Solitary confinement continues to be a widespread practice among jails and prisons in the United States, despite extensive evidence of its negative effects on mental health, particularly for individuals with serious mental illness (SMI). Given this, it is imperative for forensic mental health clinicians, especially those working in correctional settings, to be aware of the laws and policies that govern who can be placed in solitary confinement, for what reasons, and for how long. This article summarizes each state’s statutes, administrative codes, and department policies on solitary confinement regarding people with SMI, highlighting the wide variation in the treatment of individuals with SMI in the correctional system across states and the need for uniform legislation that restricts the use of solitary confinement for people with SMI. This knowledge can help clinicians to better understand the ways in which their patients may be affected by the practice of solitary confinement and, ultimately, how to advocate for incarcerated individuals placed in solitary confinement to help minimize adverse outcomes.
The United States has one of the highest incarceration rates in the world, with approximately 1.9 million people currently incarcerated in state, federal, and local facilities across the country.1 Despite an overall downward trend since 2009, the number of incarcerated individuals has begun to increase again in the years since the COVID-19 pandemic.2,3 Of these millions of incarcerated individuals, approximately 120,000 of them are held in solitary confinement,4 commonly defined as isolation in a single cell for at least 22 hours a day.5 Incarcerated individuals may be held in solitary confinement for various reasons, including as a response to a serious committed offense, as a disciplinary measure, or for an individual’s own safety within the facility.6
Although specific wording and terminology for the practice of solitary confinement differs across states, there exist three main types of general solitary confinement used by correctional systems in the United States: administrative segregation, disciplinary segregation, and protective custody. Administrative segregation refers to solitary confinement used to manage the correctional population, either to separate those with a higher perceived level of risk to maintain safety, for those awaiting a disciplinary hearing or transfer to another unit or facility, or to separate members of different gangs. Disciplinary segregation is used as a type of sanction for inmate misconduct, generally after a disciplinary hearing has taken place. Protective custody may be utilized for the protection of individuals, who can request to be placed in solitary confinement if they fear for their safety. Disciplinary segregation generally has a clear time limit, whereas individuals may be placed in administrative segregation indefinitely.6 In addition to these three types, it is also important to recognize that correctional facilities may also place individuals with mental illness in conditions that resemble solitary confinement while calling them by a different name, including placing people in safety cells, mental health watch, and suicide watch.7
Research has shown that solitary confinement leads to adverse mental health effects. Solitary confinement has been associated with higher rates of depression, anxiety, suicidal ideation, self-harm, completed suicide, symptoms of psychosis (including hallucinations and paranoia), and trauma-related symptoms.8,–,11 In fact, one study found that over half of the instances of self-harm that occurred in the Washington State jail system were completed by individuals in solitary confinement, although these individuals only comprised seven percent of jail admissions.8 Even after individuals are released from solitary confinement, they experience greatly increased rates of mortality, suicide, and overdose.12 Although it is important to recognize the deleterious effects that solitary confinement can have on anyone regardless of a history of psychiatric illness, it is well documented that individuals with serious mental illness (SMI), defined as a “mental, behavioral, or emotional disorder resulting in serious functional impairment,”13 are particularly vulnerable to the harms of solitary confinement. Not only are individuals with SMI more likely to be placed in solitary confinement and for a longer period of time as a result of behaviors stemming from their illness, they are also more vulnerable to the psychological impact of solitary confinement, which can both exacerbate preexisting symptoms and limit access to mental health services.14,–,17 One study of Pennsylvania prisons found that both men and women with a diagnosed mental illness were about 50 percent more likely to receive solitary confinement as a punishment for misconduct and spent three times longer in solitary confinement than those without a mental illness.16 Both the National Commission on Correctional Health Care and the American Psychiatric Association recommend that solitary confinement for individuals with SMI be avoided, and if these individuals are placed in solitary confinement, that they have access to adequate out-of-cell treatment and programming.18,19
In 2015, the United Nations updated its Standard Minimum Rules for the Treatment of Prisoners, commonly known as the Nelson Mandela rules, which stipulate that solitary confinement for 22 hours a day lasting more than 15 days amounts to psychological torture and advocate against its use for people with mental illness.5 Since then, several states have passed laws restricting the use of solitary confinement for various vulnerable populations, including juveniles, pregnant women, and those with SMI, with an even higher number of states introducing legislation targeting this practice.20 The laws and policies that govern the types of solitary confinement, time limits, conditions, and processes differ widely across states, making it difficult to get a clear sense of how incarcerated individuals, especially those with SMI, may be affected by the practice of solitary confinement in their specific state and facility. Even the wording used to describe solitary confinement varies, with states using numerous terms to refer to solitary confinement, including restrictive housing, detention, isolation, or segregation.
Further complicating the picture is the lack of a consistent definition of SMI used by states, as some states may refer to people with SMI as having a mental disability or functional impairment or classify individuals using state-specific mental health codes. Previous studies have examined state policies regarding mental health services for individuals in solitary confinement. A study published in 2014 looking at state policies on the treatment of mentally ill individuals in “supermax” facilities or long-term administrative segregation found that the majority of states lacked guidelines on the placement of mentally ill individuals in these facilities, although most states did include policies mandating mental health assessments prior to and during placement for anyone placed in a supermax facility.21 A similar 2020 study examining mental health policies for individuals placed in any type of solitary confinement also found significant variation in mental health services and interventions across states, with 35 percent of states including policies that exclude individuals with mental health concerns from being placed in solitary confinement.22
Given the disproportionate effect of solitary confinement on people with SMI and these recent legal reforms, this study aims to build upon previous research by reviewing current state statutes, administrative codes, and departmental policies on solitary confinement, including both administrative segregation and disciplinary segregation when specified, as they relate to individuals with SMI. To my knowledge, this is the first study to examine both state statutes and administrative codes, along with departmental policies, and to focus specifically on individuals with SMI in solitary confinement. This study also provides the most up-to-date data given significant recent changes to state legislation and policies on the topic.
Methods
Each state and the District of Columbia’s statute and administrative code were reviewed for any reference to “solitary confinement,” “restrictive housing,” “segregation,” “isolation,” and “detention,” along with any mention of “SMI,” “mental illness,” “psychiatric illness,” “vulnerable population,” “mental disorder,” and “mental disability.” The most current version of state statutes and administrative codes were reviewed online through each state’s governmental website and publicly accessible online databases, including Justia Law and the Legal Information Institute through Cornell Law School. The department of corrections websites for each state, the District of Columbia, and the Federal Bureau of Prisons were also searched for publicly accessible policies available online with any mention of the above terms, and when multiple versions of the same policy document were found, the most recently published policy was always cited. I conducted these searches during February to April 2026, conducting each search twice at least one month apart to ensure that the most comprehensive and up-to-date information was included.
Results
Table 1 categorizes each state according to its treatment of people with SMI in solitary confinement, ranging from states lacking any laws or regulations regarding the placement of SMI individuals in solitary confinement to states that generally prohibit placement of SMI individuals in solitary confinement except in exceptional circumstances. Fifteen states, or approximately 29 percent of states, prohibit solitary confinement for people with an SMI designation except in cases in which the individual presents an imminent danger to self or others. Eleven states did not mention anything regarding the treatment of individuals with SMI placed in solitary confinement in either their state statute, administrative code, or in publicly accessible online departmental policies. The rest of the 24 states, the District of Columbia, and the Federal Bureau of Prisons fell somewhere in the middle, allowing solitary confinement for individuals with SMI with some additional requirements compared with those without SMI.
Treatment of Individuals with SMI in Solitary Confinement by Jurisdiction
Table 2 categorizes these 24 jurisdictions by the degree of requirements in using solitary confinement for individuals with SMI. These requirements included a specific limit on the amount of time that someone with SMI can be placed in solitary confinement (ranging from 14 to 30 days), requiring the approval or input of a mental health clinician prior to being placed in solitary confinement, requiring clinician review or input after placement in solitary confinement, and calling for enhanced mental health treatment, services, or observation while in solitary confinement. For the eight states that included a time limit on solitary confinement placement, the majority of these states included language in their laws and policies allowing for people with SMI to be held in solitary confinement past this time if they present an imminent threat to themselves or others, similar to the language utilized by states that generally prohibit solitary confinement for individuals with SMI. Mandating clinician approval or input in the decision to place an individual with SMI in solitary confinement was much more common (14 jurisdictions) than requiring mental health clinician involvement only after an individual with SMI had already been placed in solitary confinement (four jurisdictions). Providing enhanced treatment, services, or observation was the most common requirement for placing individuals with SMI in solitary confinement, with 18 states and the District of Columbia including this in their laws or policies. This can include housing individuals with SMI in specialized restrictive housing units with more robust mental health services, developing an individualized treatment plan delineating the specific clinical treatment and services to be received by the individual, or providing individuals with a certain amount of extra out-of-cell time, therapeutic programming, or increased frequency of mental health assessments or observation.
Jurisdictions Permitting Solitary Confinement with Additional Requirements
The online supplement displays data gathered from each state’s statutes, administrative codes, and departmental policies regarding the treatment of individuals with SMI in solitary confinement and each state’s definition of SMI, if SMI is mentioned at all. Twelve states had state statutes governing individuals with SMI in solitary confinement, 12 states had administrative codes, and 33 states, the District of Columbia, and the Federal Bureau of Prisons included departmental policies on the subject. The terminology used by states to refer to SMI included severely mentally ill, mental disability, serious functional impairment, or state-specific mental health codes; some definitions included specific diagnoses, whereas others focused more on the impact of the illness on an individual’s functioning. Of the states with some form of law or policy on the treatment of individuals with SMI in solitary confinement, all but three of them (Hawaii, Tennessee, and District of Columbia) included an explicit definition of SMI or related term.
Of the 15 states that have restricted the practice of solitary confinement for individuals with SMI to rare cases where the safety of the individual or others is acutely threatened, eight of these states have passed legislation amending their state statutes within the past decade, whereas the remaining seven states have only included the relevant language within their departmental policies, rather than in the statute or administrative code.
Massachusetts was the first state to limit solitary confinement of people with SMI with the passage of the Criminal Justice Reform Act in 2018,23 followed by the Isolated Confinement Restriction Act in New Jersey passed in 2019,24 the Restricted Housing Act in New Mexico in 2019,25 and the Humane Alternatives to Long-Term Solitary Confinement (HALT) Solitary Confinement Act in New York signed into law in 2021.26 Most recently, Hawaii passed SB104 in July 2025, limiting the use of restrictive housing for those with a disability because of mental illness, which was to be fully enacted in July 2026.27 In the states with departmental policies generally prohibiting solitary confinement for people with SMI, these changes were largely brought about by either court orders, like in the case of Alabama in 201828 and Arizona in 2023,29 or court cases resulting in settlements forcing states to adopt stricter policies, like in the Disability Rights Network v. Wetzel case in Pennsylvania in 201530 and the Community Legal Aid Society Inc v. Coupe case in Delaware in 2016.31 These cases illustrate the trend in recent years toward states restricting the use of solitary confinement for people with SMI.
Discussion
More than 20 percent of states (see Table 1) lack any publicly accessible laws or policies regarding the treatment of individuals with SMI in solitary confinement. Notably, several of these states (including Mississippi, Arkansas, and Louisiana) currently have some of the highest incarceration rates in the United States,3 and Utah and Louisiana previously reported the highest rates of solitary confinement among incarcerated individuals in 2016.32 With a lack of explicit wording in statewide laws, codes, or policies, it is not difficult to imagine that the treatment and procedures relating to the practice of solitary confinement for people with mental illness might differ across facilities, painting an even murkier picture of the conditions experienced by incarcerated individuals with SMI in these states.
In addition, although some states may have laws that appear to permit solitary confinement for individuals with SMI only in exceptional circumstances, it is impossible to know how this is implemented in practice or how frequently the use of solitary confinement is justified by an individual’s threat to self or others. People with SMI may be held in isolative conditions resembling solitary confinement if they are unable to comply with facility rules because of their illness, including under suicide watch, mental health watch, and in safety cells.7,33 It is well known that a high proportion of people in solitary confinement have mental illness, even in states that appear to limit its use in people with SMI.34,35 Some states, like Maine and Delaware, only limit disciplinary segregation for those with SMI without mentioning other types of solitary confinement, like administrative segregation, leaving individuals with SMI vulnerable to experiencing solitary confinement in other forms.36,37 States with only departmental policies governing the treatment of people with SMI in solitary confinement, rather than statutes or administrative codes, may lack a degree of oversight and transparency regarding the enforcement of these policies, and policies are more easily changed from year to year compared with state laws. Finally, although several states require a mental health professional to be consulted in the decision to place someone in solitary confinement or transfer the prisoner to an alternative housing unit, the ultimate decision-making power often resides with the sheriff or chief administrator, suggesting that it is possible for individuals with SMI to be placed in segregation despite clinician recommendations to the contrary. This may place clinicians in a position where they must balance their duty toward patient health and confidentiality with the pressure to “clear” someone for placement in solitary confinement for institutional purposes, raising concerns of dual loyalty.38 Such concerns may also arise in the provision of enhanced treatment, services, or observation mandated by some states for individuals with SMI placed in solitary confinement, as there may be pressure placed on providers to minimize mental health concerns so that someone may remain in solitary confinement rather than providing the person with the appropriate or evidence-based treatment.
There are vast differences across states in terms of the way that solitary confinement is named and defined, the varying levels of restrictions on solitary confinement for people with SMI, and whether the language governing the treatment of people with SMI in solitary confinement is located within a state statute, administrative code, or departmental policy. In recent years, there is an increasing trend toward states adopting laws and policies that limit the use of solitary confinement for people with SMI, likely in the context of increasing research on and awareness of the psychological harms of solitary confinement on already vulnerable individuals. In line with this trend, there should be uniform legislation across states that prohibits the use of solitary confinement for people diagnosed with SMI. One way that this could be accomplished is through passage of federal legislation that would set forth national standards for the restriction of solitary confinement for individuals with SMI, perhaps using the Prison Rape Elimination Act (PREA)39 as a guide. In the same way that PREA established a federal framework for reducing and preventing sexual assault in correctional facilities, established standardized definitions used by facilities to increase data collection and research, and provides funding for reforms to work toward these goals, a federal law governing the use of solitary confinement for individuals with SMI could help to address the current fragmented legislative landscape across states and promote solitary confinement reform. In accordance with the United Nation (UN) rules and the American Psychological Association (APA) position statement, this legislation should exclude individuals with SMI from being held in solitary confinement whenever possible, in addition to clearly defining SMI and requiring states to track and report the number of people with SMI held in solitary confinement, for how long, and for what reasons.
At the same time, it is important to recognize that legislation simply prohibiting the use of solitary confinement for individuals with SMI without providing other alternatives or additional programming may lead to unintended consequences, including concern for increased violence toward correctional staff. For example, New York correctional officers went on strike in early 2025 in part to protest the implementation of the HALT Act, which they believed to have led to dangerous working conditions and decreased safety within correctional facilities.40 Almost all states that generally prohibit solitary confinement for individuals with SMI use language that allows for brief placement in solitary confinement in circumstances of imminent danger, indicating the reliance on solitary confinement in extreme situations. Yet research has shown that utilizing solitary confinement as a means of punishment and maintaining safety and order does not actually accomplish these goals or decrease overall violence in correctional facilities.41,–,43 States should consider expanding therapeutic units targeted toward individuals with SMI to divert them from solitary confinement while also ensuring that these units do not become solitary confinement-like conditions in practice. The Clinical Alternative to Punitive Segregation (CAPS) program adopted by the New York City (NYC) jail system, which provides treatment and programming to individuals with SMI who would have otherwise been placed in solitary confinement, has been shown to reduce rates of self-harm and injuries.44 Another alternative model is the Oregon Resource Team, adapted from an interdisciplinary approach developed in Norway, which focuses on promoting positive social interactions between staff and incarcerated individuals with SMI, meeting the specific needs of each individual, and instilling hope in individuals by maximizing out-of-cell time and developing a peer mentor program; this intervention has led to reduced violence and a greater sense of safety among both incarcerated participants and staff.45 Ultimately, states should work toward the long-term goal of diverting individuals with SMI from the criminal legal system altogether, as the problems that arise with placing individuals with SMI in solitary confinement are reflective of systemic concerns in the treatment of mental illness in the criminal legal system as a whole.
There are several limitations to this study. First, it is important to acknowledge that only publicly available documents were included in the review of each state’s departmental policies regarding the treatment of people of SMI in solitary confinement. It is likely that a state’s department of corrections maintains internal documents detailing the procedures in which people with SMI are treated in solitary confinement that are not available online or readily accessible to the public. Therefore, the departmental policies included in the online supplement may be missing certain information or the most up-to-date policies if these documents have not yet been published online or made public, particularly regarding the 11 states in which no policies mentioning the treatment of individuals with SMI in solitary confinement were found. Second, each state’s definition of SMI is different, making it difficult to directly compare states’ laws and policies with each other. The study has attempted to address this by providing each state’s definition of SMI, or the specific terminology used in each state, in the online supplement. Third, it is important to note that a few states (New York, Virginia, Connecticut, and California) have passed laws that allow those placed in restrictive housing to have greater than two hours of out-of-cell time a day, which technically does not meet the standard definition of solitary confinement, traditionally defined as isolation for 22 hours or more a day in a cell. The New York HALT Act, passed in 2021,26 limits confinement to 17 hours a day, whereas Connecticut46 and Virginia47 restrict confinement to 19 hours and 20 hours a day, respectively. California allows individuals in restrictive housing 20 hours of out-of-cell time per week, averaging slightly less than three hours of out-of-cell time per day.48 Therefore, it is difficult to directly compare states that utilize the standard definition of solitary confinement as isolation for 22 hours or more a day with the above states that use a different definition of solitary confinement altogether. In fact, some states, like Massachusetts, claim to have eliminated solitary confinement by purposely providing individuals with slightly more out-of-cell time while continuing to use the 22 hours out-of-cell time definition. As a result, these new units, known as behavior assessment units (BAUs) in Massachusetts, which mandate three hours of daily out-of-cell time and thus fall outside the technical definition of restrictive housing, allow protections for people with SMI to be bypassed even when those restrictions are clearly established in the state statute and administrative code.49
Conclusion
The various U.S. jurisdictions differ widely in statutes, administrative codes, and policies that govern the placement and treatment of individuals with SMI in solitary confinement. Although a substantial minority of states generally prohibit solitary confinement for individuals with SMI, the majority of states allow for solitary confinement placement with some additional requirements, including a stricter time limit, enhanced treatment or observation, and clinician input or approval. Psychiatrists and other mental health clinicians working in correctional settings should be aware of the laws and policies regarding the use of solitary confinement for their patients with SMI, particularly those working in states where there are no clear legal specifications for the treatment of individuals with mental illness who may be placed into solitary confinement. This knowledge will enable providers to better identify who may be at risk of adverse mental health effects as a result of being placed in solitary confinement, provide more informed and comprehensive care to those facing these conditions, and advocate for both their individual patients throughout the course of a solitary confinement placement as well as for more uniform legislation that restricts the practice of solitary confinement for people with SMI. At the same time, more research should be conducted to examine the ways that these laws and policies manifest in practice and how differing policies affect outcomes for individuals with SMI in states with stricter solitary confinement laws compared with those with more lenient policies.
Acknowledgments
I would like to acknowledge Dr. Jacob Appel for his mentorship, guidance, and feedback in the development of this paper.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2026 American Academy of Psychiatry and the Law
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