The United States currently employs tremendous levels of imprisonment and imprisonment within prison in the form of solitary confinement for behavior control, as exemplified in the recent Rikers Island scandals. This Article discusses how imprisonment and solitary confinement affect those with and without mental illness in terms of psychiatric and behavioral consequences, and shows that these approaches are largely counterproductive. It considers how a disproportionate number of inmates came to be mentally ill through a process known as trans-institutionalization and how this causes undue duress on those who need treatment the most. The authors review personal anecdotes, medical and historical literature, as well as case law dealing with the effects of prolonged isolation. All point to the benefits of better care and socialization opportunities, which are far more effective than isolation for behavioral control and violence prevention. The authors call for a rethinking of the role of prisons in the management of persons with psychiatric illness as well as for crime control in order to create societies that are truly safe and civilized.