4. RESTRICTIONS, DISCIPLINE AND SANCTIONS WHY IS IT IMPORTANT? The negative, and potentially long-lasting, impact of solitary confinement on the physical and mental health and wellbeing of prisoners is well-documented. Medical research confirms that the denial of meaningful human contact can lead to “isolation syndrome”, the symptoms of which include anxiety, depression, anger, cognitive disturbances, perceptual distortions, paranoia, psychosis, self‑harm and suicide, and which can destroy a person’s personality.232 44 The Istanbul Statement on the use and effects of solitary confinement (the Istanbul Statement) has also captured this, stating that “[s]olitary confinement may cause serious psychological and sometimes physiological ill effects (…) Negative health effects can occur after only a few days in solitary confinement, and the risk rises with each additional day spent in such conditions. (...) The central harmful feature of solitary confinement is that it reduces meaningful social contact to a level of social and psychological stimulus that many will experience as insufficient to sustain health and wellbeing.”233 45 Solitary confinement can, in certain circumstances, amount to cruel, inhuman or degrading treatment or punishment. Additionally, due to the inherent isolation of solitary confinement, there is a heightened risk of other human rights violations taking place. 46 Solitary confinement can also increase the risk of suicide or self‑harm, particularly for prisoners with pre-existing mental health conditions. As the WHO has pointed out, “[s]ocial and physical isolation and lack of accessible supportive resources intensify the risk of suicide. Therefore, an important element in suicide prevention in correctional settings is meaningful social interaction.”234 The potential long-term effects of isolation, including the risk of suicide and self‑harm, mean that there is risk not only during the period of isolation itself, but potentially long-lasting psychological effects that may persist long after the initial punishment and even after release from prison. 47 The use of solitary confinement is generally negative for staff-prisoner relations and social cohesion within the prison. Arguably, it also has a negative impact on the prisoner's prospects for reintegration and rehabilitation. The UN Special Rapporteur on torture has stated that solitary confinement is contrary to rehabilitation, which is the ultimate aim of penitentiary systems.235 48 Principle 7 of the UN Basic Principles for the Treatment of Prisoners calls for efforts towards “the abolition of solitary confinement as a punishment, or to the restriction of its use.”236 4 43 PUTTING IT INTO PRACTICE Definition of solitary confinement 49 Prohibitions and limitations of solitary confinement incorporated into the Mandela Rules apply regardless of whether the measure is used as a disciplinary sanction or for other purposes (see Rule 37(d), Rule 43(1) and the definition in Rule 44). 232. More detailed information about the harmful impacts of solitary confinement can be found in: Grassian S, ‘Psychiatric effects of solitary confinement’, Journal of Law and Policy, Vol. 22, 2006, pp. 325-383; Craig Haney, ‘Mental health issues in long-term solitary and supermax confinement’, Crime & Delinquency, Vol. 49, No. 1, 2003, pp. 124-156; Sharon Shalev, ‘A sourcebook on solitary confinement’, Mannheim Centre for Criminology – London School of Economics, 2008; Interim report of the Special Rapporteur on torture, A/66/268, op. cit., note 231. 233. The Istanbul statement on the use and effects of solitary confinement, op. cit., note 231, p. 2. 234. Preventing Suicide in Jails and Prisons, WHO/International Association for Suicide Prevention, op. cit., note 180, p. 16. 235. “‘Solitary confinement should be banned in most cases’, UN expert says”, UN News Centre, 18 October 2011. 236. Basic Principles for the Treatment of Prisoners, UNGA, op. cit., note 229, Principle 7. Guidance document on the Nelson Mandela Rules 105