A PUBLICATION OF THE AMERICAN ETHICAL UNION
Table of Contents
Ethical Healthcare for the Imprisoned
Dr. Phyllis Harrison-Ross, M.D.
Trustee and Chair, Social Service Board
New York Society for Ethical Culture
I am not sure which group is more marginalized or more expendable in our society -- the mentally ill, the substance abusers, or the incarcerated -- but I do know that if someone is mentally and/or physically ill, abusing substances, and incarcerated; they are triply cursed. And, if they happen to be ill, abusing, incarcerated, and of color, it just gets worse.
Incarceration remains the criminal sanction of choice and minority incarceration remains disproportionate. Nationally, there are 2.26 million persons in jails and prisons, the highest rate on the planet -- about 751 of every 100,000. Forty-eight percent of those in our prisons are African American. A study in the American Journal of Public Health reported that mental health problems -- such as depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder and personality disorder -- are pervasive in prisons.
Among federal inmates, 14.8 percent had a mental health diagnosis, while at least one psychiatric disorder had been diagnosed in 25 percent of both the state prison and jail inmates. In 301 state prisons and local jails, for inmates with a prior diagnosis of mental disorder, 42.8 percent were also chronically ill with rates of diabetes, hypertension, prior myocardial infarction and asthma that exceeded those in the general population. HIV disease was twice that of the outside population.
Yet, 20 percent of state prisoners and a startling 68.4 percent of local jail inmates in surveyed jurisdictions had received no medical examination since incarceration. Many injured in prison -- 12 percent of state prisoners and 24.7 percent of jail inmates -- saw no medical provider after serious injuries such as fractures, sexual assault, and traumatic unconsciousness. I have witnessed failures in prisoner health, psychiatric, and substance-abuse care over the past four decades, and although the systems have been somewhat improved, nearly everywhere such care remains deficient and rudimentary.
We need to find a way to stop what I, as a medical professional, view as inhumane treatment. Prisoners are suffering, and occasionally dying, because jail and prison officials across the nation cannot provide a level of healthcare comparable to that received by civilians in their local communities. Prisons are not sufficiently staffed and that staff is not adequately trained -- and the community itself has not prioritized its healthcare systems for those who end up incarcerated.
I am working to encourage public health officials, physicians, psychiatrists, addiction, and other treatment providers to discuss their experiences with judges, prosecutors, public defenders, correctional officials, and probation and parole officers. I believe that if they could strengthen their relationships and build consensus, they would find ways to support a workable public health approach to the problem. Also, we must work to encourage healthcare professionals to consider inmates-- employment, housing, education, spiritual values, and family relations in their treatment planning and counseling. Adequate resources must be allocated to healthcare professionals to enable them to take such a comprehensive and holistic approach.
But certainly we, who are within the system, can't right these wrongs on our own. You can help in this campaign. Here is a list of organizations that are working to foster this needed improvement in detention centers, prisons, and jails. Please join in to speed up the solutions. And if you have any ideas on the subject that you'd like to share with me, send them to ssbec[at]nysec.org or
Trustee and Chair, Social Service Board
New York Society for Ethical Culture
I am not sure which group is more marginalized or more expendable in our society -- the mentally ill, the substance abusers, or the incarcerated -- but I do know that if someone is mentally and/or physically ill, abusing substances, and incarcerated; they are triply cursed. And, if they happen to be ill, abusing, incarcerated, and of color, it just gets worse.Incarceration remains the criminal sanction of choice and minority incarceration remains disproportionate. Nationally, there are 2.26 million persons in jails and prisons, the highest rate on the planet -- about 751 of every 100,000. Forty-eight percent of those in our prisons are African American. A study in the American Journal of Public Health reported that mental health problems -- such as depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder and personality disorder -- are pervasive in prisons.
Among federal inmates, 14.8 percent had a mental health diagnosis, while at least one psychiatric disorder had been diagnosed in 25 percent of both the state prison and jail inmates. In 301 state prisons and local jails, for inmates with a prior diagnosis of mental disorder, 42.8 percent were also chronically ill with rates of diabetes, hypertension, prior myocardial infarction and asthma that exceeded those in the general population. HIV disease was twice that of the outside population.
Yet, 20 percent of state prisoners and a startling 68.4 percent of local jail inmates in surveyed jurisdictions had received no medical examination since incarceration. Many injured in prison -- 12 percent of state prisoners and 24.7 percent of jail inmates -- saw no medical provider after serious injuries such as fractures, sexual assault, and traumatic unconsciousness. I have witnessed failures in prisoner health, psychiatric, and substance-abuse care over the past four decades, and although the systems have been somewhat improved, nearly everywhere such care remains deficient and rudimentary.
We need to find a way to stop what I, as a medical professional, view as inhumane treatment. Prisoners are suffering, and occasionally dying, because jail and prison officials across the nation cannot provide a level of healthcare comparable to that received by civilians in their local communities. Prisons are not sufficiently staffed and that staff is not adequately trained -- and the community itself has not prioritized its healthcare systems for those who end up incarcerated.
I am working to encourage public health officials, physicians, psychiatrists, addiction, and other treatment providers to discuss their experiences with judges, prosecutors, public defenders, correctional officials, and probation and parole officers. I believe that if they could strengthen their relationships and build consensus, they would find ways to support a workable public health approach to the problem. Also, we must work to encourage healthcare professionals to consider inmates-- employment, housing, education, spiritual values, and family relations in their treatment planning and counseling. Adequate resources must be allocated to healthcare professionals to enable them to take such a comprehensive and holistic approach.
But certainly we, who are within the system, can't right these wrongs on our own. You can help in this campaign. Here is a list of organizations that are working to foster this needed improvement in detention centers, prisons, and jails. Please join in to speed up the solutions. And if you have any ideas on the subject that you'd like to share with me, send them to ssbec[at]nysec.org or
- Correctional Association of New York: Ms. Soffiyah Elijah, Esq., selijah[at]correctionalassociation.org
- Osborne Association of New York: Mrs. Liz Gaynes, egaynes[at]osborneny.org
- Urban Justice Institute: Mr. Bob Gangi, RGangi[at]urbanjustice.org
- Center for NuLeadership in Urban Solutions: Dr. Divine Pryor, drdpryor[at]gmail.com or infor[at]centerfornuleadership.org
- Addiction Research and Treatment Center: Dr. Reginal Fluellen, rfluellen[at]fluellenassociates.com
- New York Society for Ethical Culture: Andra Miller and Dr. Anne Klaeysen, ygarcia[at]nysec.org