CHARLOTTE MARTIN SOCIAL RESEARCH METHODS GROUP 1

ACTIVITY 3

BACKGROUND STUDY

➢ Social research topic: impact of solitary confinement in USA

➢ Research problem: how does solitary confinement impact people in US
prisons?

REVIEW OF SCIENTIFIC PAPERS

“THE BODY IN ISOLATION: THE PHYSICAL HEALTH IMPACTS OF INCARCERATION IN

SOLITARY CONFINEMENT.”

This article explores the associations between solitary confinement and a range of physical
health problems, and it incorporates explicit consideration of racial health disparities.

The health implications of solitary confinement have received increasing attention in recent
years. Until recently, however, research on the health consequences of solitary confinement
has focused almost entirely on the negative impacts on mental health.
Such studies have found that placement in solitary confinement has been associated with
symptoms of increased psychological distress, such as anxiety, depression, paranoia, and
aggression. A 2018 study, for instance, found that prisoners who had spent time in solitary
confinement were three times as likely to exhibit symptoms of post-traumatic stress disorder
(PTSD) than those who had not.

Existing research on the physical health impacts of incarceration demonstrates the need for
further study. That is why this article examines the medical effects of isolation, not just
mental health. It also studies the racial impacts, especially considering that there are
roughly 80,000 people in isolation units nationwide (US), and this population includes a
disproportionate number of racial minorities relative to the overall prison population.
Depending on the composition of the prison system, Blacks and/or Latinos are often over-
represented in solitary confinement relative to their (over)representation in the general prison
population. Any concentrated health disadvantages affecting people in prison, and especially
people of colour, is potentially even more concentrated among those living in solitary
confinement. Moreover, existing evidence suggests that conditions of solitary confinement
exacerbate health problems and pose a significant public health risk.
The methods that the authors use are the following: To explore the physical health problems
experienced in isolation, they draw upon a research study of people in long-term solitary
confinement in the Washington State Department of Corrections (WADOC). Five of the
state’s 12 prison facilities have an Intensive Management Unit (IMU), an all-male unit or

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building, housing people in solitary confinement (with highly restricted access to
commissary, phones, radios, televisions, visitors, and roughly 10 hours per week out-of-cell)
for durations ranging from months to years. Our study focused on people within the IMUs on
“maximum custody status”: the highest security level assigned to state prisoners housed in
the IMU for an indeterminate period, usually following one or more rule violations, with return
to the general prison population contingent on meeting specific benchmarks. The random
sample of 106 (all male) IMU prisoners reflects a mean age of 35; mean stay of 14.5 months
in IMU; mean of 5 prior convictions resulting in prison sentences. Among our participants
42% were white; 12% were African American; 23% were Latino; 23% were “Other.”
The study consists of four dimensions of participant data:
1. surveys of prisoners in solitary confinement: application of a Brief Psychiatric Rating Scale
(BPRS) assessment at two points in time with those prisoners.
2. in-depth interviews with a random sample of prisoners in solitary confinement
3. reviews of the medical (covering mental and physical health) files, as well as the
disciplinary records, for this subset of prisoner.
4. administrative data for the entire 2017 prison population provided by the WADOC. Data
was collected in 2017 and 2018.
First, paper surveys were distributed in-person (and collected on the same day) to all 363
people on maximum custody status in the five state IMUs in the spring of 2017. Next, during
the summer of 2017, roughly one-third (29%) of all 363 people on maximum custody status
in IMUs were interviewed, selected from randomly ordered lists of the population of each
IMU. One year later (2018), all participants from our initial random sample, who were still
incarcerated one year later, including those no longer housed in the IMU, were re-
interviewed. We also reviewed paper medical and disciplinary files for each consenting,
year-one interview participant. Interviews, file reviews, and observations were conducted
over two separate three-week periods in the summers of 2017 and 2018, by a total of 13
research team members. Finally, we received administrative data on all people within the
state prison system as of July 1, 2017.

The results indicate that after anxiety and depression, the third most common significant
health symptoms experienced by the subjects were “somatic concerns,” defined by the
BPRS as “concerns over present bodily health” The results indicate three categories of
physical symptoms people experience in solitary confinement:

• Symptoms associated with deprivation conditions: various deprivations of movement,

provisions (from food to toiletries), and human contact inherent in the institutional
restrictions defining solitary confinement. Skin irritations and weight fluctuations were
the most common of these; participants experienced both as co-morbid with anxiety
and other health issues. Participants described rashes, dry and flaky skin, and
fungus developing in isolation. They understood these conditions as being directly
associated the poor air and water quality, irritating hygiene products, and lack of sun
exposure inherent to their conditions of solitary confinement. People in the IMU
(unlike those in the general prison population) usually cannot purchase or trade for
alternative, higher-quality hygiene products; their cells have limited natural light (at
best, a window far above eye-level; at worst, no window); and even the exercise

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 areas frequently have limited natural light. Indeed, research has documented how
isolation can cause vitamin D deficiency due to lack of natural light exposure.

• Deprivation policies: Such policies and practices included the prioritization of security
over care in emergency situations, disruptions in care upon transfer into the IMU, and
overwhelming administrative hurdles to accessing care in the first place.

• Musculoskeletal pain: The experiences of people in solitary confinement with chronic

musculoskeletal pain reveal how the prior two categories of symptoms analysed,
interact to exacerbate physical health problems. While participants attributed their
musculoskeletal pain to a range of causes from physical injury to arthritis, bursitis,
and sciatica, they consistently experienced this pain as untreated and interfering
(physically and mentally) with even those few, limited activities available to them in
solitary confinement.
They also found people of colour face a disproportionate risk of being placed in solitary
confinement; such racial disparities, in turn, mean that the physical health symptoms
associated with, or possibly caused by, these conditions of confinement are likely to fall
disproportionately on certain groups. They further find that prisoners of all races describe
similar physical health challenges and complaints while in solitary confinement.

I agree with the authors regarding the race disparity, especially in the States. There are
many minorities in prisons who are not treated fairly. Quite a lot of them are in maximum
security prisons. As a result, most of these minorities suffer from the physical symptoms
mentioned above as well as the mental health troubles already studied.
After re-interviewing some inmates who were out of IMU, it was interesting to see that most
of the symptoms were gone. However, I do not think the methods used are very
representative. They only examined one male prison in the US. I think they should have
examined more US prisons and included females to make it more representative.

“SOLITARY CONFINEMENT AND RISK OF SELF-HARM AMONG JAIL INMATES”

Self-harm is a prevalent and dangerous occurrence within correctional settings. Inmates in

jails and prisons attempt to harm themselves in many ways, resulting in outcomes ranging
from trivial to fatal. Suicide is a leading cause of death among the incarcerated; however,
suicide and suicide attempt represent a small share of all acts of self-harm. The motivations
of inmates who harm themselves are complex and often difficult to discern. Inmates often
arrive in correctional settings with significant pre-existing mental illness and histories of self-
harm, but they may also be influenced by environmental stressors within correctional
settings or aim to avoid certain situations or punishments.
The objective of this paper is to better understand the acts and risk factors of self-harm
among inmates and to see if being in solitary confinement increases the probability of such
act.
The authors did their research on the NYC jail system, as it is the nation’s second largest.
First, they defined the self-harm an act performed by individuals on themselves with the

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potential to result in physical injury, and potentially fatal self-harm as an act with a high
probability of causing significant disability or death, regardless of whether death occurred.
They analysed data from all jail admissions that occurred between January 1, 2010, and
October 31, 2012. They counted only acts of self-harm committed during this time period,
with the exception of inmates admitted to the jail system in the last 3 months of the study
period. For these inmates, they extended the observation period for acts of self-harm to 3
months. The study population consisted of 134 188 individuals who experienced 244 699
incarcerations.
Examples of potentially fatal self-harm included ingestion of a potentially poisonous
substance or object leading to a metabolic disturbance, hanging with evidence of trauma
from ligature, wound requiring sutures after laceration near critical vasculature, or death. As
nearly two thirds of all self-harm acts and 85% of potentially fatal self-harm act were initial
occurrences, we focused on timing, incidence, and risk factors for initial self-harm acts
during each jail admission. The dependent variables, self-harm and potentially fatal self-
harm, were dichotomous variables (0 = no; 1 = yes). The independent variables included
ever being in solitary confinement during their incarceration, SMI, age 18 years and younger,
gender, length of stay, and race/ethnicity. We identified patients who were in solitary
confinement from housing placement, thus creating a dichotomous solitary confinement
variable (0 = no; 1 = yes). We created another binary variable to indicate inmates aged 18
years and younger (0 = older than 18 years; 1 = 18 years and younger), based on the
classification used by Department of Correction. Gender was another dichotomous variable
(0 = male; 1 = female). We calculated length of stay (in 6-month increments) from jail
admission and discharge dates, creating a dummy discharge date for those patients who
were still in jail by January 31, 2013. The race/ethnicity was categorized as Hispanic, non-
Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander, and other or
unknown.

- The results are as the following: 1303 of these incarcerations there were 2182 acts of
self-harm; in 89 incarcerations there were 103 acts of potentially fatal self-harm.
• The most common methods of self-harm were:
laceration (34%), ligature (28%), swallowing a foreign body (15%), and overdose (14%). In
addition, 15% of acts of self-harm were categorized as “other” (e.g., head banging and
setting self or cell on fire) and 6% of incidents involved multiple methods.

• For the 103 acts of potentially fatal self-harm, common methods included:
ligature (29%), swallowing a foreign body (23%), laceration (19%), overdose (16%), other
(21%), and multiple (8%).
Of the 2079 self-harm acts judged not to be potentially fatal, 1715 (82%) were treated by jail
medical staff (physician or physician’s assistant) and 373 (18%) required transfer to a higher
level of care (emergency medicine physician, inpatient admission, or diagnostic imaging) for
further evaluation or treatment.). Those ever in solitary confinement had a far greater risk of
self-harm than did those never in solitary but these inmates also had longer lengths of stay.

They found that acts of self-harm were strongly associated with assignment of inmates to
solitary confinement. Inmates punished by solitary confinement were approximately 6.9
times as likely to commit acts of self-harm after we controlled for the length of jail stay, SMI,

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age, and race/ethnicity. This association also held true for potentially fatal self-harm with a
slightly lower OR, 6.3. It is notable that acts of self-harm often preceded the actual time
spent in solitary confinement. Both SMI (OR = 7.97) and aged 18 years or younger (OR =
7.5) were also predictive of self-harm; nonetheless, the risk of self-harm and potentially fatal
self-harm associated with solitary confinement was higher independent of mental illness
status and age group. The analysis showed that a small proportion of inmates, those in
solitary confinement, with SMI, and aged 18 years or younger, accounted for the majority of
acts of self-harm.

It is interesting to see that the authors have recognized that there are limitations to the study.
This study has several limitations. First, because of the delay in placement in solitary
confinement for rules violations and because jail is a short stay setting, many inmates are
sentenced to solitary confinement but leave before their punishment occurs. Some inmates
may have engaged in self-harm anticipating stays in solitary confinement that never
occurred. A second limitation is the lack of data regarding criminal charge or jail rules
violations. These nonclinical characteristics may have some bearing on self-harm. The
practice of removing actively violent inmates from the presence of others represents a
legitimate security act and information regarding why inmates are placed into solitary
confinement.

The abstract of this paper matches the conclusion after analysing the data. It is quite
worrying that there are so many acts of self-harm occurring in jails and prisons, although it is
expected. The fact that most of these results were adolescents taking part in self harm; and
some leading to death, clearly demonstrates that solitary confinement is not the answer. The
data supports the need to reconsider the use of solitary confinement as punishment in jails,
especially for those with SMI and for adolescents. Recently, professional societies for adult
and adolescent mental health care have made recommendations against the use of solitary
confinement as punishment for adolescents and seriously mentally ill inmates.

“REDUCING THE USE AND IMPACT OF SOLITARY CONFINEMENT IN CORRECTIONS”

Now this is quite an interesting article, not like the previous ones. As I mentioned in activities
one and two, the study of solitary confinement and its impact is fairly new; so, there is not a
lot of literature on this subject. Although, it is becoming a major concern among human right
advocates as most agree that it is a deprivation of freedom.
Although the reform of solitary confinement is underway in many jurisdictions around world,
isolation remains in widespread use in many jails and prisons. The purpose of this paper is
to discuss opportunities for reform in the USA that could also be applied globally.
Internationally, correctional leaders and policymakers are increasingly aware of the health
and human rights problems and costs associated with the use of solitary confinement. In
2015, the UN General Assembly unanimously adopted updates to The Standard Minimum
Rules for the Treatment of Prisoners (the “Nelson Mandela Rules”) that, for the first time,
prohibit the use of indefinite and prolonged isolation (defined as longer than 15 consecutive
days) and condemn the use of solitary confinement for those whose mental or physical
disabilities would be worsened under such conditions, among other restrictions (UN General
Assembly, 2015). This awareness has led to a marked decrease in the use of solitary

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confinement in some countries. For example, Finland, Sweden, Norway, and the
Netherlands have adopted various distinct policies. Conversely, solitary confinement
remains widely used in the United States. An estimated 80,000 or more prisoners in the U.S.
are in solitary confinement on any given day and 1 in 5, or roughly 250,000, experienced
solitary confinement over a one-year period; about half for a period of 30 days or longer.
The mentally ill are at particularly elevated risk of solitary confinement. Nationwide, greater
use of solitary confinement occurs in facilities that report a higher percentage of prisoners
with mental health needs (Beck, 2015). Prisoners identifying as Lesbian, Gay, or Bisexual
are also more likely to be placed in solitary confinement than others (Beck, 2015). This may
reflect the common use of restrictive housing for “protective custody” and to hold prisoners in
isolation pending their transfer to another facility.

There is ample evidence of the psychological harm that solitary confinement inflicts on
prisoners regardless of their baseline mental health. According to a call from the American
Psychiatric Association to greatly restrict the use of solitary confinement, isolation makes
mentally ill persons worse and causes new mental illness in those without prior mental
health problems (American Psychiatric Association, 2012).
These negative mental health effects of solitary confinement are well documented; insomnia,
anxiety, panic, disturbances in appetite, paranoia, hallucinations, and self-mutilation are
commonly experienced by isolated persons (Andersen et al., 2000, Haney, 2003, Kaba et
al., 2014, Benjamin and Lux, 1975, Jackson, 1983, Shalev, 2008, Grassian, 1983). Other
harmful reactions include negative attitudes, withdrawal, hypersensitivity, emotional
breakdowns, depression, and suicide (Haney, 2003, Shalev, 2008).
Craig Haney, an author on this brief and a leading researcher on the adverse mental health
effects of solitary confinement, has observed that prisoners experiencing prolonged isolation
lose the ability to organize their lives around meaningful activities and purpose, often recede
further into isolation, alienate themselves from others, and face intolerable levels of
frustration that, for some, turns to anger and sometimes sudden and uncontrollable outbursts
of rage (Haney, 2003). Though less well-documented in the literature, there is considerable
reason to believe that 23-hour confinement to a cell, even for short periods of time, imposes
a considerable physical health burden on prisoners, negatively affecting prisoners with
chronic health conditions and greatly increasing the risk of new chronic conditions even
among healthy prisoners. Exercise, even the basic amounts achieved through daily
movement in an unconfined space, is crucial to maintaining health. It is a front-line treatment
for hypertension, diabetes, arthritis, heart disease and other conditions common in prisoners
(Williams, 2016)

Focusing on this evidence, the authors argue that solitary confinement is overused and
recommend a multi-level approach available to correctional systems worldwide including:

• immediately limiting solitary confinement to only those cases in which a violent

behavioural infraction has been committed for which safety cannot otherwise be
achieved, ensuring the briefest terms of isolation needed to achieve legitimate and
immediate correctional goals.
• prohibiting its use entirely for some populations.

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 • regularly reviewing all isolated prisoners for as-soon-as-possible return to general
population, including the immediate return of those showing mental and physical
health risk factors.
• assisting individuals who are transitioning out of isolation (either to the general
population or to the community)
• partnering with medical, public health, and criminal justice experts to develop
evidence-based alternatives to solitary confinement for nearly all prisoners.

As I said before, it is an interesting article, but it leaves a lot of room for debate. As for the
recommendation, I do think that we are a long way from achieving them as a lot of people
will be against abolishing this practice. Although, it is a good way to start and a good way
forward.

“THE CARDIOVASCULAR HEALTH BURDENS OF SOLITARY CONFINEMENT”

The American Medical Association recently called for the elimination of solitary confinement
for the mentally ill, citing its mental health harms. Although the living conditions in these units
(e.g., limited exercise, extreme loneliness) are known risk factors for adverse physical health
outcomes including cardiovascular disease, the lifetime cardiovascular burden of solitary
confinement is unknown.
As all the previous articles have confirmed, there is a correlation between mental and
physical health problems and solitary confinement. The objective of this study is to examine
the long-term effects of solitary confinement, paying particular attention to cardiovascular
disease due to the poor living conditions.

To estimate the lifetime cardiovascular disease burden and costs associated with solitary
confinement, the methods they used were public data from a 2015 lawsuit describing the
prevalence of hypertension diagnoses among two groups of incarcerated men ages 27–45:
- Those housed in one prison’s solitary confinement “supermax” units. Those in solitary
confinement received no group recreation or contact visits and few (if any) phone calls.
Individuals in solitary confinement scored an average of 54.9 on the UCLA Loneliness Scale
(scale ranges 20–80, 80 is most lonely)
- And those in the prison’s less-isolating maximum security units. Those in maximum
security received 2 h of daily group recreation, contact visits, and more calls. Those in
maximum security averaged 41.6 on the UCLA Loneliness Scale.
Using the Cardiovascular Disease Policy Model, a computer simulation of cardiovascular
disease in US adults,4 we estimated the lifetime incremental burden of disease, loss of
quality-adjusted life years (QALYs), and medical costs associated with new diagnoses of
hypertension.
Quality-of-life weights were based on observational data from the Global Burden of Disease
study. Medical costs were estimated using California’s Office of State-wide Health Planning
and Development, deflated using cost-to-charge ratios and the ratio of the US national
average costs to California’s, and then inflated to 2017 dollars using the Consumer Price
Index.

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The results are the following: Over a lifetime, 1000 men with newly diagnosed hypertension
at age 35 are expected to experience 10 additional myocardial infarctions and 21 additional
cardiovascular accidents, representing a loss of 732 QALYs and over $20 million in
additional healthcare costs. Because individuals in solitary confinement experienced an
absolute 31% higher hypertension prevalence than those in maximum security units, nearly
one-third may experience this higher burden of cardiovascular disease and cost. Because
we used previously collected data, this analysis assumed the following:
(1) hypertension diagnoses persist over a lifetime.
(2) individuals in prison and the community experience the same control and cardiovascular
effects of hypertension.

As the authors said, they focused on hypertension-related cardiovascular disease and did
not consider other possible conditions caused or worsened by solitary confinement,
suggesting this analysis underestimates solitary confinement’s overall impact on health and
related costs. You also need to consider that prisons are over-populated with minorities.
This states that solitary confinement does worsen pre-existing health problems and creates
new ones, and it does not stop when the individual is freed from solitary confinement or
prison. Solitary confinement can result in cardiovascular disease and hypertension, which
lasts a lifetime and reduces the quality of life; not to mention the cost of medical bills over
time.

CONCLUSION

Solitary confinement is a form of correctional housing generally defined as spending

approximately 23 hours each day in a small cell roughly the size of a parking spot, with one
hour allowed for exercise (typically occurring alone, in a small outdoor cage) (American Civil
Liberties Union, 2014). Prisoners eat, sleep, and toilet inside these small cells, which are
sometimes deprived of natural light; the cells contain a bed, a sink and a toilet, and all of the
prisoner’s possessions.

After reading all four papers, I can safely say that solitary confinement imposes severe social
deprivation, substantial isolation from others, but it also typically deprives prisoners of many
other things, including access to rehabilitative programming, work assignments, and contact
visits with family and friends. Ease of access to lawyers, medical, and mental health
personnel is also typically restricted in these units. These conditions cause mental, physical
and psychological effects on these individuals. In some cases, it can be deadly.

The effects of mental and physical health on the individual can last a lifetime, reducing the
quality of life (as mentioned by the authors of “The cardiovascular health burdens of solitary
confinement”) so, it is not just when the individual is behind bars. After reading the first
paper: “The body in isolation: the physical health impacts of incarceration in solitary
confinement”, it is also concerning how overpopulated prisons are, not only in America and

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especially with minorities. As minorities are greatly over-populated in prisons, we must think
about the impact of solitary confinement on them as some are at a greater risk of developing
heart conditions. and make sure they get the proper treatment while they are in prisons and
once, they are released.
We also have to consider the social and economic cost to solitary confinement. And, of
course, the ethical side to it. Many consider solitary confinement to be a deprivation of a
basic human right, freedom. Others argue that it is a necessary practice to punish
misbehaving prisoners and an easy way to keep them in line. It is clearly an ongoing debate
among scholars, but one thing is obvious: the impact of solitary confinement if big and it out
ways the practice of solitary confinement.
There are many people recommending different approaches and methods to solitary
confinement. As mentioned above, in 2015, the UN General Assembly unanimously adopted
updates to The Standard Minimum Rules for the Treatment of Prisoners (the “Nelson
Mandela Rules”) that, for the first time, prohibit the use of indefinite and prolonged isolation
(defined as longer than 15 consecutive days) and condemn the use of solitary confinement
for those whose mental or physical disabilities would be worsened under such conditions,
among other restrictions (UN General Assembly, 2015). As a result, some European
countries have adopted a maximum stay in solitary confinement, and others have implanted
other methods or stopped the practice completely.

The only thing that I think these papers lack, is representation. Most of these studies were
conducted examining just one prison and all male inmates. Every state in the US uses
different control and care methods in their prison, so I would have liked to have seen the
comparison between prisons and to see if they differentiate somehow. I also think that they
should have included female prisons and see if there are any differences with their time
spent in solitary confinement and if female prisons are just as overpopulated with minorities.

➢ In conclusion, a prolonged stay in solitary confinement has various effects on one’s

body and health. The main issues of solitary confinement are:

• Mental health: anxiety, depression, paranoia, and aggression, PTSD,

• Insomnia, anxiety, panic, disturbances in appetite, paranoia, hallucinations, and self-
mutilation are commonly experienced by isolated persons (Andersen et al., 2000,
Haney, 2003, Kaba et al., 2014, Benjamin and Lux, 1975, Jackson, 1983, Shalev,
2008, Grassian, 1983). Other harmful reactions include negative attitudes,
withdrawal, hypersensitivity, emotional breakdowns, depression, and suicide (Haney,
2003, Shalev, 2008).

• Physical health, mainly somatic concerns: depravation conditions, deprivation

policies and muscle pain.
• Cardiovascular issues (Hypertension)
• Lack of exercise which can lead to hypertension, diabetes, arthritis, heart disease
and other conditions (Williams, 2016)
• Over population of minorities: Across the U.S., solitary confinement
disproportionately affects individuals from traditionally disadvantaged backgrounds.
Younger and less educated prisoners are more likely to spend time in isolation, as

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 are most racial minority groups. Prisoners identifying as Lesbian, Gay, or Bisexual
are also more likely to be placed in solitary confinement than others (Beck, 2015).

• Isolation makes mentally ill persons worse and causes new mental illness in those
without prior mental health problems (American Psychiatric Association, 2012).

It is also interesting to consider the impact of solitary confinement with the coronavirus
pandemic. Many prisons are using solitary confinement as a means to isolate inmates from
each other for a long period of time.

CONCEPT MAPS

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REFERENCES

• Augustine, D., Barragan, M., Blair, T.R., Gonzalez, G., Tublitz, R., Reiter, K., Strong,
J.D., et al (2020). The body in isolation: The physical health impacts of incarceration
in solitary confinement. PloS one, 15(10), e0238510.

• Alper, H., Glowa-Kollisch, S., Hadler, J., Kaba, F., Lee, D., Lewis, A, et al. (2014).
Solitary confinement and risk of self-harm among jail inmates. American journal of
public health, 104(3), 442-447.

• Ahalt, C., Farabee, D., Fox, M. P., Haney, C., Rios, S., & Williams, B. (2017).
Reducing the use and impact of solitary confinement in corrections. International
Journal of Prisoner Health.

• Ahalt, C., Bibbins-Domingo, K., Coxson, P., Kahn, J. G., Li, A., & Williams, B. A.
(2019). The cardiovascular health burdens of solitary confinement. Journal of general
internal medicine, 34(10), 1977-1980.

• Skiba, R., The hidden damage of solitary confinement. Knowable Magazine, 2018

• Haney, C., (2018). Restricting the use of solitary confinement, Annual Review of
Criminology, (1), 285-310.

• Andersen, H. S., Gabrielsen, G., Hemmingsen, R., Kramp, P., Lillebæk, T., & Sestoft,
D. (2000). A longitudinal study of prisoners on remand: psychiatric prevalence,
incidence, and psychopathology in solitary vs. non‐solitary confinement. Acta
Psychiatrica Scandinavica, 102(1), 19-25.

• Ahalt, C., & Williams, B. (2016). Reforming Solitary-Confinement Policy--Heeding a

Presidential Call to Action. The New England journal of medicine, 374(18), 1704-
1706.

• American Psychological Association (2012). Phycologist testifies on the risks of

solitary confinement. Volume 43, Nº 9, (10)

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