' There is unequivocal evidence that solitary confinement has a profound impact on health and wellbeing, particularly for those with pre-existing mental health disorders, and that it may also actively cause mental illness.' Discipline, sanctions and restrictions Solitary confinement The negative impact of solitary confinement on physical and mental health and well-being is well-documented.27 • Only use solitary confinement in exceptional circumstances as a measure of last resort, for as short a time as possible and subject to independent review. (Mandela Rule 45) • Never place those with existing mental health conditions in solitary confinement ‘when their conditions would be exacerbated by such measures’. (Mandela Rule 45(2)) • Ensure that those segregated, as defined by the Nelson Mandela Rules, are regularly monitored for adverse effects on their mental health. (Mandela Rule 46(2)) Use of restraints and use of force The use of restraints poses particular risks for those with mental health conditions. • Only use restraints as a measure of last resort if the prisoner becomes a danger to themselves or others, or to prevent them from damaging property, and use for the shortest possible time. Never use restraints as a form of punishment. (Mandela Rule 47) • Instead of restraints, use preventive and defusing techniques, such as negotiation and mediation. • Ensure that prisoners with mental ill-health who are restrained (as a last resort) have access to health professionals. • Never use force, except in self-defence or in cases of attempted escape or physical resistance to an order based on law or regulations. Do not use force more than is strictly necessary. (Mandela Rule 82) 26 31