Mental Health & Racial Disparities in Solitary Confinement: Results from a National Survey in the United States

Background & Purpose: Solitary confinement is still widely used in prisons in the United States, despite links to poor health outcomes. Past research suggests that disparities may exist regarding who is placed in solitary confinement, although nationwide studies have been sparse. This study aims to describe the current use of solitary confinement as a disciplinary sanction in the United States and to what extent disparities exist by race, ethnicity, gender, sexual orientation, adverse childhood experiences, and certain mental health disorders.

Methods: Data come from a recently released national survey of adults incarcerated in the United States, N = 24,848 (2016 Survey of Prison Inmates). Statistical analysis applied descriptive statistics (mean, frequency, and standard deviation). Multiple univariate logistic regression models were used to describe relationships between each independent variable/covariate and both dependent variables (any disciplinary action and being placed in solitary confinement). Independent variables included race, ethnicity, gender, sexual orientation, adverse childhood experiences, and certain mental health disorders. Multivariable logistic regression models were used to identify associations between independent variables and dependent variables, while controlling for covariates (type of “rule violation”). Post hoc analysis using multivariable logistic regression was conducted to identify associations between receiving solitary confinement and gender, sexual orientation, and an interaction term for gender * sexual orientation. All analysis was conducted in Stata 16.

Results: There were disparities in the use of solitary confinement which cannot be explained by the differences in who receives disciplinary action, or rule violation type. Of note, in univariate logistic regression models, Native American people were significantly less likely to receive disciplinary action (OR = 0.73), but significantly more likely to receive solitary confinement (OR = 1.21). Even after controlling for rule violation type, solitary confinement was used at higher odds for people who are Black (aOR = 1.30), men (aOR = 1.38), have ADD/ADHD (aOR = 1.17), an anxiety disorder (aOR = 1.25), or a history of foster care (aOR = 1.19). Only heterosexual people had lower odds of being placed in solitary confinement (aOR = 0.64). Further, post hoc analysis revealed disparities for non-heterosexual women, heterosexual men, and non-heterosexual men, with all groups having about twice the odds of receiving solitary confinement as heterosexual women.

Conclusions: Findings highlight how significant disparities in the use of solitary confinement remain, despite a recent wave of policies aimed at reducing its use and diverting people with mental health disorders. Results also indicate a continued need for mental health practitioners to take action to reduce the use of solitary confinement and provide appropriate mental health services to people who are in solitary confinement.