Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Prisons. Show all posts
Showing posts with label Prisons. Show all posts

Tuesday, January 16, 2024

Criminal Justice Reform Is Health Care Reform

Haber LA, Boudin C, Williams BA.
JAMA.
Published online December 14, 2023.

Here is an excerpt:

Health Care While Incarcerated

Federal law mandates provision of health care for incarcerated persons. In 1976, the US Supreme Court ruled in Estelle v Gamble that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’” prohibited under the Eighth Amendment. Subsequent cases established that incarcerated individuals must receive access to medical care, enactment of ordered care, and treatment without bias to their incarcerated status.

Such court decisions establish rights and responsibilities, but do not fund or oversee health care delivery. Community health care oversight, such as the Joint Commission, does not apply to prison health care. When access to quality care is inadequate, incarcerated patients must resort to lawsuits to advocate for change—a right curtailed by the Prison Litigation Reform Act of 1996, which limited prisoners’ ability to file suit in federal court.

Despite Eighth Amendment guarantees, simply entering the criminal-legal system carries profound personal health risks: violent living conditions result in traumatic injuries, housing in congregate settings predisposes to the spread of infectious diseases, and exceptions to physical comfort, health privacy, and informed decision-making occur during medical care delivery. These factors compound existing health disparities commonly found in the incarcerated population.

The First Step Act

Signed under then-president Trump, the First Step Act of 2018 (FSA) was a bipartisan criminal justice reform bill designed to reduce the federal prison population while also protecting public safety. The legislation aimed to decrease entry into prison, provide rehabilitation during incarceration, improve protections for medically vulnerable individuals, and expedite release.

To achieve these goals, the FSA included prospective and retroactive sentencing reforms, most notably expanded relief from mandatory minimum sentences for drug distribution offenses that disproportionately affect Black individuals in the US. The FSA additionally called for the use of evidence-based tools, such as the Prisoner Assessment Tool Targeting Estimated Risk and Needs, to facilitate release decisions.

The legislation also addressed medical scenarios commonly encountered by professionals providing care to incarcerated persons, including prohibitions on shackling pregnant patients, deescalation training for correctional officers when encountering people with psychiatric illness or cognitive deficits, easing access to compassionate release for those with advanced age or life-limiting illness, and mandatory reporting on the use of medication-assisted treatment for opioid use disorder. With opioid overdose being the leading cause of postrelease mortality, the latter requirement has been particularly important for those transitioning out of correctional settings.

During the recent COVID-19 pandemic, FSA amendments expanding incarcerated individuals’ access to the courts led to a marked increase in successful petitions for early release from prison. Decarcerating those individuals most medically at risk during the public health crisis reduced the spread of viral illness associated with prison overcrowding, protecting both incarcerated individuals and those working in carceral settings.

Thursday, September 28, 2023

US prison labor is cruel and pointless legalized slavery.

Dyjuan Tatro
The Guardian
Originally posted 22 Sept 23

Here is an excerpt:

It costs New York around $70,000 a year in taxpayer money to imprison someone. It costs the BPI about $10,000 a year to educate an incarcerated student. New York’s recidivism rate is 40%, while graduates of the BPI and similar programs recidivate at only 4%, a tenfold decrease. Yet, despite its clear positive record, only 300 of New York’s 30,000 incarcerated people are enrolled at the BPI in any given semester. I was one of a lucky few.

Prisons are designed to warehouse, traumatize and exploit people, then send them back home in worse shape than when they entered the system. Despite having worked every day, the vast majority of people are released with no job experience, no references and no hope. Some would take this to mean that the system is failing. And it is with regard to public safety, rehabilitation and justice, but it’s horrifyingly successful at two things: guaranteeing jobs for some and perpetuating slavery for others.

Over the years, I learned that prison officials were not interested in giving us fruitful educational and job opportunities that allowed us to go home and stay home. The reality is much more sinister. Prisons are a job program for officers that requires us to keep coming back.


Here is my summary:

The article is a personal account of the author's experience working in prison. Tatro argues that prison labor is a form of legalized slavery, and that it is cruel and pointless. He writes that his work in prison was meaningless and dehumanizing, and that it did not teach him any skills or prepare him for life outside of prison. He also argues that prison labor undermines the living standards of workers outside of prison, as businesses that use prison labor are able to pay their workers less.

Tatro's article is a powerful indictment of the US prison system, and it raises important questions about the role of labor in the rehabilitation of prisoners.

Friday, May 6, 2022

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)
The Lancet, Vol 44, 101266

Summary

Background

People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.

Findings

Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).
 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.

Wednesday, September 8, 2021

America Runs on ‘Dirty Work’ and Moral Inequality

Eyal Press
The New York Times
Originally posted 13 Aug 21

Here is an excerpt:

“Dirty work” can refer to any unpleasant job, but among social scientists, the term has a more pointed meaning. In 1962, Everett Hughes, an American sociologist, published an essay titled “Good People and Dirty Work” that drew on conversations he’d had in postwar Germany about the mass atrocities of the Nazi era. Mr. Hughes argued that the persecution of Jews proceeded with the unspoken assent of many supposedly enlightened Germans, who refrained from asking too many questions because, on some level, they were not entirely displeased.

This was the nature of dirty work as Mr. Hughes conceived of it: unethical activity that was delegated to certain agents and then disavowed by society, even though the perpetrators had an “unconscious mandate” from their fellow citizens. As extreme as the Nazi example was, this dynamic existed in every society, Mr. Hughes wrote, enabling respectable citizens to distance themselves from the morally troubling things being done in their name. The dirty workers were not rogue actors but “agents” of “good people” who passively stood by.

Contemporary America runs on dirty work. Some of the people who do this work are our agents by virtue of the fact that they perform public functions, such as running the world’s largest penal system. Others qualify as such by catering to our consumption habits — the food we eat, the fossil fuels we burn, which are drilled and fracked by dirty workers in places like the Gulf of Mexico. The high-tech gadgets in our pockets rely on yet another form of dirty work — the mining of cobalt — that has been outsourced to workers in Africa and to foreign subcontractors that often brutally exploit them.

Like the essential jobs performed by grocery clerks and other low-wage workers during the Covid-19 pandemic, this work sustains our lifestyles and undergirds the prevailing social order, but privileged people are generally spared from having to think about it. One reason is that the dirty work occurs far away from them, in isolated institutions — prisons, slaughterhouses — that are closed to the public. Another reason is that the privileged rarely have to do it. Although there is no shortage of it to go around, dirty work in America is not randomly distributed. 

Wednesday, August 12, 2020

San Quentin’s coronavirus outbreak shows why ‘herd immunity’ could mean disaster

A condemned prisoner touches the mesh fence in the exercise yard during a media tour at San Quentin State Prison.Rong-Gong Lin II and Kim Christensen
The Los Angeles Times
Originally published 11 August 20

Here are two excerpts:

San Quentin is an imperfect setting to help understand when herd immunity might be achieved. Prisons are crowded settings that will promote coronavirus transmission more so than among people in other settings, like those who live in single-family homes.

But the San Quentin experience — as well as other data — does show that, in the absence of a vaccine, “in order to get to something that approaches herd immunity, we’re going to have to get something well on the far side of 50% of people infected,” Rutherford said. “Which comes with a resultant large cost in mortality and severe morbidity.

“If you believe the San Quentin stuff, you got to get up to way-up-there before you start seeing slowing of transmission,” Rutherford said.

Dr. Anthony Fauci, the U.S. government’s top infectious diseases expert, last week guessed it will probably require 50% to 75% of a population to be immune before achieving herd immunity — a goal that should be achieved not just through infected people recovering but also through vaccination.

California has a long way to go before the vast majority of residents have been infected.

(cut)

Sweden famously pursued a herd immunity strategy when it decided not to impose a severe lockdown.

But now, Sweden has among the highest mortality rates among European countries, and has a worse rate than that of the United States.

The info is here.

Wednesday, June 17, 2020

13th is now free on YouTube



Combining archival footage with testimony from activists and scholars, director Ava DuVernay's examination of the U.S. prison system looks at how the country's history of racial inequality drives the high rate of incarceration in America.

This piercing, Oscar-nominated film won Best Documentary at the Emmys, the BAFTAs and the NAACP Image Awards.

 US Rating: TV-MA For mature audiences. May not be suitable for ages 17 and under.

Monday, June 8, 2020

One Nation Under Guard

Samuel Bowles and Arjun Jayadev
The New York Times
Originally posted 15 Feb 2014
(and still relevant today)

Here is an excerpt:

What is happening in America today is both unprecedented in our history, and virtually unique among Western democratic nations. The share of our labor force devoted to guard labor has risen fivefold since 1890 — a year when, in case you were wondering, the homicide rate was much higher than today.

Is this the curse of affluence? Or of ethnic diversity? We don’t think so. The guard-labor share of employment in the United States is four times what it is in Sweden, where living standards rival America’s. And Britain, with its diverse population, uses substantially less guard labor than the United States.

In America, growing inequality has been accompanied by a boom in gated communities and armies of doormen controlling access to upscale apartment buildings. We did not count the doormen, or those producing the gates, locks and security equipment. One could quibble about the numbers; we have elsewhere adopted a broader definition, including prisoners, work supervisors with disciplinary functions, and others.

But however one totes up guard labor in the United States, there is a lot of it, and it seems to go along with economic inequality. States with high levels of income inequality — New York and Louisiana — employ twice as many security workers (as a fraction of their labor force) as less unequal states like Idaho and New Hampshire.

When we look across advanced industrialized countries, we see the same pattern: the more inequality, the more guard labor. As the graph shows, the United States leads in both.

The info is here.

Sunday, May 26, 2019

Brain science should be making prisons better, not trying to prove innocence

Arielle Baskin-Sommers
theconversaton.com
Originally posted November 1, 2017

Here is an excerpt:

Unfortunately, when neuroscientific assessments are presented to the court, they can sway juries, regardless of their relevance. Using these techniques to produce expert evidence doesn’t bring the court any closer to truth or justice. And with a single brain scan costing thousands of dollars, plus expert interpretation and testimony, it’s an expensive tool out of reach for many defendants. Rather than helping untangle legal responsibility, neuroscience here causes an even deeper divide between the rich and the poor, based on pseudoscience.

While I remain skeptical about the use of neuroscience in the judicial process, there are a number of places where its findings could help corrections systems develop policies and practices based on evidence.

Solitary confinement harms more than helps

Take, for instance, the use within prisons of solitary confinement as a punishment for disciplinary infractions. In 2015, the Bureau of Justice reported that nearly 20 percent of federal and state prisoners and 18 percent of local jail inmates spent time in solitary.

Research consistently demonstrates that time spent in solitary increases the chances of persistent emotional trauma and distress. Solitary can lead to hallucinations, fantasies and paranoia; it can increase anxiety, depression and apathy as well as difficulties in thinking, concentrating, remembering, paying attention and controlling impulses. People placed in solitary are more likely to engage in self-mutilation as well as exhibit chronic rage, anger and irritability. The term “isolation syndrome” has even been coined to capture the severe and long-lasting effects of solitary.

The info is here.

Wednesday, November 2, 2016

Hard Time or Hospital Treatment? Mental Illness and the Criminal Justice System

Christine Montross
N Engl J Med 2016; 375:1407-1409
October 13, 2016

Here is an excerpt:

When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.

It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.

When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.

The article is here.

Monday, June 6, 2016

Stopping the revolving prison door for the mentally ill

by Courtenay Harris Bond
Phillie.com
Originally posted May 10, 2016

Here is an excerpt:

But the unfortunate reality right now is that many people with serious mental illness who commit even minor infractions are locked up, making over-crowded prisons and jails responsible for mental health services they are ill equipped to deal with.

“The police are called on to do too much, and the health care system is not doing enough,” Sisti said. “The whole idea that the police are now front-line mental health workers shows that we’ve abdicated our responsibilities as health care professionals.”

“The police in their best efforts aren’t equipped with the tools”—psychiatric medications, for example, that only physicians and nurses can administer­—“to de-escalate some of these situations,” added Cyndi Rickards, an assistant professor in the Department of Criminology and Justice Studies at Drexel.

Dr. Philip Candilis, director of the forensic psychiatry fellowship at St. Elizabeth’s Hospital in Washington, described a jail diversion program in Arlington, Va., where courts work with social service agencies to aid people struggling with mental illness who find themselves in trouble with the law. Mental health courts in Philadelphia and Washington function in a similar way.

The article is here.

Wednesday, July 8, 2015

How could they?

By Tage Rai
Aeon Magazine
Originally published June 18, 2015

Here is an excerpt:

It would be easier to live in a world where perpetrators believe that violence is wrong and engage in it anyway. That is not the world we live in. While our refusal to acknowledge this basic fact may have helped to orient our own moral compass, it has also stood in the way of interventions that might actually reduce harm. Let’s put aside the philosophical questions that arise once we accept that there is moral disagreement about violence. How does the message that violence is morally motivated aid our efforts to reduce it?

For years, we have been trying to reduce crime by enacting mass incarceration, by placing restrictions on the mentally ill, and by teaching potential perpetrators how to exercise more self-control. On the face of it, these all sound like plausible strategies. But all of them miss their target.

One of the most robust findings in criminology is that increasing the severity of punishment has little deterrent effect. People simply aren’t as sensitive to the potential costs of crime as the rational-choice model predicts they should be, and so efforts to reduce it by cracking down have failed to justify the immense fiscal and social costs of mass incarceration. Meanwhile, because most violent crimes are committed by psychologically healthy individuals, legislation that focuses on the mentally ill – for example, by stopping them from buying guns – would lead to only a small reduction.

The entire article is here.

Monday, February 2, 2015

Board Votes to End Solitary Confinement for Rikers Inmates Under 21 By 2016

By Jillian Jorgensen
The New York Observer
Originally published January 13, 2014

The Board of Correction today approved a plan for an enhanced supervision unit touted by Mayor Bill de Blasio and Department of Correction Commissioner Joseph Ponte—but also voted to end solitary confinement for all inmates on Rikers Island under 21 by 2016, a sweeping change that will set the department apart from jail systems nationwide.

The board voted unanimously today to create the new Enhanced Supervision Housing Unit touted by Mr. Ponte and Mr. de Blasio at a visit to Rikers Island last month, as well as a previously discussed plan to limit the use of punitive segregation—in which inmates who commit an infraction are locked up for 23-hours a day—to no more than 30 days per offense.

The entire article is here.

Thursday, August 21, 2014

Thousands of Inmates in Illinois sign up for Obamacare for MH Treatment

By Rick Pearson
The Chicago Tribune
Originally posted August 4, 2014

Cook County Sheriff Tom Dart, attempting to cope with what he says is a growing mental health crisis among inmates at the county jail, said up to 9,000 people who have been incarcerated have signed up for health insurance under the Affordable Care Act in an attempt to get the care they need.

“Systemically, over the course of decades, we’ve sort of carved back all the mental health services to the point where there is this question, we’ve carved it back to next to nothing,” Dart said on “The Sunday Spin” on WGN AM-720.

The entire story is here.

Tuesday, August 19, 2014

California Revises Policy on Mentally Ill Inmates

By Erica Goode
The New York Times
August 2, 2014

Here is an excerpt:

The increasing number of mentally ill prisoners in prisons and jails across the country — in 2013, mentally ill prisoners made up just over 28 percent of California’s prison population — has raised questions about their treatment in corrections systems poorly equipped to deal with psychiatric symptoms. Mentally ill inmates, whose challenging behavior often leads to their placement in solitary confinement, are frequent targets for a cell extraction — the forcible removal of an inmate from a cell by a tactical team equipped with Tasers, pepper spray or other less-lethal weapons — or for other uses of force by guards.

Judge Karlton, in his April order, ruled that the use of force and lengthy solitary confinement of seriously mentally ill inmates was unconstitutional and ordered the department to revise its policies.

The entire article is here.

Tuesday, July 22, 2014

The Mind Report: Psychopaths, Morality, Neuroscience and Treatment

Laurie Santos (Yale) interviews Kent Kiehl (University of New Mexico) about his new book, The Psychopath Whisperer.  They discuss neuroscience on psychopathic prisoners, morality and the brain, and treatment research.


Saturday, May 17, 2014

U.S. Should Significantly Reduce Rate of Incarceration

Unprecedented Rise in Prison Population ‘Not Serving the Country Well,’ Says New Report

Press Release from the National Academy of Sciences
Released April 30, 2014

Given the minimal impact of long prison sentences on crime prevention and the negative social consequences and burdensome financial costs of U.S. incarceration rates, which have more than quadrupled in the last four decades, the nation should revise current criminal justice policies to significantly reduce imprisonment rates, says a new report from the National Research Council.

A comprehensive review of data led the committee that wrote the report to conclude that the costs of the current rate of incarceration outweigh the benefits.  The committee recommended that federal and state policymakers re-examine policies requiring mandatory and long sentences, as well as take steps to improve prison conditions and to reduce unnecessary harm to the families and communities of those incarcerated.  In addition, it recommended a reconsideration of drug crime policy, given the apparently low effectiveness of a heightened enforcement strategy that resulted in a tenfold increase in the incarceration rate for drug offenses from 1980 to 2010 — twice the rate for other crimes.

“We are concerned that the United States is past the point where the number of people in prison can be justified by social benefits,” said committee chair Jeremy Travis, president of John Jay College of Criminal Justice in New York City.  “We need to embark on a national conversation to rethink the role of prison in society.  A criminal justice system that makes less use of incarceration can better achieve its aims than a harsher, more punitive system. There are common-sense, practical steps we can take to move in this direction.”

The rest of the press release is here.

Sunday, April 20, 2014

Solitude’s Despair

By Alexander Nazaryan
Newsweek Magazine
Originally published on April 3, 2014

Here is an excerpt:

Though daunting, Solitary Confinement is lucid as hell. Lucid about hell, too. Its fundamental premise is that no man is an island, and that throwing inmates into concrete rooms, especially for minor offenses like possessing Black Panther writings or disobeying guards, is an exile no human psyche should (or can) bear. "The absence of even the possibility of touching or being touched by another," Guenther writes, "threatens to unhinge us." Jean-Paul Sartre said hell is other people. Guenther reminds that this hell of Others is far better than the hell of no Others at all. You don't have to care about prisons or prisoners to care about the philosophical valence of the human touch. That, I'm pretty sure, is what this book is really about.

Some researchers have tried to quantify the suffering of solitary confinement. In 2003, Craig W. Haney of the University of California at Santa Cruz published a study of inmates in the Security Housing Unit at Pelican Bay State Prison in Crescent City, Calif. He found that 88 percent of those in prolonged isolation suffered from irrational anger; chronic depression plagued 77 percent, while violent fantasies visited 61 percent of these prisoners. Nearly a third (27 percent) wanted to kill themselves.

The entire story is here.

In essence, the author is arguing that solitary confinement is an attack on the "self."

Monday, October 21, 2013

The New Asylums: Jails Swell With Mentally Ill

By Gary Fields and Ericka Phillips
The Wall Street Journal
Originally published September 25, 2013

Here is an excerpt:

America's lockups are its new asylums. After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. Many of the afflicted wound up on the streets, where, untreated, they became more vulnerable to joblessness, drug abuse and crime.

The country's three biggest jail systems -- Cook County, in Illinois; Los Angeles County; and New York City -- are on the front lines. With more than 11,000 prisoners under treatment on any given day, they 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.

Put another way, the number of mentally ill prisoners the three facilities handle daily is equal to 28% of all beds in the nation's 213 state psychiatric hospitals, according to the National Association of State Mental Health Program Directors Research Institute Inc.

The entire story is here, hiding behind a paywall.

Tuesday, July 16, 2013

Prisons and the Mentally Ill

Religion and Ethics Newsweekly
Originally published June 21, 2013

It doesn’t make moral, ethical, or fiscal sense, according to Cook County sheriff Tom Dart, to house people who are mentally ill in jails and prisons.



Thursday, March 22, 2012

Prisons Rethink Isolation, Saving Money, Lives and Sanity

By Erica Goode
The New Yor Times - US
Originally published March 10, 2012

The heat was suffocating, and the inmates locked alone in cells in Unit 32, the state’s super-maximum-security prison, wiped away sweat as they lay on concrete slab beds.

Kept in solitary confinement for up to 23 hours each day, allowed out only in shackles and escorted by guards, they were restless and angry — made more so by the excrement-smeared walls, the insects, the filthy food trays and the mentally ill inmates who screamed in the night, conditions that a judge had already ruled unacceptable.

So it was not really surprising when violence erupted in 2007: an inmate stabbed to death with a homemade spear that May; in June, a suicide; in July, another stabbing; in August, a prisoner killed by a member of a rival gang.

What was surprising was what happened next. Instead of tightening restrictions further, prison officials loosened them.

They allowed most inmates out of their cells for hours each day. They built a basketball court and a group dining area. They put rehabilitation programs in place and let prisoners work their way to greater privileges.
In response, the inmates became better behaved. Violence went down. The number of prisoners in isolation dropped to about 300 from more than 1,000. So many inmates were moved into the general population of other prisons that Unit 32 was closed in 2010, saving the state more than $5 million.

The transformation of the Mississippi prison has become a focal point for a growing number of states that are rethinking the use of long-term isolation and re-evaluating how many inmates really require it, how long they should be kept there and how best to move them out. Colorado, Illinois, Maine, Ohio and Washington State have been taking steps to reduce the number of prisoners in long-term isolation; others have plans to do so. On Friday, officials in California announced a plan for policy changes that could result in fewer prisoners being sent to the state’s three super-maximum-security units.