A Within-Person Test of the Impact of Extended Solitary Confinement on Mental Health Functioning and Service Use

• Author: Sonja E. Siennick,Jennifer M. Brown,Daniel P. Mears,Jasmine Clayton
• DOI: http://doi.org/10.1177/00938548221131953
• Published date: 01 April 2023
• Date: 01 April 2023
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 4, April 2023, 459 –479.

DOI: https://doi.org/10.1177/00938548221131953

Article reuse guidelines: sagepub.com/journals-permissions

© 2023 International Association for Correctional and Forensic Psychology

459

A WITHIN-PERSON TEST OF THE IMPACT

OF EXTENDED SOLITARY CONFINEMENT

ON MENTAL HEALTH FUNCTIONING

AND SERVICE USE

SONJA E. SIENNICK

JENNIFER M. BROWN

DANIEL P. MEARS

JASMINE CLAYTON

Florida State University

There is conflicting evidence on whether people, particularly those with preexisting mental health problems, have worse

mental health during and after extended solitary confinement (SC) stays. Using administrative data on 843 men, we examined

within-person changes in mental health functioning and service use surrounding long-term stays in SC in Florida correctional

facilities. During these stays, service use increased, psychological functioning improved, and mental health crises declined.

The former two associations persisted during step-down placements in lower levels of restrictive housing and during the

month following restrictive housing stays. The same associations were observed among men with and without serious mental

illnesses, though they were more muted among the former group. The increased provision of treatment might prevent mental

health problems from developing or worsening among those held in long-term SC and might even improve psychological

functioning relative to when the same people are in general population housing.

Keywords: corrections; incarceration; mental health; prison; solitary confinement

Solitary confinement (SC), or the isolation of a person from a jail’s or prison’s general

population, is a staple feature of prisons today. Justifications for SC center on improv-

ing system order by deterring misconduct and incapacitating those deemed to be a serious

threat to facility safety and security (Mears & Watson, 2006). Generally, this confinement

involves confinement in a cell for 22 or more hours per day, with an hour or two allotted for

personal hygiene and solitary exercise (for descriptions see Haney, 2003; Smith, 2006). The

AUTHORS’ NOTE: We thank Shino Someya for research assistance. This project was supported by Grant No.

2016-IJ-CX-0014 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of

Justice. Points of view in this document are those of the authors and do not necessarily represent the official

position or policies of the US Department of Justice or the Florida Department of Corrections. Correspondence

concerning this article should be addressed to Sonja E. Siennick, College of Criminology and Criminal Justice,

Florida State University, 112 S. Copeland Street, Tallahassee, FL 32306, USA; e-mail: ssiennick@fsu.edu.

1131953CJBXXX10.1177/00938548221131953Criminal Justice and BehaviorSiennick et al. / SOLITARY CONFINEMENT AND MENTAL HEALTH

research-article2023

460 CRIMINAL JUSTICE AND BEHAVIOR

housing can consist of small, windowless, steel-door-enforced cells, and include 24-hr arti-

ficial lighting that can make it difficult for residents to determine whether it is day or night.

Access to personal belongings is strictly regulated. People in SC are restricted from privi-

leges like education, programming, and recreation, reducing the opportunity for mental

stimulation. Their human interaction is severely limited, and they are not permitted any

contact visits or participation in most congregate activities like communal exercise, dining,

or religious services. Stays in what we term “extended” solitary confinement (ESC), which

has been opposed by advocacy groups, can last for months or years at a time (Arrigo &

Bullock, 2008).

Critics charge that these conditions harm the mental health (MH) of the people who

experience them (Haney, 2009; Lovell, 2008). The psychological problems observed among

people in long-term SC include anxiety, mood disturbances, psychotic symptoms, and self-

harm (Arrigo & Bullock, 2008; Haney, 2003). Due to the possibility that the SC stays them-

selves cause these problems, some have described ESC as torture, as disabling, and as cruel

and inhumane punishment (Conley, 2013), and the United Nations has prohibited its use

(United Nations, 2015). Scholars have also raised concerns about the use of SC with people

with mental illness, who may be especially vulnerable to any psychological impacts

(Metzner & Fellner, 2010). Although many studies have found harmful MH effects of SC,

others—including Morgan et al.’s (2016) comparison of two recent meta-analyses—have

not. Firm conclusions about these effects have been further hampered by the difficulty of

carrying out strong quantitative studies on the topic (Brown, 2020; Haney, 2018), the incon-

sistent use of SC (Reiter, 2016), and a lack of documentation of health services provided to

individuals in ESC.

Our study uses a pre-during-post adaptation of within-individual regression (Osgood,

2010) to examine whether ESC is associated with changes in MH functioning and MH ser-

vices received. This longitudinal design helps us overcome two problems that are common

in past studies: causal order ambiguity and unmeasured confounds (Brown, 2020; Luigi

et al., 2020). The data are from Florida, which revised its ESC- and MH-related practices

following a 1997 lawsuit about the use and effects of ESC (Osterback v. McDonough,

2008). In the following text, we discuss the existing theory and evidence on SC and MH,

describe relevant policies of the Florida Department of Corrections (FDC), and present a

series of tests of the impact of ESC on the MH of people with and without diagnoses of

serious mental illness (SMI). Our findings provide new information on how ESC may influ-

ence MH-related needs, MH service use, and MH crises in one of the largest correctional

systems in the United States

BACKGROUND

SC AND MENTAL HEALTH: POSSIBLE MECHANISMS OF EFFECTS

One theoretical account of the potential MH effects of SC involves SC’s possible effects

on brain structure and function. Studies suggest that stress and social and sensory depriva-

tion decrease the anatomical complexity of the brain (Lobel & Akil, 2018). In addition,

people need social contact to distinguish between their inner worlds and the real, external

world; social psychological mechanisms thus may help explain distress among those held

in SC (Arrigo & Bullock, 2008). These potential mechanisms reflect the brain’s “hard-

wired” need for social interaction and connectedness (Haney, 2018) and may be especially

problematic for people with preexisting mental illnesses (Arrigo & Bullock, 2008).