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Solitary confinement linked with increased risk of death after release from prison

October 17, 2019

A new study led by researchers at the University of North Carolina at Chapel Hill has found that being held in restrictive housing (i.e., solitary confinement) is associated with an increased risk of death after a person is released from prison.

Incarcerated individuals who were placed in restrictive housing in North Carolina from 2000 to 2015 were 24% more likely to die in the first year after their release, compared to those who were not held in restrictive housing. In addition, people held in restrictive housing were 78% more likely to die from suicide, 54% more likely to die from homicide and 127% more likely to die from an opioid overdose in the first two weeks after their release. Further, the number of placements in restrictive housing and spending more than 14 consecutive days in restrictive housing were associated with further increase in the risk of death and re-incarceration.

“For the first time ever, using data shared with us from our partners at the North Carolina Department of Public Safety, we’ve been able to demonstrate a connection between restrictive housing during incarceration and increased risk of death when people return to the community,” said Lauren Brinkley-Rubinstein, PhD, assistant professor of social medicine at the UNC School of Medicine and lead author of the study, which was published October 4 by JAMA Network Open. “In addition, our study found that the more time people spent in restrictive housing, the higher their risk of mortality after release. This study provides empirical evidence to support ongoing nationwide reforms that limit the use of restrictive housing. North Carolina is a leader in this thinking, as the Department of Public Safety has pre-emptively implemented multiple reforms that have resulted in the limited use of restrictive housing.”

“We appreciate this research collaboration and recognize the importance of these results in shaping policy and practice,” added Gary Junker, director of behavioral health for the Department of Public Safety Adult Correction and Juvenile Justice.  “Since 2015, the Department has initiated several programs to divert people from restrictive housing, including Therapeutic Diversion Units for those with mental illness. While safety and security must remain our top priority, we recognize that reduced use of restrictive housing will likely improve post-release outcomes.”

The findings are from a retrospective cohort study conducted by Brinkley-Rubinstein and co-authors from UNC, Emory University, the N.C. Department of Public Safety and the N.C. Department of Public Health. Incarceration data for people who were confined in North Carolina between 2000 and 2015 were matched with death records from 2000 to 2016.

Dr. Shabbar Ranapurwala

Dr. Shabbar Ranapurwala

“We also found that non-white individuals were disproportionately more likely to be assigned to restrictive housing than their white counterparts,” said co-author Shabbar Ranapurwala, PhD, an assistant professor of epidemiology in the UNC Gillings School of Global Public Health and a core faculty member of the UNC Injury Prevention Research Center. “In fact, the mortality and re-incarceration outcomes after release were also quite different between these racial groups. The post-release opioid overdose and suicide death outcomes among those receiving restrictive housing were more pronounced among white individuals, while the all-cause and homicide death and re-incarceration outcomes were higher among non-white Americans.”

Given the observational nature of the study, establishing cause and effect may be difficult. Still, the strength and consistency of the findings point to the fact that solitary confinement is an important marker of increased mortality risk among formerly incarcerated individuals. To prevent potential harm, the study authors say, we not only need innovative prison programs like the Therapeutic Diversion Units, but also need to link this vulnerable population to appropriate care.

Other co-authors of the study are Meghan Shanahan, PhD, of the UNC Gillings School and the UNC Injury Prevention Research Center; Josie Caves, MPH, of the UNC Injury Prevention Research Center; David L. Rosen, PhD, MD, of the UNC Division of Infectious Diseases; David H. Cloud, JD, of Emory University; Gary Junker, PhD, of the N.C. Department of Public Safety; and Scott Proescholdell, MPH, of the N.C. Division of Public Health.

For more information and current data, see the N.C. Opioid Action Plan and Opioid Research Agenda.

Contact the Gillings School of Global Public Health communications team at

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