1. Definitions of the terms “solitary confinement,” “isolation,” and “segregation” vary between jurisdictions and facilities.  This report uses the term “segregation” to describe the general practice, described in more detail below, of isolating an inmate for 22 to 24 hours a day in a small cell.
  2. See Am. Civil Liberties Union, The Dangerous Overuse of Solitary Confinement in the United States 2 (2014),; Peter Scharff Smith, The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature, 34 Crime & Just. 441, 442-43 (2006).
  3. See Chad S. Briggs et al., The Effect of Supermaximum Security Prisons on Aggregate Levels of Institutional Violence, 41 Criminology 1341, 1345 (2003).
  4. See Sarah Baumgartel et al., The Liman Program, Yale Law School, Association of State Correctional Administrators, Time-In-Cell: The ASCA-Liman 2014 National Survey of Administrative Segregation in Prison ii (2015),
  5. In discussing inmates with mental illness, this report uses the broad definition of “individual with a mental illness” from the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.  Under this act, an “individual with a mental illness” is an individual “who has a significant mental illness or emotional impairment, as determined by a mental health professional qualified under the laws and regulations of the State….”  42 U.S.C. § 10802(4)(A).  “Significant mental illness” and “emotional impairment” are not further defined in the PAIMI Act or its implementing regulations. However, courts have generally favored a broad definition of these terms. See Connecticut Office of Prot. & Advocacy for Persons with Disabilities v. Hartford Bd. of Educ., 355 F. Supp.2d 649, 655 (D. Conn. 2005), aff'd, 464 F.3d 229 (2d Cir. 2006).
  6. See Human Rights Watch, US.: Number of Mentally Ill in Prisons Quadrupled (2006),; Stuart Grassian, Psychiatric Effects of Solitary Confinement, 22 Wash. U. J.L. & Pol’y 325, 333 (2006).
  7. See Allen J. Beck, Bureau of Justice Statistics, U.S. Dep’t of Justice, Special Report: Use of Restrictive Housing in U.S. Prisons and Jails, 2011-12 1 (2015),
  8. See Jessica Knowles, “The Shameful Wall of Exclusion”: How Solitary Confinement for Inmates with Mental Illness Violates the Americans with Disabilities Act, 90 Wash. L. Rev. 893, 904-05 (2015) (citing several studies).
  9. See Kenneth L. Appelbaum, MD, American Psychiatry Should Join the Call to Abolish Solitary Confinement, 43 J. Am. Acad. Psychiatry & L. Online 406, 411 (Dec. 2015),
  10. See Barack Obama, Opinions, Why we must rethink solitary confinement, Wash. Post, Jan. 25, 2016,
  11. This report focuses on the segregation of individuals with mental illness. However, some of the same concepts apply to people with developmental and intellectual disabilities, and people with brain injuries.  Therefore, much of the analysis applied throughout this report to individuals with mental illness holds for people with other cognitive disabilities as well.
  12. See Rebecca Vallas, Center for American Progress, Disabled Behind Bars: The Mass Incarceration of People With Disabilities in America’s Jails and Prisons 1-2 (2016),
  13. To fund AVID, DRW applied for cy pres funds that were the result of litigation against AT&T regarding prison phone charges. DRW, along with dozens of other organizations in Washington, was awarded funding from this cy pres pool to conduct corrections-based advocacy. DRW has since obtained additional private grant funding to expand the AVID project to encompass advocacy in specific local Washington jails as well.
  14. While many P&As engage in advocacy relating to conditions in city jails, county jails, and immigration detention or holding facilities, this report primarily focuses on the work P&As have done in state prisons, with one example from a federal correctional facility.
  15. The report includes examples from the following 22 states: Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Montana, Nebraska, Nevada, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Vermont, and Washington.
  16. See Nat’l Disability Rights Network, Our History, (last visited July 22, 2016).
  17. See, e.g., Developmental Disabilities Assistance and Bill of Rights Act of 1975, 42 U.S.C. § 15041-15045; Protection and Advocacy for Individuals with Mental Illnesses Act, 42 U.S.C. § 10801-10851; Protection and Advocacy of Individual Rights, 29 U.S.C. § 794e.
  18. See 42 C.F.R. § 51.42(b).
  19. Given the exhaustion requirements of the Prison Litigation Reform Act, most inmates and advocates begin with advocacy via the prison’s internal grievance system, moving onto other forms of advocacy, particularly litigation, only after exhausting the avenues of redress available within the prison. See 42 U.S.C. § 1997e(a).
  20. See 42 U.S.C. § 10807(a) (requiring that P&As exhaust administrative remedies where appropriate before commencing litigation).
  21. The requirements for an agency asserting organizational standing are set forth in Hunt v. Wash. State Apple Adver. Comm’n, 432 U.S. 333, 343 (1997).
  22. See Alison Shames et al., Vera Institute of Justice, Solitary Confinement: Common Misconceptions and Emerging Safe Alternatives 8 (2015),
  23. See Thomas L. Hafemeister & Jeff George, The Ninth Circle of Hell: An Eighth Amendment Analysis of Imposing Prolonged Supermax Solitary Confinement on Inmates with a Mental Illness, 90 Denv. U. L. Rev. 1, 47-48 (2012).
  24. See American Bar Association, ABA Standards for Criminal Justice: Treatment of Prisoners 55-57, 95-99 (3d ed. 2011), (recommending that inmates in segregation be provided equal access to services and mental health treatment).
  25. Grassian, 22 Wash. U. J.L. & Pol’y at 333.
  26. Jeffrey L. Metzner & Jamie Fellner, Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics, 38 J. Am. Acad. Psychiatry & L. Online 104, 105 (2010),
  27. See Am. Civil Liberties Union, The Dangerous Overuse of Solitary Confinement in the United States 3 (2014),
  28. See Metzner & Fellner, supra note 25, at 104.
  29. See American Bar Association, ABA Standards for Criminal Justice: Treatment of Prisoners 32 (3d ed. 2011),
  30. See Maclyn Willigan, Solitary Watch, What Solitary Confinement Does to the Human Brain, (Aug. 2014).
  31. Am. Civil Liberties Union, The Dangerous Overuse of Solitary Confinement in the United States 5 (2014),
  32. Am. Pub. Health Ass’n, Solitary Confinement as a Public Health Issue (2013),
  33. See Sasha Abramsky & Jamie Fellner, Human Rights Watch, Ill-Equipped: U.S. Prisons and Offenders with Mental Illness 110 (2003),
  34. See, e.g., Complaint, Disability Advocates, Inc. v. N.Y. State Office of Mental Health, No. 02 CV 4002 (S.D.N.Y. May 28, 2002),; Expert Report of Kathryn Burns & Jane Haddad for Plaintiffs at 28, Bradley v. Hightower, No. 92-A-70-N (N.D. Ala. June 30, 2000),
  35. The Eighth Amendment reads: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” U.S. Const. amend. VIII.
  36. See Hutto v. Finney, 437 U.S. 678, 685 (1978).
  37. Farmer v. Brennan, 511 U.S. 825, 836 (1994).
  38. Id.
  39. See Ruiz v. Johnson, 37 F. Supp. 2d 855, 887 (S.D. Tex. 1999), rev'd and remanded sub nom. Ruiz v. United States, 243 F.3d 941 (5th Cir. 2001).
  40. See Helling v. McKinney, 509 U.S. 25, 35 (1993).
  41. Farmer, 511 U.S. at 837.
  42. Id. at 842.
  43. Estelle v. Gamble, 429 U.S. 97, 103 (1976).
  44. See id. at 104-05.
  45. Madrid v. Gomez, 889 F. Supp. 1146, 1265 (N.D. Cal. 1995).
  46. Id. at 1280.
  47. Ruiz, 37 F. Supp. 2d at 907.
  48. Id. at 915.
  49. Jones’ El v. Berge, 164 F. Supp. 2d 1096, 1122, 1124 (W.D. Wis. 2001).
  50. The protections of the Rehab Act are substantially the same as those afforded under Title II of the ADA in relation to inmates. Bragdon v. Abbott, 524 U.S. 624, 632 (1998); 42 U.S.C. § 12201(a).
  51. For more information about the ADA and prison, see Rachael Seevers, Disability Rights Washington, Amplifying Voices of Inmates with Disabilities Prison Project, Making Hard Time Harder: Programmatic Accommodations for Inmates with Disabilities Under the Americans with Disabilities Act (2016), also Margo Schlanger, Memorandum Re: The ADA/Rehab Act and solitary confinement (2015),
  52. Disability Advocates, Inc. (DAI), now Disability Rights New York, was a regional protection and advocacy office with the New York P&A system.
  53. The Legal Center is not using federal grant money to fund this litigation since it involves a federal agency.
  54. Many of the settlement terms were incorporated into New York’s “SHU Exclusion Law” which passed both houses and was signed into law in July 2007.   The SHU Exclusion provisions went into effect in July 2011, following the anticipated sunset of the lawsuit’s settlement agreement.  (See discussion at pp. 13-14 under Non-Litigation Advocacy).

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The AVID Prison Project is a collaboration between The Arizona Center for Disability Law, Disability Law Colorado, The Advocacy Center of Louisiana, Disability Rights New York, Protection and Advocacy for People with Disabilities of South Carolina, Disability Rights Texas, Disability Rights Washington and The National Disability Rights Network.