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Why Can’t California Get Prison Healthcare Right?
By Jonathan SimonShare on facebook
J. Clark Kelso, the federally court-appointed receiver, outside of Folsom State Prison. (AP Photo/Rich Pedroncelli)
J. Clark Kelso, the federally court-appointed receiver, outside of Folsom State Prison. (AP Photo/Rich Pedroncelli)
To considerable embarrassment, no doubt, in the Brown-Beard administration, admissions to California’s newest prison near Stockton California were halted February 5 by the court-appointed healthcare receiver, law professor Clark Kelso.
The prison, the first new facility in a decade, is the lynch-pin of the administration’s frequent claim to have gotten on top of California’s decades old prison health care crisis. The prison is the first of its kind to be purposely built to house and care for many of the state’s seriously ill prisoners, whose suffering in the grip of the state’s chronic overcrowding led the Supreme Court to describe the state’s system as unfit for a civilized society (see Brown v. Plata, 2011).
Under pressure to show that it can make progress in reducing that overcrowding, the administration is no doubt frustrated to have to halt adding inmates to the facility intended to hold nearly ,1800 prisoners at full capacity.
But Receiver Kelso’s order, and the report that accompanied it, raises more basic questions as to whether the State has yet drawn any lessons, from its decades of human-rights abuse, about what it takes to operate prisons that respect human dignity as required by the Constitution (as well international human rights conventions to which the state is answerable through the courts of the United States).
So what went wrong in this brand new prison designed from the ground up to deliver health care? Problems with the radiation-treatment equipment for cancer patients? Problems staffing the dialysis center? Actually the problems were a bit more basic. As reported in the Sacramento Bee):
A shortage of towels forced prisoners to dry off with dirty socks; a shortage of soap halted showers for some inmates, and incontinent men were put into diapers and received catheters that did not fit, causing them to soil their clothes and beds, according to the inspection report and a separate finding by Kelso.
The report also said there were so few guards that a single officer watched 48 cells at a time and could not step away to use the bathroom.
Kelso said the problems at the facility call into question California’s ability to take responsibility for prison health care statewide. He accused corrections officials of treating the mounting health care problems as a second-class priority, the newspaper said.
Spokes persons for the administration described the situation as a normal glitch associated with the rolling out of a new facility. Perhaps. But it also looks like business as usual in a system where medical neglect of chronically ill prisoners went on for decades under the deliberate indifference of prison administrators and governors.
Rather than apologize to the citizens of this state and seek to make amends to the prisoners, former prisoners, and correctional workers forced to experience and participate in those degrading conditions, the administration has continued with smugness to defend the status quo, with an attitude that borders on contempt to the courts.
Is it surprising that actors never held to account for their human-rights violations cannot create conditions that respect human rights? Good healthcare takes medical professionals and modern infrastructure, which appear to be still lacking to a significant degree even in this brand new purpose built “Health Care Facility.”
jonathan simonBut healthcare also takes humanity.
A prison system that can’t get that right, can ‘t run its healthcare system and shouldn’t be allowed to continue to operate prisons on which the good name of the people of California is stamped.
Jonathan Simon
The Berkeley Blog
Published by the LA Progressive on February 10, 2014
Inside a Mental Hospital Called Jail
FEB. 8, 2014 New York Times
CHICAGO — THE largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire.
Just one thing: It’s a jail. The only way to get treatment is to be arrested.
Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incarceration. And as more humane and cost-effective ways of treating mental illness have been cut back, we increasingly resort to the law-enforcement toolbox: jails and prisons.
More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.
In the jail here, some prisoners sit on their beds all day long, lost in their delusions, oblivious to their surroundings, hearing voices, sometimes talking back to them. The first person to say that this system is barbaric is their jailer.
“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart, told me as he showed me the jail, on a day when 60 percent of the jail’s intake reported that they had been diagnosed with mental illness. Dart says the system is abhorrent and senseless, as well as an astronomically expensive way to treat mental illness — but that he has no choice but to accept schizophrenic, bipolar, depressive and psychotic prisoners delivered by local police forces.
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The Cook County sheriff, Thomas Dart, center, talks with inmates Russell, right, and Compton. Russell, 46, has been diagnosed with severe depression. John Gress for The New York Times
People are not officially incarcerated because of psychiatric ailments, but that’s the unintended effect. Sheriff Dart says that although some mentally ill people commit serious crimes, the great majority are brought in for offenses that flow from mental illness.
One 47-year-old man I spoke to, George, (I’m not permitted to use last names for legal reasons) is bipolar, hears voices and abuses drugs and alcohol. He said he had been arrested five times since October for petty offenses. The current offense is criminal trespass for refusing to leave a Laundromat.
The sheriff says such examples are common and asks: “How will we be viewed, 20, 30, 50 years from now? We’ll be looked on as the ones who locked up all the mentally ill people.
“It really is one of those things so rich with irony: The same society that abhorred the idea that we lock people up in mental hospitals, now we lock people up in jails.”
A few data snapshots:
• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.
• Mentally ill inmates are often preyed upon while incarcerated, or disciplined because of trouble following rules. They are much more likely than other prisoners, for example, to be injured in a fight in jail, the Justice Department says.
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The Cook County Jail has become a de facto mental health hospital, the county’s sheriff says. John Gress for The New York Times
• Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.
In the 1800s, Dorothea Dix led a campaign against the imprisonment of the mentally ill, leading to far-reaching reforms and the establishment of mental hospitals. Now we as a society have, in effect, returned to the 1800s.
Among those jailed here is Russell, 46, who is being held for burglarizing a garage. He has been diagnosed with severe depression and said that he self-medicates with alcohol and drugs. Most of his adult life has been spent behind bars for one offense after another, and he said he became aware of his mental health problems when he was being clubbed by a thug with a baseball bat and realized that he was enjoying it.
“I just want to be normal,” he said as we spoke in a large dormitory room for inmates with psychiatric problems. “I want to have a job. I’ve never had a job. I want to be able to say hi to a co-worker.” He stopped, and there were tears in his eyes.
In 1955, there was one bed in a psychiatric ward for every 300 Americans; now there is one for every 3,000 Americans, the 2010 study said. So while more effective pharmacological treatments are theoretically available, they are often very difficult to access for people who are only borderline functional.
“Some people come here to get medication,” says Ardell Hall, a superintendent of a women’s unit at the jail. “They commit a crime to get in.”
India, a 42-year-old woman, suffers from manic depression and post-traumatic stress disorder. She said she tried at various times to get psychiatric care but found it almost impossible, so she self-medicates when on the outside with heroin — and has spent almost all of her adult life in jails and prisons on a succession of nonviolent offenses relating to drugs and shoplifting.
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India, 42, suffers from manic depression and post-traumatic stress disorder. She has spent almost all of her adult life in jails and prisons. John Gress for The New York Times
TAXPAYERS spend as much as $300 or $400 a day supporting patients with psychiatric disorders while they are in jail, partly because the mentally ill require medication and extra supervision and care.
“Fiscally, this is the stupidest thing I’ve seen government do,” Dart says. It would be far cheaper, he adds, to manage the mentally ill with a case worker on the outside than to spend such sums incarcerating them.
Cook County has implemented an exemplary system for mental health support for inmates. While in jail, they often stabilize. Then they are released, go off their medications and the cycle repeats.
One woman in the jail, Kristen, said she had been diagnosed with depression and anxiety disorders. On the outside, her prescription medication cost $100 a month, so she skipped it.
“When I’m not on my medicine on a regular basis, I don’t make decisions well,” she said, explaining her long arrest record for theft and narcotics offenses. I asked her if access to medicine would keep her out of jail, and she said: “I don’t know if that’s necessarily true, to be totally honest. But it would help.”
As Sheriff Dart puts it: “We’ve systematically shut down all the mental health facilities, so the mentally ill have nowhere else to go. We’ve become the de facto mental health hospital.”
Do we really want to go back two centuries? Doesn’t that seem not only inhumane but also deluded — on our part?
Action Committee For Women In Prison 