It has been three years since John Wilson – not his real name – was allowed normal interaction with another human being.Since mid-2009, the 30-year-old has spent nearly 24 hours a day, every day, in a small, windowless cell in a Special Management Unit at the Arizona State Prison Complex.Measuring little more than seven square metres, the cell has a metal bed, a desk, a stool and a toilet. The only natural light and air comes from a small skylight in a central area beyond the cell tiers – conditions are specially designed to reduce visual and environmental stimulation. John is not allowed to work or to participate in any communal activities and eats all meals in his cell. His contact with other inmates is restricted to shouted exchanges with inmates in nearby cells. He is only allowed out a maximum of three times a week for up to two hours a time to shower and exercise alone in a small yard covered by a wire mesh which rarely gets any sunlight. First guards wearing heavy gloves strip-search him and shackle his wrists and ankles. This is the only physical contact he has. Even visits with family and friends take place behind a sheet of glass.John suffers from severe mental health problems. Since 2009, he has been placed on “suicide watch” on numerous occasions but has received scant psychiatric help. When he gets a session with a mental health expert it is from the other side of his the cell door – conversations that can be overheard by staff and other inmates.Neither has he received any medical attention for the skin infections that result from the lack of proper sanitation in a building where food, urine and faeces are stuck on some walls.When he completes his sentence, John will be given 50 US dollars, an ID card and be expected to walk from isolation straight back into society.Built for purposeJohn is one of the more than 2,000 men confined to solitary in one of Arizona’s two special Management Units (SMU’s) – that’s more than one in 20 of the state’s total prison population.124 of them are on death row and 14 are between 14 and 17 years old. According to official statistics, 35% of prisoners in isolation were imprisoned for non-violent crimes such as drugs offences, theft and burglary.Arizona holds more prisoners in isolation than many other US states — and the USA more than any other country in the world. Conditions in Arizona’s isolation units are so harsh, particularly for inmates with mental health conditions that Amnesty International wrote, on 28 March 2012, to Charles Ryan, Director of the Arizona Department of Corrections, asking for solitary confinement to be imposed only as a last resort and for short periods of time. The organization also requested for isolation not to be used against children or the mentally ill. A delegation from the human rights organization travelled to Arizona in 2011 and spoke to lawyers and prison advocates as well as family and friends of inmates held in these units. But the Arizona Department of Corrections turned down a request to tour the SMU units; and, despite repeated attempts by Amnesty International to set up a meeting to discuss concerns, the department declined to meet with them.In March 2012 a legal team led by the American Civil Liberties Union and the Prison Law Office filed a lawsuit against the Arizona Department of Corrections claiming that prisoners in their custody received grossly inadequate medical and mental health care.“Solitary confinement for long periods of time is utterly inhumane,” said Angela Wright, researcher on the USA at Amnesty International. “Everything – from the cells to the lack of heath care and rehabilitation opportunities – seems to be specifically designed to dehumanise prisoners.”“Isolation should only be used as a last resort and for short periods. It should never be imposed against children or prisoners with mental illnesses.” Long term damageHuman rights organizations – including Amnesty International – and the United Nations have said conditions in SMU’s violate international standards. According to official statistics, as of March 2011 a third of inmates held in isolation were receiving mental health treatment and nearly 4% were designated as seriously mentally ill. Studies and data from various sources also reveal that suicides occur more frequently in isolation units than in the prison population at large. Between October 2005 and April 2011, at least 43 suicides took place in Arizona’s adult prisons. 22 of the 37 cases where Amnesty International obtained information took place in isolation facilities.Prison authorities claim problems within the SMU’s lie in the lack of resources. But there is evidence that a change in approach would improve the behaviour of inmates.Economic crisisA number of states across the US have recently reduced their super-maximum security populations or closed down long-term isolation units altogether. In 2007, authorities in the state of Mississippi initiated changes leading to a reduction by 80% in the number of prisoners held in isolation. Its long-term segregation facility was transformed to provide space for group activities and the eventual integration into the general prison population of those formerly segregated for 23 hours a day. Gang leaders who remained in isolation were also given opportunities to interact with others and prisoners with serious mental illness received small group therapy and access to a step-down program. In 2010, the unit was closed altogether.The changes led to a significant improvement in prisoner behaviour and a reduction in violence and the use of force by staff.But the fact remains the US, with one of the largest prison population in the world, holds tens of thousands of prisoners in isolation – more than any other country in the world. That is a policy that has to change.