and suicide, which are anyway higher in prison than they are in the general population, are even higher in solitary confinement units.7 If solitary confinement can be damaging to those with no previous history of mental health issues, individuals with pre-existing mental illness are at a particularly high risk of worsening psychiatric problems as a result of their isolation.8 Children and young people are also particularly vulnerable to the damaging effects of solitary confinement, as they are still in the process of developing physically, mentally and socially, and solitary confinement effectively ‘freezes’ their development.9 Not everyone will experience solitary confinement in the same way. Individual responses to the stresses of solitary confinement vary, “depending on the premorbid adjustment of the individual and the context, length and conditions of confinement. The experience of previous trauma will render the person more vulnerable, as will the involuntary nature of his/her solitary confinement and confinement that persists over a sustained period of time. Initial acute reactions may be followed by chronic symptoms if the regime of solitary confinement persists”.10 Some of these reactions may subside once the person is no longer in solitary confinement, but some individuals will carry with them the damage caused by solitary confinement long after their release from solitary confinement. The damaging effects of solitary confinement are therefore best mitigated by avoiding the placement of people in isolation altogether. Where people are held in solitary confinement, this should be limited to a short and pre-defined time, during which they should be housed in decent conditions, have access to meaningful human contact and to purposeful activities, and be able to exercise some personal autonomy. Following three decades of what seemed like an unstoppable expansion in the use of solitary confinement, especially in the United States, in recent years the practice has been attracting increasing international attention. Human Rights and professional bodies, both international and regional, begun focusing their attention on its uses and consequences, seeking ways to minimise and better 7 Kaba, Fatos et al (2014) Solitary Confinement and Risk of Self-Harm Among Jail Inmates. American Journal of Public Health 104.3 (2014): 442–447; Fazel S et al. (2011) Prison suicides in 12 countries: an ecological study of 861 suicides during 2003–2007. Social Psychiatry Psychiatric Epidemiology, 46:191–195. 8 United Nations General Assembly, Report of the Special Rapporteur on Torture A/HRC/22/53 1 February 2013, par. 67-68. See also: Kupers T. (1999) Prison madness: the mental health crisis behind bars and what we must do about it. San Francisco: Jossey Bass; Reid W.H. (2000) Offenders with special needs. Journal of Psychiatric Practice, 6(5):280–283. 9 American Civil Liberties Union (ACLU) (2013) Alone and Afraid: Children Held in Solitary Confinement and Isolation in Juvenile Detention and Correctional Facilities. ACLU: Washington DC. 10 Shalev, S. (2014). ‘Solitary Confinement as a Prison Health Issue’. In: Enggist, S., Moller, L., Galea, G. and Udsen, C., (Eds.) Prisons and Health: a World Health Organisation (WHO) guide to the essentials in prison health (2nd edition), Copenhagen: WHO Regional Office Europe. pp27-35. 18