PSYCHOLOGICAL
EFFECTS OF
SOLITARY
CONFINEMENT AND
SECLUSION
Associate Professor Donald Grant
Forensic Psychiatrist
SOLITARY CONFINEMENT
CONFINEMENT OF A PRISONER ALONE
IN A CELL FOR ALL, OR NEARLY ALL,
OF THE DAY, WITH MINIMAL
ENVIRONMENTAL STIMULATION AND
MINIMAL OPPORTUNITY FOR SOCIAL
INTERACTION
SECLUSION
THE CONFINEMENT IN A CLINICAL
SETTING OF A PATIENT IN A ROOM
WITH THE DOOR CLOSED OR
LOCKED WITH NO ABILITY TO LEAVE.
OFTEN PRECEEDED BY FORCIBLE
“TAKE DOWN” AND INVOLUNTARY
MEDICATION.
WHAT MAKES SOLITARY CONFINEMENT HARMFUL?
 SOCIAL ISOLATION -
deprivation of meaningful, sympathetic social interaction
and physical contact. Can lead to further withdrawal, with
ongoing discomfort in social situations after release.
 REDUCED ACTIVITY AND STIMULATION -
boredom, monotony, sensory deprivation, detachment
from the outside world. Brain activity slows.
 LACK OF CONTROL –
Others control everything, no personal autonomy,
complete dependency, If prolonged may lead to loss of
self-reliance, subsequent dysfunction in society.
FACTORS RELEVANT TO THE EFFECTS OF CONFINEMENT

The individual prisoner or patient
(resilience, attitudes).

The background of the person
(unstable, deprived, dislocated).

Intellectual or psychological vulnerabilities
(low intelligence, mental illness, personality disorder, history of abuse, PTSD).

Substance abuse history
(drug/alcohol dependence, withdrawal, craving).

The context of the confinement
(punishment, containment, safety).

The duration of the confinement and the knowledge of the prospective duration
(more than 10 days, indeterminate length)

The conditions of the confinement
(size, facilities, light).

The meaning of the experience to the person confined
(Political prisoner / Maximum secure prisoner /Patient).
EFFECTS OF CONFINEMENT
 Effects can arise from confinement alone, but are exaggerated
by poor hygienic conditions, abuse or torture.
 Effects are worse with increased individual vulnerability and
increased duration.
 Psychological effects compounded by possible physical effects
– pain, GIT issues, urinary problems, headache etc.
 Some individuals report no effects, the majority have some
negative effects.
 Short term, long term and permanent effects possible.
PSYCHOLOGICAL EFFECTS OF CONFINEMENT

ANXIETY DISORDERS - stress, anxiety, irritability, fear of impending death, panic attacks,
PTSD

DEPRESSION - Emotional flatness, loss of feeling, mood swings, hopelessness, withdrawal,
apathy, lethargy, Major Depression.

ANGER - irritability, hostility, poor impulse control, verbal and physical outbursts towards others
and/or self, unprovoked rage.

COGNITIVE DISTORTIONS – short attention span, poor concentration, poor memory,
confusion, disorientation in time and space.

PERCEPTUAL DISTORTIONS – hypersensitivity to noise and smells, visual distortions,
depersonalisation/derealisation, hallucinations (auditory, visual, touch, smell, or taste).

PARANOIA and PSYCHOSIS – obsessional ruminations, vengeful and violent thoughts,
persecutory ideas, paranoid states (eg, being poisoned), psychotic episodes, psychotic
depression.

SELF HARM and SUICIDE – self mutilation, head banging, self-starvation, suicides more
common than in general prison population.
What to do?
 Be aware of the effects of seclusion
 Be aware of person’s vulnerabilities
 Provide explanations and be humane
 Use seclusion for the right reasons only
 Use seclusion as a last resort, for shortest time possible
 Provide therapy for patients affected by seclusion
 Use alternatives (time out, quiet room, medication, anger
management)
 Train staff in de-escalation and management of
aggression
 Provide extra resources and better facilities
 Recruit younger, capable staff