Primary Submission Category: Non-health institutions (business, political, education systems)
The Use of Solitary Confinement and Associations with In-Custody Mortality in North Carolina State Prisons, 2021-2023
Authors: Katherine LeMasters, Sara Levintow, Jennifer Lao, Erin McCauley, Craig Waleed, Zaire Cullins, Michael Behne, Lauren Brinkley-Rubinstein,
Presenting Author: Katherine LeMasters*
Solitary confinement, a punitive practice in which individuals are housed alone for 22-24 hours a day, is associated with increased mortality post-release. Little is known about its use following recent reforms (e.g., ending use for sub-populations) and COVID-19 challenges (e.g., increased use under the guise of public health), and its association with in-custody deaths. In partnership with Disability Rights North Carolina (NC), we investigated patterns of and associations between solitary confinement and mortality in NC state prisons.
With weekly housing data from Disability Rights NC, we created a retrospective cohort of individuals newly incarcerated in NC prisons between 2021-2023 with weekly data on housing and movements (e.g., release, admission, death). We calculated the weekly proportion experiencing solitary confinement for 2+ weeks by type (e.g., administrative control). We calculated all-cause mortality rates, and used a generalized linear model with a Poisson distribution to calculate incidence rate ratios comparing all-cause mortality between those who did and did not experience solitary.
Nearly one-quarter of 41,525 individuals in NC state prisons experienced solitary confinement. By the end of follow-up, over 6% of individuals were in solitary confinement per week, 18% had experienced solitary confinement for 2+ weeks, and the median length of stay in all types of solitary was 3+ weeks. There were 43 in-custody deaths with those experiencing solitary having twice the all-cause mortality rate of others (2.15, 95%CI: 1.14, 4.08).
Solitary confinement is common in NC prisons and is associated with elevated death rates in custody. As states implement reforms to reduce solitary, work is needed to ensure that solitary use is reduced and that length of stay aligns with United Nations standards, which require that use of solitary confinement be <15 days. There is an urgent need to document the types and duration of solitary stays to end this punitive practice.