Prisoners’ Risk of Death In Custody More than Doubles in Solitary Confinement
by Chuck Sharman
A study of North Carolina state prisoners published in September 2025 found that those who experienced solitary confinement had a mortality rate over twice as high as those who did not.
The results echo those of a 2020 Danish study, which found that the risk of death after release from prison jumped from 2.5% to 4.8% for those who had spent at least 72 hours in isolation. That study also found a shocking overall increase in the mortality rate of released prisoners compared to non-prisoners—a thirty-fold rise from 0.1% to 3%, as PLN reported. A U.S. Census Bureau study released two years later also showed that “former prisoners have higher mortality rates than their demographic counterparts in the general population.” [See: PLN, Sep. 2020, p.52; and Oct. 2022, p.58.]
The new data from North Carolina provide an in-custody companion to those studies and an earlier study in the state published in 2019, which found that spending any time in “restrictive housing” caused a prisoner’s risk of death to rise 24% in the first year after release. See: “Association of Restrictive Housing During Incarceration With Mortality After Release,” Journal of American Medicine Network (Oct. 2019).
That study did not break down its findings by the type of solitary to which prisoners were exposed. But the new study did, reporting findings for five of the seven types of housing assignments other than “general population” in the state Department of Adult Correction (DAC). The other two housing types allowed much more time out of cell than the rest, so they were excluded by authors Katherine LeMasters, Sara N. Levintow, Jennifer Lao, Erin McCauley, Craig Waleed, Zaire Cullins, M. Forrest Behne and Lauren Brinkley-Rubinstein.
Two of the five forms of solitary, High Security Maximum Control and Intensive Control, were used rarely, and the authors did not calculate mortality rates for them. The other three types of solitary all feature isolation in a cell for at least 22 hours a day, and they include:
- Restrictive Housing for Administrative Purposes (RHAP), which is used with those “at risk of experiencing or committing violence” and can last up to 72 hours;
- Restrictive Housing for Disciplinary Purposes (RHDP), which is for those found guilty of disciplinary infractions and can last up to 60 days;
- Restrictive Housing for Long-Term Control Purposes (RHCP), which isolates those posing “a threat to the safety and security of the facility”; it has no time limit, but the other two types of isolation can also be extended under certain circumstances.
During the two-year study period between 2021 and 2023, there were 41,525 prisoners admitted to the DAC. About 23%, or 9,245 of them, experienced some form of solitary confinement. Of those, 7,500 were held in isolation two weeks or longer. The rest were held from one week to two weeks. As the study pointed out, “[t]his means that 18 % of all [North Carolina prisoners] were in solitary confinement for two or more consecutive weeks.”
There were a total of 43 prisoner deaths during the study period, disproportionately representing those who experienced solitary confinement. As a result, the authors calculated that the mortality rate for prisoners jumped from 1.96 per 100,000 for those who never experienced solitary to 4.8 per 100,000 for those who did—a rate almost 2.5 times higher. See: “The use of solitary confinement and in-custody mortality in North Carolina State Prisons, 2021–2023,” SMS Population Health (Sep. 2025).
Of the many harmful aspects of prison life, the risks to health and mental health from solitary confinement are among the best-known. Yet the practice persists because officials find it an effective tool of control—if only in the way that a flame-thrower is an effective means of controlling household flies. As the authors of this study concluded, “more work is needed to ensure that solitary confinement use is reduced in practice” and that the length of a prisoner’s stay in solitary aligns with the United Nations cap of 15 days.
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