In the United States, thousands of prisoners are put in “the hole” for years, and while it’s established the practice of isolating people results in trauma while they are in prison, new research shows solitary confinement is linked with massive costs once prisoners are released.

Scientists reported Friday that people who spent any time in what’s officially known as “restrictive housing” during their incarceration at a North Carolina state prison were “significantly more likely to die of all causes in the first year after release than those who did not.” Furthermore, spending more than 14 days in solitary confinement was linked with a higher risk of death and reincarceration after release from prison.

Their work was published the journal JAMA Open Network, and it examined those prisoners between 2000 to 2015. The data was provided to the team by the North Carolina Department of Public Safety, which has expressed interest in reforming how the state approaches solitary confinement.

First author Lauren Brinkley-Rubinstein, Ph.D., an assistant professor at the University of North Carolina School of Medicine, tells Inverse that previous research has shown that solitary confinement can be detrimental to health, but “traditionally it has been very hard to obtain administrative data on time in solitary confinement during incarceration.”

Similarly, it’s been difficult for researchers to establish how many Americans have been placed in solitary confinement. A 2016 study by Yale Law School found that about 66,000 prisoners were in solitary confinement, based on data from 73 percent of the country’s prison population. The study also estimates that if all data was available, that number would rise to 80,000 people.

In the case of this new study, Brinkley-Rubinstein and colleagues were able to use data provided by the North Carolina Department of Public Safety, then matched that data to mortality records. The cohort study included 229,297 people, some who had been placed in restrictive housing and others who had not.

People who spent any time in restrictive housing were 24 percent more likely to die in the first year of their release

Certain patterns emerged: People who spent any time in restrictive housing were 24 percent more likely to die in the first year of their release. Within this group, 78 percent died from suicide while roughly 54 percent from homicide. These individuals were also 127 percent more likely to die from an opioid overdose in the first two weeks after their release. This was especially true for white individuals.

"These individuals were also 127 percent more likely to die from an opioid overdose in the first two weeks after their release."

While this study shows that exposure to restrictive housing “may be a contributing factor” to risk of death during community reentry, it can’t establish exactly why.

“We know that being incarcerated increases the risk of adverse health outcomes post-release but, what is understudied, is what are the ‘mechanisms of incarceration’ that heighten this risk above and beyond what we already know,” Brinkley-Rubinstein explains.

But testaments of prisoners and psychiatrists point to the mechanisms that are likely at play. To be in restrictive housing means to be within a cell about the size of a king-sized bed for 22 to 24-hours a day. These settings mean social isolation, sensory deprivation, and intense physical idleness. Interviews with prisoners in solitary show indicate that time spent there can induce paranoia, hallucinations, panic attacks, and suicidal intentions among other repercussions. They can lose their ability to interact with other people and to know who they are.

Currently, there is a lawsuit filed against the Virginia Department of Corrections for holding a man named Tyquine Lee in solitary confinement at Red Onion State Prison for more than 600 days. Lee has lost over 30 pounds, as well as his ability to speak and remember his name.

There are movements to reform restrictive housing rules in the United States, but various agencies and advocacy groups differ on when it should be applied. Some consider it torture and advocate for its complete restriction, while others argue for more gradual efforts or alternatives.

In 2016, the Department of Justice argued that in certain occasions “correctional officials have no choice but to segregate inmates from the general population” but “we believe strongly this practice should be used rarely, applied fairly, and subjected to reasonable constraints.” Meanwhile, the nonprofit the Vera Institutes argues it should only be used as a “last resort” and “for the shortest time possible.” While federally there are no restrictions on solitary confinement, as of July 2019 there are eight states that have legislation that limits the use of restrictive housing.

In turn, the authors of this new study argue that their results can be used to “identify people for linkage to trauma-informed, community-based substance use and mental health treatment, overdose prevention and harm reduction, and wraparound care and services.

To Brinkley-Rubinstein, the goal is that the data can ignite change: “I hope that jails and prisons reconsider the use of solitary confinement and restrict its use.”

In 2015, the United Nations instituted the “Mandela Rules,” which state that no one should be put in solitary confinement for more than 15 days. However, the US doesn’t follow those rules.

Partial Abstract:

Importance: Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes.

Objective: To characterize the association of restrictive housing with reincarceration and mortality after release.

Conclusions and relevance: This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.