Coskrey, said he's been impressed with Poindexter's progress since arriving at the center nervous, agitated and withdrawn. He's now focused, works hard to care for his family and would likely prosper in a regular job if he could find one, he said.

"Randy's done exceedingly well considering all he's been through. It's amazing, really," he said. "The fact is, he had a serious mental illness which was made even worse by what happened to him in prison."

Poindexter said his one hope is that the system changes as a result of the class-action lawsuit, that more focus is placed on treatment for inmates and training staff to deal with the mentally ill. Prison officials insist such changes are already underway.

Poindexter hopes so. Four mentally ill men he befriended in prison killed themselves rather than live another day behind bars. He stills wears the wedding band one man gave him before committing suicide by hanging himself with a sheet. At times, Poindexter is still amazed he made it out alive.

"If I hadn't gotten into (the mental health unit) I'd probably still be locked up there today," he said. "I never expected to get out of there. I don't think anyone expected me to."