The right to healthcare: A false promise of health in America’s prisons

Last month’s coverage of the conditions at Riker’s Island have people across the country appalled. Dr. Vernier, former physician at Riker’s Island, shared many of his experiences with patients at the prison with NPR, describing the horrific case of Carlos Mercado, who died within 15 hours of arriving at the prison due to complications of his diabetes. He had been denied insulin during the intake process.

Prisoners are the only people in the country with a constitutional right to healthcare, under the 1976 Supreme Court Estelle v. Gamble decision, which held that withholding healthcare from prisoners constituted “cruel and unusual punishment,” prohibited by the Eighth Amendment. But isn’t the case of Carlos Mercado grounds for “cruel and unusual punishment?” The right to healthcare seems to be a false promise at Riker’s, especially when we consider the facility’s history.

Riker’s is notorious for cruelty and inhumane treatment of prisoners. Earlier in de Blasio’s appointment as city mayor, a 2014 report from U.S. attorney Preet Bharara detailed graphic human rights abuses and use of violence against adolescent males placed at Riker’s Island. One such account from 2012 reads:

“…Inmate F, a mentally impaired inmate, was repeatedly punched in the face by an officer who has been involved in well over 20 other RNDC use of force incidents. Although the officer admitted that he delivered multiple blows to the inmate’s face, the Department concluded that the force used was appropriate based on the officer’s contention that he was acting in self-defense… There is no video of the incident…

…Inmate F reported that the officer challenged him to a one-on-one fight… According to DOC records, the officer was involved in a total of 24 use of force incidents… from 2007 through early 2013, including eight incidents in 2012 alone. He also has been subject to repeated disciplinary actions.”

Unfortunately, these human rights violations persist not just at Riker’s, but as an inherent part of the nation’s correctional system. Earlier this year, approximately 1,600 prisoners at the Metropolitan Detention Center in Brooklyn were left with sporadic heating and no lighting over the course of multiple days. Families were left completely in the dark about the fact that their loved ones were suffering in the facility. No generators were powered on to restore lights and heating as detainees pounded on the windows in retaliation to being left to freeze.

There are physical health consequences of being unable to read your medication labels in the dark. However, more latent are the mental health repercussions when prisoners realize they are not just trapped, but that there is nobody to even allow them their basic rights or human dignity. The right to healthcare applies to mental as well as physical health. We need to take a close look at outcomes to truly assess whether the right to healthcare is upheld in prisons or not.

The capacity for cities like New York to harm people through incarceration is vast, and there is a poor track record of tangible benefit coming from imprisonment for those detained nationwide. In 2016, the Avid Prison Project described that solitary confinement routinely exacerbates symptoms for those with mental illness. Moreover, inmates with psychiatric needs are put on waiting lists for hospital treatment much too often, even when hundreds of beds are available. It seems that the right to healthcare is a promise to take two leaps back for every small step forward.

Broken policies that keep the mentally-ill from receiving care in prisons can change. We can start by re-routing those with mental health needs from prisons to programs focused on healing and reintegration for the 42% of inmates at Riker’s Island who suffer from mental illness. Instead of reverting to punishment-based criminal justice, we can transform the lives of those in prison and reduce incarceration rates by expanding proven alternatives to incarceration.

In particular, we should expand New York’s assertive community treatment (ACT) programs for those with mental illness. Programs like Manhattan ACT bring holistic treatment and therapy to those with mental illness who face incarceration due to a felony arrest directly to them in their communities. Manhattan ACT itself has seen a 36% decrease in psychiatric hospitalizations among program participants in Northern Manhattan. In addition to their mental health benefits, ACT programs have also reduced recidivism rates. Nathaniel ACT’s graduates since 2014 have had no violent arrests within one year of graduation and its graduates since 2013 had no new felony convictions within two years. ACT programs turn lives around and are one just solution to the crisis of housing the mentally-ill in federal and state prisons.

The right to healthcare is one of prisoners’ civil rights, protected under the Eighth Amendment to the Constitution. However, if prisoners are delayed necessary treatment and placed in conditions that worsen their health problems, then this right is far from being upheld seriously. With 45% of federal prisoners having mental health or behavioral problems, we need to expand evidence-based alternatives to incarceration like ACT programs and work with our communities instead of against them.

Syed Kaleem is a medical student at Drexel University College of Medicine. He is a fellow of Physicians for Criminal Justice Reform. @ZaneKaleem on Twitter

Waffle House: America’s Best Place To Eat, Not Engage Police

by Drs. Otega Edukuye, Christopher Hoffman, Kevin Simon, and Christopher Smith on behalf of Physicians for Criminal Justice Reform, Inc.

If you have lived in the South, you know Waffle House for its 24-hour table service and meals like the All-Star breakfast served with a waffle, bacon, eggs, toast, and hash browns – scattered, smothered and chunked for under ten bucks. If you lived in this country last year, you also know Waffle House as the place where 22-year-old Anthony Walls and 25-year-old Chikesia Clemons were manhandled by police. Then, tensions were so high that Bernice King, daughter of Martin Luther King, Jr., called for a boycott of Waffle House. [1] While the media coverage has dwindled, we will revisit these situations so that passion for change and resolve does not die when the incidents are no longer headlines.

We empathize with Ms. Clemons and Mr. Anthony and recognize that her experience at Waffle House is representative of a larger dilemma. As Black male physicians, these incidents are a grim reminder that our medical degrees will have little influence on our path to address health disparities as long as the criminal justice system ensnares and oppresses those of the darker skin tone.  As more videos of police exerting excessive force on people of color continue to surface, it is evident that a paradigm shift in law enforcement is necessary.

Many argue that the constant influx of police brutality videos overestimate its occurrences, but the evidence and available literature suggest otherwise. It is estimated that law enforcement officers use measures of force against Black people a staggering 3.6 times higher than when dealing with White people. [2] These differences persist even when controlling for variables such as alleged offense committed and type of force utilized. The study “Deaths of People with Mental Illness during Interactions with Law Enforcement” found that “African American race and presence of mental illness were strongly associated with fatalities.”

Our concern is that while there is compelling data to support that over-use of force against citizens of color is indeed a real issue, there is resistance among law enforcement agencies to adopt tactics that will universally decrease excessive use of force, namely, de-escalation training.

In these videos, we noticed that police rarely attempt to reduce the suspect’s tensions. As fourth-year psychiatry residents, we have been skillfully trained in human behavior and treatment of patients with mental health concerns. We realize that approaching agitated people with demands and hostility rarely, if ever, improve a situation. Each of us has successfully de-escalated many of our agitated patients by simply talking with them; no physical contact or medications. Although conditions for a police officer in a community differ from those we face as doctors on the psychiatry wards, there is ample evidence that increased training in de-escalation could have merit for professionals working to save lives and keep the peace across disciplines.

According to reporter Albert Samaha, “excessive force complaints against the Dallas Police Department dropped by 64% between 2009 and 2014. The number of arrests and officer-involved shootings also declined in recent years.” [3] The changes Dallas Police Chief David Brown implemented emphasized de-escalation. Brown stated, “Rather than running into a situation, take your time approaching a suspect, talk over a strategy with your partner. Have just one officer talking with a suspect — rather than multiple people shouting — try to build a rapport with the suspect.”[4] To us, calm discussion with an agitated individual seems the obvious first step. We perceive this unfathomable opportunity a loss in the fact that nearly 70% of states do not require de-escalation training for police. [5]

With all the videos, data, and protests by those marginalized by the majority, police still maintain permission to overstep justice in their attempt to restore order and make an arrest. The United States was founded nearly 250 years ago, and yet, people of color continue to find themselves treated as second-class citizens. As Black men and physicians backed by Physicians for Criminal Justice Reform, we are advocating for concerted collaborative change within the policing community. While Waffle House employees should receive better training, the positive impact on disenfranchised communities and people of color will be greatest if police training across the U.S. included de-escalation training. As psychiatrists in training, we know that as protracted trauma and mistrust persist, the psychological effects worsen and become intractable. Until we see genuine changes in the way law enforcement engages our communities, tensions between police and Black people will not improve.

 

REFERENCES

  1. Baer, Drake. “The Dallas Police Force Is Evidence That ‘De-Escalation’ Policing Works.” The Cut, 8 July 2016, www.thecut.com/2016/07/deescalation-policing-works.html.
  2. Cognac , Chris. “Ready, Set, Engage! Ideas and Options for Community Engagement and Partnership Building.” COPS, June 2015, cops.usdoj.gov/html/dispatch/06-2015/community_engagement_and_partnership_building.asp.Samaha, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016, www.buzzfeed.com/albertsamaha/dallas-police-numbers?utm_term=.ead1DP0L8.
  3. Samaha, Albert. “Dallas Officer-Involved Shootings Have Rapidly Declined In Recent Years.” BuzzFeed, BuzzFeed, 8 July 2016, www.buzzfeed.com/albertsamaha/dallas-police-numbers?utm_term=.ead1DP0L8.
  4. Gilbert, Curtis. “Most States Neglect Ordering Police to Learn De-Escalation Tactics to Avoid Shootings.” What It Takes | APM Reports, 5 May 2017, www.apmreports.org/story/2017/05/05/police-de-escalation-training.
  5. King, Bernice. “Family, Let’s Stay out of @WaffleHouse until the Corporate Office Legitimately and Seriously Commits to 1) Discussion on Racism, 2) Employee Training, and 3) Other Plans to Change; and until They Start to Implement Changes. Https://T.co/NJWFOBKN7i.” Twitter, Twitter, 10 May 2018, twitter.com/BerniceKing/status/994564295374655488.

Alton Sterling, Philando Castile and Dallas Police Killings: PfCJR Call to Action. Open Conference Call Monday, July 11, 2016 at 9:00PM EST

PfCJR OPEN CONFERENCE CALL MONDAY, JULY 11, 2016 AT 9:00PM EST

  In the last four days, this country has watched a devastating series of tragedies unfold.  We watched police shoot Alton Sterling at point blank range while pinned to the ground.  We watched Philando Castile die after being shot four times by a police officer in front of his fiancée and daughter.  We watched Dallas police officers massacred even as they seeked to protect citizens at a peaceful protest.   All of these have served to underscore the urgency of acting NOW to begin combatting the forces that are driving these events. pfcjr call invite Physicians for Criminal Justice Reform invites you to join us on an open conference call this Monday, July 11, 2016 at 9:00pm EST.  You do not need to be a physician to join either the call or the organization.  We recognize that we need the unified voices of all allies if we are to effect meaningful, lasting change.  Click the graphic above for more details about the call.  If you haven’t already, please join us at www.pfcjreform.org/join so we can keep you informed of updates.   Please spread the message far and wide.  We need as many voices as possible.

Legislation – S.2123 – Sentencing Reform and Corrections Act of 2015

S.2123 – Sentencing Reform and Corrections Act of 2015
People of color comprise more than 60 percent of the population behind bars despite making up only approximately 39.9 percent of the U.S. population. Policymakers act to end mass incarceration and overcriminalization—particularly with regard to how they affect poor communities and communities of color—by creating an equitable and balanced justice system that removes unnecessary barriers to opportunity for people with criminal records. Congress is now moving to address some of these issues. The Sentencing Reform and Corrections Act of 2015, also known as the Sentencing Reform Act. The bipartisan Sentencing Reform Act includes several key recommendations proposed by the Center for American Progress, including improving the accuracy of criminal history records and sealing or expunging juvenile records under certain circumstances. The bill takes a number of steps to end the unnecessarily harsh penalties and outcomes that characterized the now-discredited policies of the tough-on-crime era. These measures include:

  • Expanding the existing safety valve and giving judges additional discretion to relieve significant numbers of people from unnecessarily harsh mandatory minimum sentences
  • Making the Fair Sentencing Act of 2010 retroactive, thereby making the reductions in the sentencing disparities between crack and powder cocaine—disparities that have a disproportionate racial impact—available for thousands of current federal prisoners
  • Providing sentence reductions and early releases for prisoners who successfully complete rehabilitation programs
  • Limiting the use of solitary confinement for juveniles in federal custody
  • Providing for the sealing or expungement of juvenile criminal records under certain circumstances, which would help create opportunities for young people to overcome or avoid many of the barriers that confront those with criminal records, including barriers to employment, housing, and education
  • Requiring the attorney general to develop a process for individuals who are undergoing employment criminal background checks to challenge the accuracy of their federal criminal records, which would help to address the well-documented problem of errant criminal records databases

Legislation – S.993/H.R.1854 – Comprehensive Justice and Mental Health Act of 2015 – passed Senate

S.993/H.R.1854 – Comprehensive Justice and Mental Health Act of 2015 – passed Senate, currently Referred to the Subcommittee on Crime, Terrorism, Homeland Security, and Investigations (House). Introduced by Senator Al Franken (D-MN) and Representative Doug Collins (R-GA) – primarily reauthorizes and improves the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) of 2004. The legislation would also:

  • Continue support for mental health courts and crisis intervention teams;
  • Expand services to veterans that include treatment court programs, peer to peer services, appropriate services to veterans who have been incarcerated, and training programs for criminal justice, law enforcement and corrections personnel to identify and respond to incidents involving veterans with a mental health condition;
  • Make grants to provide broader training during police academies and orientation that teach law enforcement personnel how to identify and respond to incidents involving persons with mental health disorders;
  • Would create programs that offer federal first responders and tactical units comprehensive training in procedures to identify and respond appropriately to incidents involving mentally ill individuals;
  • Increases focus on prison and jail-based programs;
  • Gives local officials greater control over program participation eligibility; and
  • Requires annual audits of all grant recipients to prevent waste, fraud, and abuse of funds by grantees.

The legislation extends the Mentally Ill Offender Treatment and Crime Reduction Act , including support for mental health courts and crisis intervention teams; supports efforts to identify people with mental health conditions at each point in the criminal justice system and direct them to appropriate mental health services; specifically directs assistance to veterans with mental health conditions in the justice system; and increases focus on corrections-based programs and supports additional training for law enforcement officials. APA endorses S.993.

Legislation – HR 2646, the Helping Families in Mental Health Crisis Act of 2015, House Energy and Commerce Health Subcommittee passed

HR 2646, the Helping Families in Mental Health Crisis Act of 2015, House Energy and Commerce Health Subcommittee passed.

Positives of legislation:

  • Screening and early intervention;
  • Community-based systems of care;
  • Enhancing the behavioral health workforce;
  • Innovation to develop new evidence-based programs;
  • Integration of health and behavioral health care;
  • Enforcement of parity in coverage between health and behavioral health services;
  • Incentives for Assisted Outpatient Treatment (AOT) rather than mandates;
  • Elevation of behavioral health in the federal government, including increased coordination of services; and
  • Suicide prevention based on the Garrett Lee Smith Act Reauthorization.

 

Additions needed

  • Provisions that best support the development of a properly-credentialed peer workforce that can work competitively in clinical settings;
  • Preservation of Protection and Advocacy organizations’ flexibility to promote recovery and non-discrimination for individuals with serious mental illness, not only to prevent abuse and neglect;
  • Funding for community mental health programs with money taken from the jail and prison system, not from other health services; and
  • Assurance that individuals with serious mental illness will be able to voluntarily access to the services associated with AOT, and that community-based services will be adequately funded.

American Psychiatric Association (APA), Mental Health America (MHA) endorse HR 2646.

Medicaid Expansion Shifts Focus to Improve Re-Entry and Community Transitions

Medicaid Expansion Shifts Focus to Improve Re-Entry and Community Transitions – Erick Allen Eiting

Mass incarceration has had a significant impact on urban America. Los Angeles County and New York City represent the largest municipalities in the country, and they also have some of the highest incarceration rates. Both New York and Los Angeles have taken recent steps to improve the health and healthcare provided to their inmates. Rikers Island in New York had previously contracted out its correctional healthcare to a private company. Last spring, Mayor Bill de Blasio shifted this care to Health and Hospital, the network of public hospitals and clinics in New York City. Similarly, the Los Angeles County Board of Supervisors voted to move correctional care to its Department of Health Services, a similar healthcare network that provides public medical care.

Several provisions in the Affordable Care Act (ACA), often referred to as Obamacare, were major drivers in these decisions. The Medicaid expansion under the ACA includes several provisions that make it easier for inmates to qualify for insurance while they are incarcerated. This has shifted the focus of many providers to improving the re-entry process to society for released inmates, reducing recidivism and addressing the social determinants of healthcare for these patients. All eyes will be on these two large, urban areas to see the impact of this expansion. Medicaid coverage is only the first step. Inmates will need appropriate community transitions and treatment options to ensure access to housing, substance abuse treatment and mental health care to have a significant impact on mass incarceration. PfCJR salutes these two cities for their progressive, patient-focused approach to this issue.

Expedited Medicaid Access Increases Use of Mental Health Services, Unfortunately Did Not Reduce Recidivism for Those Recently Released from Prison

Expedited Medicaid Access Increases Use of Mental Health Services, Unfortunately Did Not Reduce Recidivism for Those Recently Released from Prison – Kristin Huntoon

Providing expedited access to Medicaid to people with serious mental illness as they are released from prison increases their use of mental health and general medical services, but does not reduce criminal recidivism, according to new research published online today in Psychiatric Services in Advance.

People with serious mental illness depend on public-sector mental health services and are covered primarily by Medicaid. Most states suspend or terminate Medicaid for prison inmates. At any given point, an estimated 250,000 people with severe mental illness are in prisons, and more than a million others are on probation or parole in the U.S. Many have difficulty accessing mental health services and other services when they leave these institutions. Lack of health insurance can be a particular barrier to access.

The study used data from Washington state to look at whether enrolling people with severe mental illness in Medicaid before their release from prison increased their use of community mental health services and reduced rearrest and reincarceration rates. State and local programs that expedite Medicaid enrollment for people being released from jails and prisons have become more common in recent years as part of efforts to reduce soaring criminal justice costs.

PRESS RELEASE: PfCJR Officially Partners with the Campaign for Youth Justice to Raise the Age

Physicians for Criminal Justice Reform, Inc. (PfCJR), which advocates to eliminate the damaging health consequences that can result from negative interactions with the criminal justice system, has officially partnered with Campaign for Youth Justice, a national initiative focused entirely on ending the practice of prosecuting, sentencing, and incarcerating youth under the age of 18 in the adult criminal justice system.

(DECATUR – March 9, 2016) – Physicians for Criminal Justice Reform, Inc. (PfCJR) is pleased to support advocacy efforts of the Campaign for Youth Justice by officially partnering to lend the collective voice of our physician members to the national initiative to end the prosecution, sentencing and incarceration of youth under the age of 18 in the adult criminal justice system.

Medical literature reflects that adolescent brains are developmentally different from those of adults, often leading to impulsive decision-making, increased risk-taking and decreased appreciation for long-term consequences of behaviors. As a result, youth, by law, are prohibited from taking on major adult responsibilities such as voting, jury duty and military service. It follows, then, that youth should not be held to an adult standard of accountability when involved with the criminal justice system.

Furthermore, youth in adult jails and prisons are more likely to be sexually assaulted, physically assaulted and, upon release, are more likely to re-offend than youth housed in juvenile facilities. Each of those experiences, as well as early developmental experiences that put youth and adolescents at risk for involvement with the criminal justice system, result in long-lasting, negative physical and mental health consequences that could be avoided by juvenile justice reform that identifies and diverts at-risk youth.

Osvaldo Gaytan, M.D., Ph.D., Director of Physicians for Criminal Justice Reform’s Juvenile Justice Taskforce and a physician with specialties in Child and Adolescent Psychiatry, Neuropharmacology and early childhood trauma states “Children and adolescents are our future. I think we can all agree on that. As doctors, it is our duty to make a united stand against environmental factors that affect both the mental and physical health outcomes of our patients. Every bit of evidence we have as physicians points to the fact that adolescent brains do not function in an equal capacity as adult brains. Therefore, it is not scientifically sound to equate the functioning of an adolescent brain with that of an adult. It is unjust.”

Please join Physicians for Criminal Justice Reform and the Campaign for Youth Justice on insisting that the legal age for being treated as an adult be raised to 18 years of age as a national standard.

 

About PfCJR:

Physicians for Criminal Justice Reform, Inc. (PfCJR) was founded by a group of physicians who were struck by the myriad of ways that negative encounters with the criminal justice system lead to detrimental health consequences. We firmly believe that changing the interaction between the criminal justice system and individuals of targeted populations will ultimately lead to improved health of targeted communities.

 

#GivingTuesday

WHAT IS #GIVINGTUESDAY?

Choose Physicians for Criminal Justice Reform for your #GivingTuesday!  All donations are tax-deductible and can be made at https://pfcjreform.org/donate/

We have a day for giving thanks. We have two for getting deals. Now, we have #GivingTuesday, a global day dedicated to giving back. On Tuesday, December 1, 2015, charities, families, businesses, community centers, and students around the world will come together for one common purpose: to celebrate generosity and to give.

It’s a simple idea. Just find a way for your family, your community, your company or your organization to come together to give something more. Then tell everyone you can about how you are giving. Join us and be a part of a global celebration of a new tradition of generosity.