Discuss the chosen crime and violence issue, Prisons as Mental Health Institutions, in terms of evidence-based social advocacy. To do this, connect some dots between the mainstream media coverage from Discussion 1 (paper attached – 1_1 Discussion) of Prisons as Mental Health Institutions and the academic research (resources attached)..Using the two attached academic articles related to the issue and address the following questions:How is this issue discussed in academic research as opposed to the mainstream media?What evidence is used in each source?How effective does the evidence seem in each source and why?What solutions, if any, are proposed for the issue in the sources?Thank you!
1_1_discussion__mainstream_news_accounts_and_their_relationship_to_sociological_research.docx
desiraehutchisoninadequat.pdf
dorothea_dix_crusader_for_patients_with_mental_illness.pdf
Unformatted Attachment Preview
1-1 Discussion: Mainstream News Accounts and Their Relationship to Sociological
Research
I chose to read an article regarding the awareness of the use of prisons as mental health
institutions. The link is:
https://www.thestar.com/opinion/editorialopinion/2012/10/28/there_are_many_ashley_smiths_in
_canadas_prisons.html
I believe from a sociologist’s point of view, this article touches on a very important issue that is
affecting modern correction centers across the globe. There are calls for the government to stop
segregated imprisonment of persons with mental illness. However, this is an issue that has
seemed to have hit a deadlock, with little to no progress being made. There is nothing much
being done to save the lives of these people suffering from a mental disorder. Rather, the local or
federal government on any level, who has the responsibility of taking care of the people, is
seriously violating their rights.
However, I believe that some sociologists would agree it is not the time to blame the government
and the correction centers as they are doing their work. They are instilling correction and
discipline upon the segregated personnel. Despite their mind being with issues or having some
challenges health-wise, there is a possibility that the society has failed to a great extent. These
people need to get the necessary attention not only from the government but across multiple
areas. The social groups have failed to keep track of the personnel in the correction centers who
need help. Only the researchers, like in the news article have identified a case and compared it
with a previous one involving a person going by the name Smith.
We need to look at issues head on not only coming to the rescue when it is too late. The
government has to do its work and the society has to do the much-needed support work to the
community in these prisons. There is a need to change the perspective of view of this issue and
apply a multiagency and social approach to help out the women suffering from mental health and
who are at risk in the correction centers. We should not look at this as the responsibility of the
government, but rather the responsibility of the whole society.
References:
Mandhane and Rebecca Sutton, R., & Sutton, R. (2012, October 28). There are many Ashley
Smiths in Canada’s prisons | The Star. Retrieved from
https://www.thestar.com/opinion/editorialopinion/2012/10/28/there_are_many_ashley_s
miths_in_canadas_prisons.html
+(,121/,1(
Citation:
Desirae Hutchison, Inadequate Mental Health Services
for Mentally Ill Inmates, 38 Whittier L. Rev. 161
(2017)
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INADEQUATE MENTAL
HEALTH SERVICES FOR
MENTALLY ILL INMATES
DESIRAE HUTCHISON
ABSTRACT
Individuals in prison suffer from mental illness at a significantly
higher rate than individuals in the general population. Even still, prisons
continuously fail to provide adequate mental health care services for
mentally ill inmates. Numerous factors explain this phenomenon,
including but not limited to, (1) stigmatization/lack of understanding of
mental health issues; (2) the punitive purpose of prisons; (3) the
cost/administration of providing adequate mental health services; (4) the
lack of an adequate screening program to continuously identify those
who need mental health services; and (5) the Prison Litigation Reform
Act. Inmates have brought class actions against these institutions,
alleging, among other things, violations of their constitutional right
against cruel and unusual punishment as protected by the Eighth
Amendment. Despite court orders and consent decrees to bring mental
health services up to par, prisons continue to fail when it comes to
providing adequate mental health services to inmates who need them.
This failure results in further significant injury and/or unnecessary and
wanton infliction of pain on mentally ill inmates as their conditions
worsen. Moreover, inmates whose mental illnesses go unidentified and
untreated often engage in more disruptive behaviors. As a result, these
inmates are routinely subjected to heightened disciplinary action and
increased prison sentences. Current research has failed to identify
whether prisons themselves exacerbate mental illness due to their rigid
stringency and failure to provide adequate mental health services. It also
has failed to identify steps prisons may take to provide adequate services
by way of review of current programs and policies adoptions on mentally
WHITTIER LAW REVIEW
Vol. 38:1
ill inmates. Although litigation has been the most successful tool in
effectuating a move toward adequate mental health care services, policy
is the proper tool to proceed with in uniformly resolving the
inadequacies.
Since California has one of the biggest jail systems in the country,
this paper will often look to California as a reference.1
I. INTRODUCTION
There Sare2 more than 2.3 million people incarcerated in United
States prisons. Although the United States only represents five percent
of the world’s population, it houses an estimated twenty-five percent of
the world’s prisoners.3 According to a 2012 report by the United States
Department of Health and Human Services, about five percent of all
adults in the United States suffer from serious mental illness. 4 In 2006,
the Department of Justice estimated that over half of all United States
inmates suffer from a mental health problem, “including 56 percent of
state prisoners, 45 percent of federal prisoners and 64 percent of local
jail inmates.” 5 The statistics regarding mental health problems among
inmates have often been defined by two measures: (1) “a clinical
diagnosis or treatment by a mental health professional”; or (2) symptoms
of a mental disorder based on criteria specified in the Diagnostic and
1. “With more than 11,000 prisoners under treatment on any given day,” Cook
County in Illinois; Los Angeles County in California; and New York City in New York
“represent by far the largest mental-health treatment facilities in the country. By
comparison, the three largest state-run mental hospitals have a combined 4,000 beds.”
Gary Fields & Erica E. Phillips, The New Asylums: Jails Swell With Mentally Ill, WALL
ST.
J.
(Sept.
25,
2013,
10:33
PM),
http://www.wsj.com/articles/SB 10001424127887323455104579012664245550546.
2. NAACP, Criminal Justice Fact Sheet, http://www.naacp.org/pages/criminaljustice-fact- sheet (last visited Jan. 19, 2017).
3. Id.
4. SUBSTANCE ABUSE AND MENTAL HEALTH SERVS. ADMIN., U.S. DEP’T OF HUMAN
HEALTH SERVS., RESULTS FROM THE 2012 NATIONAL SURVEY ON DRUG USE AND HEALTH:
MENTAL
HEALTH
FINDINGS
(2013),
available
at
https://www.samhsa.gov/data/sites/default/files/2kl2MH-Findings/2kl2MH-Findings/
NSDUHmhfr2012.htm#sec2-2.
5. Press Release, Bureau of Justice Statistics, Study Finds More Than Half of all
Prison and Jail Inmates Have Mental Health Problems (Sept. 6, 2006), available at
https://www.bjs.gov/content/pub/press/mhppjipr.cfm (“The findings represent inmates’
reporting symptoms” they experienced in the last year, “rather than an official diagnosis
of a mental illness.”).
2017 INADEQUATE MENTAL HEALTH SERVICES FOR INMATES 163
Statistical Manual of Mental Disorders, both of which must have
occurred in the preceding twelve months. 6 The Wall Street Journal
conducted a survey asking all fifty state Departments of Corrections
about inmates with mental-health issues.7 Mentally ill “[i]nmates in all
23 responding states account for 55% of the prisoners in the U.S. under
state jurisdiction.
In California, the total estimated prison population
is approximately 132,658. For every 100 inmates, 27.2 percent have a
mental-health issue. 9 Although, mental-health issues affect at least 27.2
percent, or 132,658 inmates, mental
health spending still only accounts
0
for 4.9 percent of total spending.’
The failure of institutions to provide adequate mental health care
services to inmates has been the subject of widespread litigation.In
Estelle v. Gamble, a landmark case in medical health care for prisoners
in 1976, the Supreme Court held that inmates had a constitutional right
of access to health
care as provided
•
• by the11Eighth Amendment protection
against cruel and unusual punishment.
Most federal circuits have
extended this right of medical health care to mental illness treatment,
noting that the two are not distinguishable for purposes of a prisoner’s
right to care. ” The Southern District of Texas set forth components of a
minimally adequate mental health treatment program, holding that a
prison’s mental health services must include the following: (1) a”
method for screening and evaluating inmates to identify those who need
mental health services”; (2) appropriate treatment options that are not
limited to segregation and increased supervision;…. (3) enough menal
health professionals to treat inmates in need on an individualized
basis;…. (4) ….confidential and adequate record keeping; and (5) a plan
for identifying, treating, and supervising inmates with suicidal
predispositions .
The court also opined that the use of prescription
6. DORIS J. JAMES & LAUREN E. GLAZE, U.S.
DEP’T OF JUSTICE, BUREAU OF JUSTICE
STATISTICS SPECIAL REPORT: MENTAL HEALTH PROBLEMS OF PRISON AND JAIL INMATES
(2006), available at https://www.bjs.gov/content/pub/pdf/mhppji.pdf.
7. Fields & Phillips, supra note 1.
8. Id.
9. Id.
10. Id.
11. Estelle v. Gamble, 429 U.S. 97, 102-04 (1976) (“[E]lementary principles
establish the government’s obligation to provide medical care for those whom it is
punishing by incarceration. An inmate must rely on prison authorities to treat his medical
needs; if the authorities fail to do so, those needs will not be met.”).
12. Ruiz v. Estelle, 503 F. Supp. 1265, 1339. (S.D. Tex. 1980).
WHITTIER LAW REVIEW
Vol. 38:1
or behavior-altering medications without proper administration,
supervision, or periodic review was an inadequate mental health
treatment program. These standards of minimally adequate health
mental health care services have been consistently applied by other
courts. “”
Mentally ill prisoners who have not been provided with adequate
mental health care services have brought class action suits against the
government, alleging, among other things, violation of their Eighth
Amendment right against cruel and unusual punishment. In order to
succeed on these claims, the prisoner must prove that there was a
“deliberate indifference” to serious medical needs by showing (1) the
defendants knew that the inmates faced a substantial risk of harm as a
result of the systematic deficiencies; and (2) that the defendants
13
disregarded that risk by failing to take reasonable measures to abate it.
The Supreme Court has held that the failure to provide adequate medical
health services can “result in further significant injury or the
‘unnecessary and wanton infliction of pain,”‘ i.e., deliberate
indifference.
Such lawsuits have led to consent decrees and court
orders instituting reforms and the court appointment of monitors to
oversee compliance.
In California, a class of California state prisoners who suffer from
serious mental disorders sued under section 1983 of the United States
Code, “alleging that the mental health care provided at most institutions
within the California Department of Corrections 15 [(“CDC”)] is so
inadequate” that it violated, among other things, 16their Eighth
Amendment right against cruel and unusual punishment.
In making a
determination of whether mental health care services were minimally
13. Estelle, 429 U.S. 97 at 105, n.11.
14. Id.
15. Although the CDC officially changed its name to California Department of
Corrections and Rehabilitation in 2005, 1 will refer to it as the CDC throughout the paper.
Don Thompson, California Inmate Release: Schwarzenegger Prison Reform Policies
were
Mixed,
HUFFINGTON
POST
(Jul.
14,
2011,
12:00
PM),
http://www.huffingtonpost.com/2011/05/24/california-inmate-release n 866189.html.
16. Coleman v. Wilson, 912 F. Supp. 1282, 1293 (E.D. Cal. 1995). This case later
became consolidated with Platav. Brown, 754 F.3d 1070 (9th Cir. 2014), looking at both
mental and medical health care provisions from the perspective of overcrowding, and
was ultimately decided by the Supreme Court in Brown v. Plata,563 U.S. 493 (2011).
For the purposes of this paper, I am looking at the mental health analysis discussed in
Coleman.
2017 INADEQUATE MENTAL HEALTH SERVICES FOR INMATES 165
17
adequate, the court applied the six components established in Ruiz.
The results were as follows:
Screening: The CDC was found to have inadequate screening
measures because the only inmates that were identified as needing
mental health care services were those who (1) self-reported, (2)
presented medical records at the time of admission, (3) showed bizarre
behavior, or (4) asked to see a psychiatrist. This practice left thousands
of mentally ill inmates undetected and untreated.
Treatment: Due to chronic understaffing and inadequate screening,
the CDC was found to have engaged in unconstitutional delays in
treatment to mentally ill inmates, especially for those mentally
ill
19
inmates that had been segregated from the general population.
Competency and Sufficiency of Staffing: After reviewing several
case studies and reports, the court found the CDC to be significantly and
chronically understaffed. Moreover, the court found that the staff was
not adequately competent
because there was no quality assurance
20
program in place.
Record Maintenance: The records were disorganized, untimely
kept, incomplete, insufficient, and contained no treatment plans.
Moreover, the computing tracking systems that were in place only
worked at the individual institution, so there was no way to make
sure
21
that the treatment carried over when inmates were transferred.
Suicide Prevention:Because of reasons mentioned above,
the court
22
found the institution of suicide prevention to be insufficient.
Medication:The court found the supervision of use inadequate, the
refills untimely. Further, there was no system in place to prevent
hoarding or to ensure continuity, and some medicines that were very
effective in treatment were not being provided “because there was not
enough staff to do necessary post-medication monitoring.” In addition,
some institutions did not have protocols to administer involuntary
medicine, and thus involuntary medicine administration was
underutilized. Places that did administer involuntary medicine did so
over the phone without examination of the inmate by the physician.
17.
18.
19.
20.
21.
22.
Coleman, 912 F. Supp. at 1296-98.
Id.at 1305-06.
Id. at 1307-08.
Id. at 1308.
Id. at 1310, 1314.
Id. at 1297.
WHITTIER LAW REVIEW
Vol. 38:1
These places also allowed custodial staff to “play a significant role in
recommending involuntary” medication, including the right to veto a
medical decision concerning the involuntary medicine, and inmates were
often involuntarily medicated in inappropriate settings.23
After finding that the CDC did not provide adequate mental health
services to mentally ill inmates, the court ordered the CDC to work with
the Special Master and his experts to come up with an action plan to
remedy the Eighth Amendment violations and to meet their
constitutional obligation
to deliver adequate health •care
. to seriously
• •24
mentally ill inmates. Although the CDC has made significant progress
in adopting and implementing a program that provides adequate mental
health care services to mentally ill inmates, eighteen years later, the
program has still been found to be inadequate.
In 2013, lawyers representing California state mentally ill inmates
being held in San Quentin brought a motion for enforcement of the court
orders established in the 1995 Coleman case to provide adequate mental
health care services.
Despite the CDC’s efforts in working with the
Special Master to come up with an operative remedial plan to rectify the
inadequacies in mental health care services, these services for mentally
ill inmates remain inadequate. 2 6 Currently, inmates deemed to have
serious mental health needs can be sent to an offsite medical facility for
a short-term period.27 While there, they are held in a single cell, severely
isolated, unable to go to group therapy or interact with other inmates,
and have no use of day rooms or prison yards.28 The court concluded
that the restrictions are so severe that they continued to preclude access
to adequate mental health care services, as research has confirmed that
this solitary treatment of mentally ill inmates actually causes further
harm 29
The CDC
• has also come up•with a program of30specialized care for
inmates who need a long-term higher level of care.
Although a move
23. Id. at 1309,1311-12.
24. Id. at 1324.
25. Coleman v. Brown, No. CIV. S-90-520 LKK/DAD (PC), 2013 WL 6491529, at
*1 (E.D. Cal. Dec. 10, 2013).
26.
27.
28.
29.
30.
Id.
Id. at *8.
Id. at *6.
Id. at *9.
Id. at *3.
2017 INADEQUATE MENTAL HEALTH SERVICES FOR INMATES 167
in the right direction, the court found this to be inadequate as well,
because the long-term treatment onlx lasts for six to twenty-four months
before inmates would be cycled out. Moreover, there are only ten beds
available, which the CDC knows is not enough for inmates who would
need to be put in the program. 32 Also, it is unclear whether these beds
will be provided exclusively for inmates suffering from mental health
issues or whether they will also be used for those suffering from physical
health issues. 3 3 Finally, the court took issue with the fact that the beds
were licensed for outpatient use and not inpatient use. 34 Ultimately, the
court held that the CDC was not in compliance with the Eighth
Amendment, and it still needed to work with the Special Master to
establish a durable remedy to provide access to necessary inpatient
health care for seriously mentally ill inmates. 35 The court also required
the CDC to report its elected remedy and method of implementation
within a six-month period. 36 The court further ordered the 37CDC to
conduct an assessment of unmet inpatient need at San Quentin.
II. ORIGINS OF THE DISPARITY
The failure to provide adequate mental health services can be
explained by numerous factors, including, but not limited to, (1)
stigmatization/lack of understanding of mental health issues; (2) the
punitive purpose of prisons; (3) the cost/administration of providing
adequate mental health services; (4) the lack of an adequate screening
program to continuously identify those who need mental health services;
and (5) the Prison Litigation Reform Act.
A. STIGMATIZATION/LACK OF UNDERSTANDING OF MENTAL HEALTH
ISSUES
As a society, the U.S. has failed to consistently and actively engage
in discussions regarding mental health illness. Those who suffer from
mental illnesses often encounter public stigmatization and self-
31.
32.
33.
34.
35.
36.
37.
Id. at *6
Id. at *5.
Id.
Id.
Id. at *11.
Id. at *12.
Id.
WHITTIER LAW REVIEW
• •
•
Vol. 38:1
38
stigmatization.
Mental health issues are often regarded as a sign of
weakness, even though they can arise from genetics, stress, or traumatic
events, just like physical health issues. In most respects, many people
do not even regard mental illness as an actual disease.
The advancement of social media as a popular tool for individuals
to express themselves has caused negative backlash against mental
illness. It is common for users to react to expressions of sufferanc …
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