LAUSR

Individuals released from prison experience a higher risk of death compared to non-incarcerated individuals [1, 2]. The transition back into the community post-release is characterized by instability related to social and economic factors that contribute to poor access to housing, employment, and health care [3, 4]. While this connection between incarceration and death has been demonstrated, little is known about the effect of specific conditions of confinement on mortality. One specific condition of confinement that is known to affect health is solitary confinement. Solitary confinement—also sometimes referred to as restrictive housing or segregation—is widely used by both prisons and jails. Prisons use solitary confinement for both disciplinary purposes when someone breaks a rule and administrative purposes to isolate an individual who is at risk of victimization or violence. Individuals in solitary confinement are isolated in single cells for 22-24 hours daily and have limited access to privileges available to others (eg, visitation and participation in certain programs). Previous research has shown that solitary confinement leads to social isolation, sensory deprivation, and idleness. Furthermore, individuals with mental illness are over-represented in solitary confinement and are even more susceptible to psychological deterioration when isolated [5, 6, 7]. A recent study among individuals incarcerated in the North Carolina prison system demonstrated that any time spent in solitary confinement was associated with an increased risk of all-cause mortality in the first year after release [8]. In response to public debate and the evidence that solitary confinement is harmful, the United Nations in 2015 revised…