"We just needed to open the door": a case study of the quest to end solitary confinement in North Dakota

Solitary confinement and the well-being of people in prison

BACKGROUND

Solitary confinement and mental well-being has been researched extensively, with a significant increase in studies over the last ten years. These recent studies produce mixed evidence for whether placement in solitary confinement is associated with psychological distress. We advance our understanding of these relationships in two critical ways. First, we conduct both between- and within-person analyses within the same data to better understand the relationship of solitary confinement and mental well-being relative to the well-being of people in less restrictive prison settings. Second, we ask the men in our sample questions about their personality style, coping strategies, and interactions with staff, which allows us to explore how individual characteristics and prison experiences matter, alongside isolation, in understanding mental well-being.

METHODS

We gather data from interviews at three time points with 122 men in solitary confinement and 204 men in other conditions of confinement in Arizona from 2017 to 2019. We merge these interview data with administrative data on study sample and population sample to include critical measures such as mental health score, risk level, and visitation status. Our interviews contain a Global Severity Index (GSI), created from 90 self-reported psychopathological symptoms experienced, that we use to assess well-being. We estimate cross-classified multilevel models to assess between-person differences and within-person change in well-being over time.

RESULTS

There was a small relationship between solitary confinement and worsening well-bring (longitudinal, within-person) and a small relationship between solitary confinement and worse well-being (cross-sectional, between-person), with this between-person association reduced significantly upon inclusion of additional individual characteristics and prison experiences.

CONCLUSIONS

Our results suggest that the incarceration experience, including conditions of confinement, is associated with mental well-being in different ways for different people. We believe that collective confinement and well-being could receive the same scholarly attention and public concern as solitary confinement.

Public Health and Prisons: Priorities in the Age of Mass Incarceration

Mass incarceration is a sociostructural driver of profound health inequalities in the United States. The political and economic forces underpinning mass incarceration are deeply rooted in centuries of the enslavement of people of African descent and the genocide and displacement of Indigenous people and is inextricably connected to labor exploitation, racial discrimination, the criminalization of immigration, and behavioral health problems such as mental illness and substance use disorders. This article focuses on major public health crises and advances in state and federal prisons and discusses a range of practical strategies for health scholars, practitioners, and activists to promote the health and dignity of incarcerated people. It begins by summarizing the historical and sociostructural factors that have led to mass incarceration in the United States. It then describes the ways in which prison conditions create or worsen chronic, communicable, and behavioral health conditions, while highlighting priority areas for public health research and intervention to improve the health of incarcerated people, including decarceral solutions that can profoundly minimize-and perhaps one day help abolish-the use of prisons.

Stakeholder-engaged research is necessary across the criminal-legal spectrum

People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.

The Impact Of COVID-19 On The Health Of Incarcerated Older Adults In California State Prisons

The number of older adults (age fifty-five or older) incarcerated in US prisons reached an all-time high just as COVID-19 entered correctional facilities in 2020. However, little is known about COVID-19's impact on incarcerated older adults. We compared COVID-19 outcomes between older and younger adults in California state prisons from March 1, 2020, to October 9, 2021. Adjusted odds ratios (aORs) revealed an increasing risk for adverse COVID-19 outcomes among older age groups (ages 55-64, 65-74, and 75 or older) compared with younger adults, including for documented infection (aOR, 1.3, 1.4, and 1.4, respectively) and hospitalization with COVID-19 (aOR, 4.6, 8.7, and 15.1, respectively). Moreover, although accounting for 17.3 percent of the California state prison population, older adults represented 85.8 percent of this population's COVID-19-related deaths. Yet a smaller percentage of older adults than younger adults were released from prison during the pandemic. The differential rates of morbidity and mortality experienced by incarcerated older adults should be considered in future pandemic response strategies regarding prisons.