6 Discussion, Conclusions and Recommendations 6.1 Discussion and conclusions This report reveals a continued and troubling picture of high use of segregation and arbitrary and punitive practices towards the women in segregation. Women were often seen as troublesome or dangerous rather than vulnerable and were managed as such. Solitary confinement is a known risk factor for self-harm55 especially for women.56 A literature review of peer-reviewed studies found that there was consistent evidence of an association between lower time out of cell and time in purposeful activity and worse mental health and higher suicide risk.57 Yet this review has found that women in segregated housing were subjected to strict and prolonged solitary confinement in harsh, highly restrictive, conditions. They hardly spent any time outside their small cell, their contact with friends and family was reduced to short telephone conversations twice weekly. They were routinely disciplined, violently restrained, forcibly stripped of their clothing, and searched. Some were sprayed with pepper-gas whilst inside their cells- their home- without convincing reason or credible efforts to de-escalate situations first. Women had to follow detailed, punitive and at times arbitrary, rules, and were punished for any deviation from these rules. On the other hand, it was not clear what the women needed to do in order to be returned to the general prison population and a normal prison regime. These women were set to fall foul of the unreasonable behavioural expectations of them. 55 Kaba, F, Lewis, A, Glowa-Kollisch, S. (2014) Solitary confinement and risk of self-harm among jail inmates. American Journal of Public Health 104(3): 442–447. 56 Favril L, Yu R, Hawton K, Fazel S. Risk factors for self-harm in prison: a systematic review and meta-analysis. Lancet Psychiatry. 2020 Aug;7(8):682-691. doi: 10.1016/S2215-0366(20)30190-5. 57 Stephenson T, Leaman J, O’Moore É, Tran A, Plugge E. Time out of cell and time in purposeful activity and adverse mental health outcomes amongst people in prison: a literature review. International Journal of Prison Health. 2021 Jan 6;17(1):54-68. 53