Individuals with mental illness have the right to receive appropriate medical treatment in correctional settings and upon release. It sounds perfectly reasonable, but unfortunately, is far from reality. That was the consensus of a distinguished panel of mental health and legal experts who recently spoke at an event about the rights of the mentally ill in the criminal justice system.
The event was sponsored by the Working Group on Human Rights and Mental Health within the Non-Governmental Organization Committee on Mental Health, which consults with the United Nations to foster mental health awareness across the globe. The co-chairs of the event were Erin Falconer, Ph.D., Associate Director of Medical Affairs at ODH, Inc. and John P. Docherty, M.D., Vice President, Clinical Sciences, Digital Medicine Medical of Otsuka America Pharmaceutical, Inc.
According to U.N. conventions, all persons with mental illness, including criminal offenders, should receive the best available mental health care. Access to high-quality mental health care, in fact, is a basic human right and ethical responsibility, noted the panelists.
Various U.S. professional associations have also weighed in on the rights of the mentally ill. For example, the American Psychiatric Association has stated that the fundamental goal of a mental health service should be to provide the same level of care to patients in the criminal justice process that is available in the community. And, according to the American Bar Association’s standard on mental health, “severely mentally ill or persons with serious intellectual disabilities should be treated in a mental health or intellectual disability facility.”
Sadly, however, medical care for those with mental illness in the criminal justice system has not come close to meeting these standards. In the U.S. today, more mentally ill people are in jails and prisons than hospitals. And the proportion of prisoners with serious mental illness (estimated at 15 – 25 percent) is larger than the estimated prevalence of 5 – 8 percent found in the general population.
Many mentally ill prisoners receive inadequate medical care. In fact, for those placed in highly traumatizing environments, such as solitary confinement – which is associated with self-harm – their conditions may worsen, according to research studies.
Dual loyalty of medical providers who work in the prison system can lead to human rights violations, noted panelist Homer Venters, M.D., Director of Programs, Physicians for Human Rights in New York. These providers have an ethical obligation to advocate for the welfare of their patients, he noted. At the same, they are typically employed by public departments of correction or private prison operators whose primary objectives are maintaining security and reducing costs.
An example of dual loyalty is the practice of “clearing” patients for punishment in solitary confinement. Security staff members ask health staff to confirm that an inmate who has broken prison rules is physically and mentally sound enough to be placed in solitary confinement. This scenario does not reflect a provider–patient interaction that is in the patient’s best interest, said Dr. Venters.
According to his research, prisoners who harmed themselves in solitary confinement felt that the mental health staff were not there to serve patients’ needs but rather, were part of the security apparatus.
The panelists also discussed how social determinants of health can help mental health professionals understand recidivism. Disadvantaged neighborhoods, communities with high rates of unemployment, poverty and substance abuse – which disproportionately affect people with severe mental illness – are associated with criminal justice involvement, noted April Thames, Ph.D., associate professor and clinical psychologist, department of psychiatry and biobehavioral sciences at the University of California Los Angeles.
She stressed the key role played by appropriate social support networks in preventing recidivism. Receiving behavioral health services, such as case management services, has also been associated with a significant reduction in risk for re-arrest (Falconer et al. Health and Justice, 2017;5:4).
Alternatives to incarceration were also reviewed by Cheryl Roberts, executive director of the Greenburger Center for Social and Criminal Justice in New York. She described Hope House, a residential treatment secure facility in the Bronx, N.Y., expected to open this year, which aims to offer clinical and therapeutic services to up to 25 people with serious mental illness who are charged with certain felonies.
The U.S. has the highest rate of incarceration in the world. Until we reorient the criminal justice system around rehabilitation instead of punishment, individuals with mental illness will continue to be victimized.
Erin Falconer, PhD, is Associate Director, Medical Affairs, and Amy Joscelyne, PhD, is Medical Affairs Consultant, at ODH, Inc.