New Position Statement Provides Guidance on Solitary Confinement

Posted Apr 19, 2016

Controversy over the use of solitary confinement in the nations’ jails, prisons and juvenile detention centers has been increasing. Many national and international organizations have recognized prolonged solitary confinement as cruel, inhumane and degrading treatment, and harmful to an individual’s health. In January, President Obama ordered the federal prison system to reform its solitary confinement policies, which could then serve as a model for state and local corrections systems.

NCCHC has issued a position statement to guide correctional health professionals in addressing issues about solitary confinement. Background information emphasizes contemporary understanding of the harms of solitary confinement. Juveniles, in particular, are vulnerable to the negative consequences of isolation. Likewise, special consideration must be given to individuals with mental illness and pregnant females. The discussion also examines the role of correctional health professionals in actions related to solitary confinement.

The position statement articulates 17 guiding principles:

  1. Prolonged (greater than 15 consecutive days) solitary confinement is cruel, inhuman and degrading treatment, and harmful to an individual’s health.
  2. Juveniles, mentally ill individual and pregnant women should be excluded from solitary confinement of any duration.
  3. Correctional health professionals should not condone or participate in cruel, inhuman or degrading treatment of adults or juveniles in custody.
  4. Prolonged solitary confinement should be eliminated as a means of punishment.
  5. Solitary confinement as an administrative method of maintaining security should be used only as an exceptional measure when other, less restrictive options are not available, and then for the shortest time possible. Solitary confinement should never exceed 15 days. In those rare cases where longer isolation is required to protect the safety of staff and/or other inmates, more humane conditions of confinement need to be utilized.
  6. Correctional health professionals’ duty is the clinical care, physical safety and psychological wellness of their patients.
  7. Isolation for clinical or therapeutic purposes should be allowed only upon the order of a health care professional and for the shortest duration and under the least restrictive conditions possible, and should take place in a clinically designated and supervised area.
  8. Individuals who are separated from the general population for their own protection should be housed in the least restrictive conditions possible.
  9. Health staff must not be involved in determining whether adults or juveniles are physically or psychologically able to be placed in isolation.
  10. Individuals in solitary confinement, like other inmates, are entitled to health care that is consistent with the community standard of care.
  11. Health care staff should evaluate individuals in solitary confinement upon placement and thereafter, on at least a daily basis. They should provide them with prompt medical assistance and treatment as required.
  12. Health care staff must advocate so that individuals are removed from solitary confinement if their medical or mental health deteriorates or if necessary services cannot be provided.
  13. Principles of respect and medical confidentiality must be observed for patients who are in solitary confinement. Medical examinations should occur in clinical areas where privacy can be ensured. Patients should be examined without restraints and without the presence of custody staff unless there is a high risk of violence. In situations where this cannot occur, the patient’s privacy, dignity and confidentiality should be maintained as much as possible. If custody staff must be present, they should maintain visual contact, but remain at a distance that provides auditory privacy.
  14. Health care staff should ensure that the hygiene and cleanliness of individuals in solitary confinement and their housing areas are maintained; that they are receiving sufficient food, water, clothing and exercise; and that the heating, lighting and ventilation are adequate.
  15. Adults and juveniles in solitary confinement should have as much human contact as possible with people from outside the facility and with custodial, educational, religious and medical staff.
  16. Appropriate programs need to be available to individuals in confinement to assist them with the transition to other housing units or the community, if released from isolation to the community.
  17. In systems that do not conform to international standards, health care staff should advocate with correctional officials to establish policies prohibiting the use of solitary confinement for juveniles and mentally ill individuals, and limiting its use to less than 15 days for all others.

The statement also lists numerous sources for research and policy in this area.

View the statement, titled Solitary Confinement (Isolation) »

View all NCCHC position statements »