Solitary Confinement

Scale, Duration, and the Georgia SMU

Solitary confinement in the United States is practiced at a scale difficult to fully account for. Estimates from 2014 placed the national population in isolation at 80,000–100,000; by 2016, the first Liman Center census counted approximately 68,000; the 2018 ASCA-Liman Nationwide Survey found 49,197 individuals — 4.5% of the population across 43 reporting prison systems — in restrictive housing, projected to approximately 61,000 nationwide. By 2019, 31,542 people were documented in restrictive housing across 39 reporting states — representing 3.8% of the total prisoner population — though Solitary Watch and Unlock the Box, drawing on BJS and Vera data and a survey of jails, estimated approximately 122,000 people in restrictive housing across prisons and jails combined, roughly 6% of the total incarcerated population. The 2021 estimate ranged between 41,000 and 48,000, with researchers noting that pandemic-era lockdowns may have expanded use significantly. These numbers should be understood as floors, not ceilings: reporting is inconsistent, definitions vary by jurisdiction, and many states do not disclose data voluntarily. In 36 jurisdictions reporting on duration, 25 counted more than 3,500 individuals held in restrictive housing for more than three years. (Solitary Confinement & Restrictive Housing)

Georgia's own record within this national pattern is stark. As of May 2026, GDC houses approximately 53,571 incarcerated people, with an additional 2,372 individuals backlogged in county jails awaiting transfer — figures that supersede the U.S. Department of Justice's October 2024 findings letter, which documented "almost 50,000" people in custody across 34 state-operated and 4 private prisons. The state's primary isolation unit — the Special Management Unit (SMU) at Georgia Diagnostic and Classification Prison — was designed for approximately 192 single-bunked cells and housed approximately 180 people at the time of the 2017 Haney inspection. As of July 2017, 78% of SMU prisoners — 141 of 182 people — had been in isolation for more than two years. (Solitary Confinement & Restrictive Housing) Approximately 20% of those held in the SMU had been confined there for six or more years, and the average duration of confinement was three to four years. By contrast, the 2019 national census found that 46% of people in restrictive housing had been held for three months or less, suggesting Georgia's SMU represented an extreme tail of long-term isolation even by national standards.

The human cost of these durations is visible in individual cases. Timothy Gumm — the lead plaintiff in Gumm v. Ford — was held in the SMU continuously for more than seven years, from 2010 to 2017, before being transferred. Robert Watkins, an additional named plaintiff, had been held for at least seven years at the time of the 2018 amended complaint. Daniel Barfield had been confined in the SMU for eight years at the time of the 2017 SCHR letter. These are not outliers in the statistical sense — they are the predictable product of a system that, as Gumm litigation documented, released residents directly from isolation to the community at sentence expiration, without any transitional programming. More recently, GPS Case #40 documents Christian Yandel Flores Tirado (GDC# 1003554733), a confirmed MH-3 prisoner held in segregation at GDCP and Rutledge State Prison with documented emotional deterioration — illustrating that long-term isolation of mentally ill people in Georgia's restrictive housing units remains an ongoing practice, not a closed chapter.

The SMU also housed a population with significant mental health needs. Dr. Craig Haney's 2017 inspection found that 70 of the SMU's 180 inmates — approximately 39% — were designated as mentally ill, and that it was "dangerous" to house them under those conditions. That figure almost certainly understates true prevalence, given the documented failures of mental health screening and care across GDC. The American Psychiatric Association's December 2012 Position Statement on Segregation of Prisoners with Mental Illness, retained December 2017, explicitly opposes prolonged segregation of seriously mentally ill prisoners; and in Madrid v. Gomez, 889 F. Supp. 1146 (N.D. Cal. 1995), a federal court held that conditions in a supermax unit violated the Eighth Amendment as applied to inmates with mental illness, likening prolonged isolation to torture. The DOJ's October 2024 findings letter goes further, explicitly finding that "GDC fails to control violence even in its segregated housing units and exposes incarcerated persons to an unreasonable risk of harm due to its inappropriate use of segregation" — a conclusion that extends well beyond the SMU to GDC's restrictive housing practices system-wide.

Two men committed suicide in the SMU in 2017 alone. The broader pattern of suicide in GDC custody has worsened in the years since: GPS estimates GDC's suicide rate at 40 or more per 100,000 annually — approximately double the national prison-system average, which BJS has historically reported at 15–20 per 100,000. GDC reported 301 total deaths in 2025, of which 295 were identified by name, facility, and cause; six died with no name, facility, or cause ever disclosed. The 2025 homicide total reported by GDC was 51. Recent individual cases illustrate the intersection of segregation, mental illness, and death in custody: Justin Waymon Hollingsworth, 43, died by suicide by hanging in segregation at Rogers State Prison on June 26, 2025; Miguel Angel Duran, 44, died by suicide on March 1, 2026 in segregation at Central State Prison; Denecia Nichelle Randall, 28, died by suicide by hanging on March 30, 2026 at Pulaski State Prison while in lockdown; and Christopher Lee, 19, was found dead in a stripped cell in H-house at Georgia Diagnostic and Classification Prison on January 31, 2026 — the same facility that houses the SMU — over a weekend, with staff attributing his death to cold and exposure.

The physical conditions Haney documented in the SMU were extreme: cells smaller than the average parking space, confinement of nearly 24 hours per day on average, inmates unable even to see out of a window, and in one documented instance a man who had been locked for months inside a pitch-black cell and another naked psychotic man in a blood-covered cell. Conditions documented by DOJ in subsequent years across GDC's restrictive housing units extend this pattern: in February 2023, an incarcerated person was found dead in his restrictive-housing cell at Calhoun State Prison, wrapped in mattress padding, with the coroner describing the cell as resembling a makeshift sauna. Haney described the SMU as one of the most disturbing facilities he had encountered in decades of prison inspection — a characterization that DOJ's 2024 findings suggest reflects not an isolated aberration but a systemic condition across Georgia's use of segregated confinement.

Mental Health Population and the De Facto Psychiatric System

The scale of mental illness within GDC custody is substantial, though chronic underreporting and classification failures make precise figures difficult to establish. GDC's own mental health classification data from May 2026 identifies 1,243 people classified as "poorly controlled health" and 45 people classified as being in "active mental health crisis" — figures that almost certainly represent a small fraction of actual need. Approximately 14,000 people in GDC custody have "identified mental health needs," per testimony before the 2024 Georgia Senate Study Committee on Prison Conditions, representing approximately 26–27% of the population. Applying the Treatment Advocacy Center's peer-reviewed range of 15–20% serious mental illness (SMI) prevalence in state prison populations to GDC's current population would predict between 8,000 and 10,700 individuals with SMI in GDC custody. The BJS 2006 Mental Health Problems of Prison and Jail Inmates report found that 56% of state prisoners nationally report symptoms of a recent mental health problem.

These numbers reflect, in part, a structural failure upstream of the prison gates. Georgia ranks 48th of 51 states and the District of Columbia for adult access to mental health care; 51st (last) for the share of adults with frequent mental distress unable to see a doctor due to cost (34.95%); 48th for the share of adults with substance use disorder not receiving treatment (80.36%); 48th for the share of adults with mental illness who are uninsured (18.70%); and 48th for mental health workforce availability, with one mental health provider per 600 Georgia residents. The Commonwealth Fund's 2025 Scorecard on State Health System Performance ranks Georgia 45th overall. As MHA Georgia and NAMI have documented, an individual with serious mental illness in Georgia has a one-in-five chance of ending up in prison instead of a hospital. GDC Commissioner Tyrone Oliver acknowledged to the Board of Corrections in February 2024 that "most of the people coming to our system haven't seen a physician or don't have a primary care physician" — meaning entry into GDC custody is, for many people with mental illness, their first point of contact with any form of health system.

The forensic and competency-restoration system that bridges the criminal legal and mental health systems is similarly overwhelmed. Georgia courts issued 2,500 adult forensic evaluation orders in FY 2025. As of April 2026, more than 500 adults are awaiting pre-trial competency evaluation, and more than 700 individuals are waiting for a state hospital bed for competency restoration — consistent with a February 2025 estimate of approximately 800 individuals waiting in Georgia jails for court-ordered competency restoration services. DBHDD operates approximately 670 forensic beds statewide; Georgia Regional Hospital-Atlanta alone operates 114 adult mental health beds and 124 forensic beds. The General Assembly allocated $1.6 million for FY 2026 (and a further $20.7 million in AFY 2026) to expand "Operation New Hope" forensic capacity — a program that currently operates 30 beds in Savannah, 17 beds in Milledgeville, and 30 beds in Columbus, for a total of 77 beds statewide. Under the 2010 DOJ-Georgia ADA/Olmstead settlement, the state has invested approximately $521 million in community services but has placed only approximately 2,300 of the promised 9,000 people in supported housing — a failure rate that contributes directly to the pipeline from untreated mental illness to incarceration. The Olmstead plaintiffs themselves, Lois Curtis (deceased November 3, 2022) and Elaine Wilson (deceased December 4, 2005), sued Tommy Olmstead, then-Commissioner of the Georgia Department of Human Resources, to establish the constitutional and statutory right that Georgia has still not fully honored.

Healthcare Contracting and Staffing Collapse

GDC's ability to deliver mental health care within custody has been further undermined by a cascade of contracting failures and staffing vacancies. By 2020, a systemwide vacancy of around 480 healthcare providers left some prisons without a medical director or enough nurses to meet need. Correctional officer vacancy rates — which directly bear on the delivery of mental health care, since security escorts are required for mental health appointments, suicide-watch protocols, and medication passes — ran at 49.3% systemwide in 2021, 56.3% in 2022, and 52.5% in 2023; at the most violent GDC facilities, CO vacancy rates exceeded 70%. The Eleventh Circuit's holding in Marbury v. Warden, 936 F.3d 1227 (2019), that deliberate indifference can be shown by "pervasive staffing and logistical issues rendering prison officials unable to address" serious medical needs is directly applicable to these conditions.

In 2021, GDC ended a 23-year arrangement with Georgia Correctional HealthCare (Augusta University) for medical care and privatized medical care to Wellpath (formerly Correct Care Solutions). Wellpath cited trauma costs in Georgia "more than twice as high as those in the other states" and had absorbed $32 million in excess costs, including $15 million in trauma-related off-site costs. Approved treatment referrals dropped from approximately 90% to around 30% during Wellpath's tenure, with denials characterized as "costly" or "unnecessary." In November 2024, Wellpath filed for Chapter 11 bankruptcy, citing $644 million in debt; public ambulance services and hospitals are owed approximately $75.6 million from Wellpath in Georgia, with more than 750 medical and EMS providers holding claims — Macon County EMS alone is owed approximately $108,625.

In April 2024, GDC awarded a $2.4 billion, nine-year contract to Centurion Health for combined medical, mental, and dental services — without a competitive RFP, under an emergency procurement justification. Centurion (a Centene subsidiary, originally MHM Correctional Services LLC) has been contracted with GDC since 1997 for mental health services. Centurion simultaneously serves as the prison mental health contractor for GDC and the state psychiatric hospital staffing contractor for DBHDD — a concentration of roles that has not been publicly interrogated or subjected to conflict-of-interest review. Georgia operates 38 certified adult mental health courts under the Council of Accountability Court Judges, but coverage is incomplete across large swaths of the state, and alternatives to incarceration for people with SMI remain the exception rather than the rule. Comparison data from other jurisdictions is instructive: the Miami-Dade Criminal Mental Health Project's felony track reduced recidivism from approximately 75% to 6%; under the DRN v. Wetzel settlement in Pennsylvania, approximately 800 SMI individuals were removed from Restricted Housing Units statewide; and under the Coleman v. Brown remediation framework, 34,000 prisoners in California are receiving mental health care with over $1 billion in remediation spending — reforms that Georgia has not undertaken and that pending DOJ enforcement action may ultimately compel.