By Bruce Western

A large social science research literature examines the effects of prisons on crime and socioeconomic inequality, but the penal institution itself is often a black box overlooked in the analysis of its effects. This paper examines prisons and their role in rehabilitative programs and as venues for violence, health and healthcare, and extreme isolation through solitary confinement. Research shows that incarcerated people are participating less today than in the 1980s in prison programs, and they face high risks of violence, disease, and isolation. Prison conditions suggest the mechanisms that impair adjustment to community life after release provide a more complete account of the costs of incarceration and indicate the performance of prisons as moral institutions that bear a responsibility for humane and decent treatment.

Journal of Economic Perspectives—Volume 35, Number 4—Fall 2021—Pages 1–27

By The Delaware Community Legal Aid Society, Inc. Disabilities Law Program

The Disabilities Law Program (DLP) of Community Legal Aid Society, Inc. (CLASI) serves as Delaware’s Protection and Advocacy (P&A) system, charged with protecting the legal rights of people with physical and mental disabilities. Under federal law, P&A systems have the authority to conduct monitoring and investigative activities in a variety of settings where people with disabilities live and receive services, including correctional facilities. Conditions in correctional facilities are of great concern to CLASI and to other P&A systems around the country, due to the overrepresentation of people with disabilities, including mental illness, in correctional settings. Research also suggests that the experience of incarceration, and of segregation or solitary confinement in particular, can cause mental health problems and also exacerbate existing mental illness. History of CLASI’s Interventions on Behalf of Incarcerated People with Mental Illness Held in Solitary Confinement In 2013, CLASI and the ACLU of Delaware became troubled by reports they were receiving about the placement of individuals with serious mental illness in solitary confinement, meaning that they were confined to cells for at least 22 hours per day, often for extended periods of time. After investigation, in 2015 CLASI, the ACLU, and Pepper Hamilton LLP filed a federal lawsuit, CLASI v. Coupe, against the Delaware Department of Correction (DDOC), which detailed concerns about the treatment of individuals with mental illness placed in restrictive housing environments, including solitary confinement. These concerns included minimal out-of-cell time, lack of access to mental health treatment, and conditions for individuals placed on suicide watch. The parties settled the suit in 2016, and DDOC agreed to make several changes related to the use of restrictive housing. These included: increased mental health staffing; minimum requirements for out-of- cell time; establishing that individuals could not be placed in disciplinary detention for more than 15 consecutive days; requiring a break of at least 15 days between disciplinary detention sanctions; and that no individual classified as seriously mentally ill could be placed in disciplinary detention for any period of time unless they presented an immediate danger and there was no reasonable alternative. The terms of the settlement were effective for five years and concluded in 2021. While the settlement was in effect, CLASI monitored DDOC’s progress by reviewing data, meeting regularly with DDOC leadership, and conducting on-site facility visits with an expert monitor. CLASI’s Recent Monitoring of Correctional Facilities and Treatment of Individuals with Mental Illness In the spring of 2023, CLASI retained two experts to assist its staff in conducting updated monitoring, in order to assess current conditions at DDOC facilities with a specific focus on restrictive housing units, including designated mental health units and units housing individuals in disciplinary detention. CLASI’s monitoring found areas where DDOC appeared to remain in compliance with the policy changes agreed to as part of the CLASI v. Coupe settlement. It also found areas where additional progress had been made, particularly in the implementation of Residential Treatment Units (RTUs) for individuals with mental illness at two facilities. However, the monitoring also identified several major areas of concern. These areas included: suicide prevention practices, the need to expand RTUs, the continuum of mental health services and crisis intervention practices, substance abuse treatment protocols, and the use of punitive point and classification systems and privilege sanctions as “backdoor” methods to restrict and isolate incarcerated individuals, now that more traditional disciplinary detention practices, such as solitary confinement, have been reformed. CLASI is particularly concerned with the need for increased transparency and data sharing to enable it to effectively assess current conditions and carry out its obligations as the P&A. During the monitoring process, DDOC unfortunately denied many of CLASI’s requests for more specific data and information, which made it difficult to assess how DDOC’s current practices compare with those reported while the CLASI v. Coupe settlement was in effect. There is a particular need for more transparency with respect to DDOC’s practices surrounding the use of points-based classification, privilege restrictions, and administrative segregation. CLASI urges DDOC to review the findings and specific recommendations in this report, summarized below, to ensure that incarcerated Delawareans with mental illness are treated fairly and humanely. We also urge DDOC to increase transparency by collecting and making available data regarding the length of restrictions, use of point-based classification, privilege restrictions, and administrative segregation in its facilities.

The Delaware Community Legal Aid Society, Inc, 2024. 25p.

By Justin D. Strong, Keramet Reiter, Gabriela Gonzalez, Rebecca Tublitz, Dallas Augustine, Melissa Barragan, Kelsie ChesnutI, Pasha Dashtgard, Natalie Pifer, Thomas R. Blair

We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.

PLoS ONE, 2020, 20 p.

By Keramet Reiter, Joseph Ventura, David Lovell, Dallas Augustine, Melissa Barragan

Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement. Methods. We gathered data via semistructured, in-depth interviews; Brief PsychiatricRating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary filesfor 106 randomly selected people in solitary confinement in the Washington StateDepartment of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, orguilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are even-tually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.

Am J Public Health. 2020, 7 p.

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By Jean Dunbabin

This book explores the growing importance of prisons, both lay and ecclesiastical, in western Europe between 1000 and 1300. It attempts to explain what captors hoped to achieve by restricting the liberty of others, the means of confinement available to them, and why there was an increasingly close link between captivity and suspected criminal activity. It discusses conditions within prisons, the means of release open to some captives, and writing in or about prison.

Springer, Oct 23, 2002, 207 pages

By Marie Manikis and Nicholas Doiron

The continuous perpetration of unjustified harms by the carceral state through its use of solitary confinement justifies the creation of a novel process of automatic sentence review. This process is necessary to account for such state-perpetrated harms and communicate censure more accurately. This article proposes the use of a communicative theory of punishment developed in sentencing to characterise and account for the state’s wrongdoing and harms in the context of a sentence that involves solitary confinement. Specifically, it outlines a justification for an automatic review process of the offender’s carceral sentence based on an expanded and relational understanding of censure developed in the literature and proposes a two-step process to implement this review.

(2024) 26:1 Punishment & Society 72-90.

By Ben Laws

Recent calls from senior managers, human rights groups and academics continue to scrutinize the impact of solitary confinement. But much less attention has been paid to prisoners’ own motivations for segregation. By analysing interviews with 16 segregated men in a high-security prison (Category-A) in England, this article foregrounds motivation. The argument involves a detailed description of the complex, and sometimes contradictory, motives that may lead prisoners into seeking isolation. It further attempts to explore the relationship between segregation and the wider prison environment. For many prisoners, segregation has a ‘negative benefit’ or amounts to a form of ‘lesser evil’. Such phrasing hints at the difficult decisions that prisoners navigate and offers an alternative perspective on solitary confinement.

The British Journal of Criminology, 2021, 61, 1452–1468

By Roger Grimshaw

Across the UK, an individual can find themselves detained, with no clear sense of when they might be released, under a number of different powers, laws and regulations. In the case of criminal justice detention, indeterminate detention takes three main forms. An unconvicted individual can be remanded in prison while awaiting trial. Given the current backlog of cases in the criminal courts, an individual can be left languishing in prison awaiting trial for months, in some cases years. Life imprisonment – mandatory in the case of a murder conviction – is the second form of indeterminate criminal justice detention. An individual subject to a life sentence has to serve a minimum period in custody (the so-called ‘tariff’) before they can be considered for release. Ongoing detention at the end of the tariff period is common. On release, a life sentence prisoner is subject to lifelong supervision, with recall to prison at any point a real possibility. The third form of indeterminate criminal justice detention are the three life sentence-like sentences: in England and Wales, the imprisonment for public protection (IPP) sentence; in Northern Ireland, the indeterminate custodial sentence (ICS); and in Scotland, the order for lifelong restriction (OLR). The IPP, ICS and OLR sentences work in a way similar to the life sentence: an indeterminate period in custody, followed by ongoing supervision on release in the community, if the prisoner manages to secure release. They can, though, be imposed for a far wider range of offences than is allowed for by the relatively narrow set of offences in the case of a life sentence. The subject of this briefing is the IPP, ICS and OLR sentences. The main conclusion it draws relates to the question of whether such sentences should be considered a form of psychological torture. With the failed abolition of the IPP sentences in England and Wales, and the ongoing operation of the ICS and OLR sentences in Northern Ireland and Scotland, the torturous and unfair aspects of these indeterminate sentences are likely to become ever more apparent.

London: Centre for Crime and Justice Studies , 2023. 8p.

by Solitary Watch and the Unlock the Box Campaign

The watchdog group Solitary Watch and the advocacy coalition Unlock the Box released a groundbreaking joint report showing that at least 122,840 people are locked daily in solitary confinement in U.S. prisons and jails for 22 or more hours a day. Calculating Torture is the first report to combine the use of solitary in local and federal jails in addition to state and federal prisons. It is based on analysis of data recently released by the federal Bureau of Justice Statistics (BJS) as well as by state prison systems that did not report to BJS, and data from a survey of local jails conducted by the Vera Institute of Justice.

These report numbers come closer than have any previously published figures in accounting for the total number of people in solitary confinement in U.S. prisons and jails. Previous counts have largely focused on prisons, failing to include jails. In some cases, earlier data also omitted some states, and/or counted only those individuals held in solitary confinement for more than two weeks. For these reasons, previous reports have offered an incomplete picture of how extensively the discredited practice is used and the number of people it affects.

Solitary Watch and the Unlock the Box Campaign, 2023. 16p.

By the Unlock the Box Campaign

There is a growing movement across the United States to end or restrict solitary confinement and to employ alternative interventions that improve safety and well-being. Fueling this surge in efforts at ending solitary is a recognition that solitary confinement is a form of torture. It inflicts terrible suffering and injury—physical, psychological, emotional, and social—on individuals who have experienced it or are currently subjected to it and has severe effects on their loved ones and on the wider community. This horrific practice is in extensive use across the country, damaging or destroying untold lives. Deeply disturbed by this reality, an increasing number of campaigns led by people who have survived solitary confinement and those with loved ones in solitary now or in the past have helped spur legislative and administrative policy changes to curb the use of solitary and to promote alternatives. Between 2009 and 2022, in 45 states, 886 bills were introduced to restrict or end solitary confinement in some form; 40 states have passed at least one of these bills. In 2021 alone, 153 pieces of legislation were filed across 37 states to regulate some aspect of solitary confinement, the vast majority seeking to end at least some aspect of the practice in state prisons and jails, youth facilities, and other carceral settings. An additional 74 bills were introduced in 2022, and 16 bills were passed in 2022, namely, in New York, Kentucky, Illinois, Connecticut, Louisiana, Virginia, Hawaii, Colorado, and Maryland, with additional bills to be acted on, as of the writing of this report. Anti-solitary efforts have also contributed to the closure of entire prisons, buildings, and units used to inflict solitary, most recently with the closure of supermax prisons in New York and Connecticut

Unlock the Box Campaign, 2023. 64p.

By Andreea Matei

Solitary confinement (also commonly referred to as restrictive housing) is one of the most consistently researched prison practices. This brief synthesizes the extensive research on solitary confinement, identifies areas for continuing research, and highlights policy and practice reforms. After reviewing extensive research, this scan found that the overwhelming amount of research proves that solitary confinement is psychologically and physiologically damaging and has negative outcomes on the safety of people in prison and the public through increased recidivism rates. Based on these results, carceral agencies should end their use of solitary confinement if they wish to improve the health and safety of those in prisons and the general public.

Washington, DC: Urban Institute, Justice Policy Center, 2022. 19p.

By Partnership for the Public Good

Solitary confinement exacts an incalculable human toll. It also imposes heavy financial costs for New York State and localities across the state. Reducing the use of solitary confinement by enacting the Humane Alternatives to Long Term (HALT) Solitary Confinement Act1 could not only most importantly stop inhumane practices and save lives, but also save New York State and localities over $1.32 billion over 10 years. New York State is grappling with the economic devastation of the COVID-19 pandemic, while also in the midst of the largest protests against racial inequality in a generation. Meanwhile, Black and Latinx people continue to suffer disproportionately, and often fatally, from solitary confinement. As these crises converge, it is both a fiscal and moral imperative for New York State to reduce the billions of dollars spent on its incarceration system and use the savings to better fund education, housing, health care, and employment opportunities for the communities most harmed by COVID-19 and longstanding systemic racism and inequality.

New York: Partnership for the Public Good, 2020. 32p.

By Juditih Resnik, Skylar Albertson, Skylar Grace Li and Jennifer Taylor

Time-In-Cell 2021 is the only comprehensive, current national data on the number of prisoners in solitary confinement — or what prison directors call restrictive housing — and the length of time prisoners are housed under these conditions. As of the summer of 2021, an estimated 41,000 to 48,000 prisoners in the United States were held in isolation for an average of 22 hours a day for 15 days or more. Moreover, three states reported holding no one in that form of isolation in July 2021; two other states reported fewer than ten people in solitary; and ten states reported not using solitary in any of their women’s prisons. In contrast, as documented in the study published in 2014, every jurisdiction reported using solitary confinement, and an estimated 80,000 to 100,000 people were in solitary confinement in prisons throughout the United States.

This research intersects with efforts around the country—spearheaded by people in confinement, by communities, by many organizations including of correctional leaders, and by legislators—to limit or end the use of isolation in prison. National campaigns (“Unlock the Box,” “Stop Solitary”) have brought attention to the harms, as has the recent death of Albert Woodfox, author of Solitary, who spent more than forty years in isolation at Louisiana’s Angola prison before he was released in 2016. Time-in-Cell also examined the demographics of people held in isolation, including its continued use for people whom their own jurisdiction defines as having “serious mental illness.” Moreover, the number of Black women held in solitary was higher than the number of white women.

New Haven, CT: Arthur Liman Center for Public Interest Law at Yale Law School, 2022. 307p.

By Ian O'Donnell

Prisoners, Solitude, and Time by Ian O’Donnell is a major addition to the number of outstanding books on imprisonment already published in the Clarendon Studies in Criminology series. As the title indicates, its focus is on prisoners’ experience of solitary confinement, their handling of time, and the interface between these. Professor O’Donnell brings to bear on these issues a wealth of academic expertise, primarily as a psychologist and historian, as well as experience in penal reform, prison visiting, and as a magistrate. The result is an immaculately written book that is not only scholarly but also thought-provoking, moving, and ultimately inspiring about the potential of human beings to somehow and sometimes transcend even the most cruel and unusual deprivations and pains. Time is of the essence of prison as punishment, captured in the cliché ‘if you can’t do the time, don’t do the crime’. Yet the vast criminological literature scarcely focuses on the subjective experience of ‘doing time’.

Oxford, UK; New York: Oxford University Press, 2014. 353p.