In the United States, correctional authorities are relying increasingly on special super-maximum security facilities to confine disruptive or dangerous prisoners. Prisoners in these facilities spend an average of 23 hours a day in small, often windowless cells, facing years of extreme social isolation, enforced idleness, and extraordinarily limited recreational or educational opportunities. Prolonged confinement in these conditions can be devastating psychologically, particularly for the many prisoners who are incarcerated with pre-existing psychiatric illnesses. This report deals specifically with the findings and recommendations from site visits to Indiana's Maximum Control Facility (MCF) and the Secured Housing Unit (SHU) of the Wabash Valley Correctional Institution. Prisoners in the MCF and SHU, many of whom are severely mentally ill, are confined 22 or more hours a day in solitary isolation in small cells, spend each day idle, are placed in restraints whenever they are escorted from their cells, exercise alone, and remain shackled in front of their families during non-contact visits conducted behind clear partitions. At both facilities, prisoners have experienced physical abuse, including beatings and unnecessary and excessive use of cell extractions carried out by five-member teams of guards, macings, and placement in four-point restraints as punishment. Human Rights Watch concludes that subjecting prisoners to long periods of confinement in the MCF and the SHU is inconsistent with respect for the inherent dignity of each person. Many aspects of the conditions exceed what is required to meet reasonable security goals and are simply punitive. The confinement of persons who are mentally ill in these facilities is particularly reprehensible. This report proposes offering treatment and conditions of confinement appropriate for mentally ill prisoners, reducing periods of solitary confinement, improving physical conditions, eliminating unnecessarily harsh and counterproductive practices, and monitoring conditions at the MCF and SHU.