Saturday marked the second anniversary of the death of Michael Anthony Kerr, a fifty-four-year-old schizophrenic man who died of dehydration while being transferred between North Carolina prisons. His death raised serious questions about the state prison system’s use of solitary confinement and its treatment of mentally ill prisoners.

Kerr was put into solitary on February 5, 2014, at the Alexander Correctional Institution in Taylorsville, where he stayed for thirty-five days. On March 12, he was transported to Central Prison in Raleigh. Once he arrived, officials found him unresponsive. In the wake of Kerr’s death, the U.S. Department of Justice launched a federal investigation, at least nine Department of Public Safety workers were fired, and Kerr’s family reached a $2.5 million settlement with the NCDPS.

For current inmates, however, the situation hasn’t improved much, activists say.

An August 2015 letter by a coalition of groups, including the ACLU, which was sent to the Justice Department’s civil rights division, says that prisoners are often put in solitary confinement for offenses like profanity and that more than 20 percent of prisoners in solitary “require some kind of treatment for mental health issues.”

“Every day that the status quo endures without intervention, North Carolina’s system for housing inmates in solitary confinement claims more victims to needless suffering and death,” the letter says.

Part of the problem is funding. Governor McCrory and state prison officials requested $24 million in last year’s budget to help provide inmates with mental health treatment; the legislature gave them half that.

But NCDPS deserves a share of the blame as well, says Deborah Weissman, a UNC school of law human rights professor. “If you think about the fact that prisons have become the default institution for people whose criminal behavior is a direct result of their mental health and a lack of treatment,” she says, “there just hasn’t been enough done.”

To make matters worse, North Carolina is one of two states (the other is New York) that treat sixteen- and seventeen-year-olds as adults. And a quarter of those inmates are being held in solitary.

Earlier this year, President Obama barred the federal prison system from using solitary confinement as punishment for juveniles. North Carolina hasn’t yet followed suit.

“[DPS Commissioner W. David Guice] said that he agreed with that goal,” North Carolina ACLU legal director Chris Brook says. “But, unfortunately, we haven’t seen a policy barring sixteen- and seventeen-year-old prisoners in the N.C. system from being held in solitary confinement.”

In response to Kerr’s death, Guice says, the department has put in place new leadership, improved staffing levels, and implemented new policies.

“We have ended [solitary confinement] for juveniles in the state’s juvenile justice system,” Guice writes in an email, “and are moving toward the same for the youngest inmates in the state prison system. … There are only about sixty inmates in the adult prison system who are sixteen or seventeen years old. In the past year, we have decreased the percentage of those young inmates in restrictive housing from 52 percent to 26 percent.”

The biggest reform has been the creation of therapeutic diversionary unitsa more humane alternative to solitary confinement. WRAL reported over the weekend that the first seventy TDU beds will open at the end of April, with a total of around 230 expected by the end of 2017.

But given the current number of North Carolina inmates in solitary who have mental health issues350that’s not enough. Guice says the DPS is lobbying the legislature for additional funds. But activists say the state’s responseboth at the legislative and executive levelshas been wholly inadequate.

“These are people, human beings, who, we understand, go from solitary to the streets,” Weissman says. “To say they have a chance of meaningful, smooth re-entry [into society] is a joke. Their lives hang in the balance.”