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A new study published in the Journal of looked at the relationship between mental illness and solitary confinement.

“Past work had shown that incarcerated people with mental illnesses are overrepresented in solitary confinement units,” study author Sonja Siennick, professor of criminology and criminal justice at Florida State University told us. “This could be because solitary confinement triggers or worsens symptoms of mental illness, or because people with mental illnesses are more likely to be sent to solitary in the first place. Interestingly, there was very mixed evidence on the possible mental health effects of solitary confinement. So we began with the other possibility: whether having a mental health problem is a risk factor for extended solitary confinement.”

According to the Bureau of Justice Statistics, there are more than 80,000 men, women, and children in solitary confinement in prisons across the United States. According to the American Friends Service Committee, solitary confinement can mean confinement behind a steel door for 22 to 24 hours a day. Contact with other people is severely limited, there are infrequent phone calls and "grossly inadequate medical and mental health treatment." 

Researchers considered two main possibilities. The first was that there would be no association between mental illness and solitary confinement once they accounted for risk factors that might lead to both, such as education and test scores, substance abuse problems, and criminal history. The second was that people with mental illnesses would have higher chances of getting sent to solitary confinement even when shared risk factors were accounted for.

“We used data from a large state’s correctional department to examine this topic,” Siennick told us. “We used a matching method to identify a group of incarcerated people without mental illnesses that had the same background characteristics as the group of incarcerated people who did have mental illnesses.”

By matching the groups on background risk factors and other individual and facility factors (40 in total), researchers sought to isolate the independent impact of mental health diagnoses on the risk of experiencing extended solitary confinement.

“Even under our stringent design, having a mental illness positively predicted being sent to extended solitary confinement,” Siennick told us. “The association was moderate in size, rather than weak as we’d expected.”

Other studies had found that the presence of a mental disorder increases the odds of being sent to solitary confinement by 30–80 percent; Siennick and the team found that it increases the odds of such confinement by up to 170 percent, depending on the diagnosis.

“We also found that serious mental illnesses and personality disorders, but not anxiety or post-traumatic stress disorders, were linked to solitary confinement,” Siennick told us. “Finally, in-prison experiences like disciplinary infractions and victimization did not fully explain the relationship.”

Although Siennick said she was not surprised by the general finding, she was surprised by the strength of the association. Often associations become weaker, not stronger when more rigorous methods are used. That was not the case here, she said.

“There is a real need to better understand the in-prison experiences of people with mental illnesses,” Siennick told us. “We identified that a mental illness-solitary confinement association exists net of a host of individual, facility, and prison experience factors, but we were unable to explain why. We also lacked information on several relevant in-prison factors, such as treatment received, staff training, and other such initiatives. We could better address the association, and take other steps to improve the experiences of incarcerated people with mental illnesses, if we had high-quality, detailed information on how people with mental illnesses adapt to incarceration and on how correctional systems respond to them.”