Tag Archives: prison reform

California Judge Says State of California is Still Providing Inadequate Health Services to Inmates

Currently, health care in California’s prison system is under court supervision, in the aftermath of a lawsuit pointing out that conditions were so poor in California’s prisons that an average of one inmate per week was dying due to inadequate health care. Huge numbers of people in California’s prisons are disabled; just for example, people with developmental disabilities make up around four percent of California’s inmate population. This adds considerably to the complexity of providing health care services in California prisons, as does the very high rate of infectious disease observed in most prisons.

The state recently attempted to end the receivership of its prisons on the grounds that conditions had improved. More studies were conducted to assess the current situation, and Judge Charles Breyer issued a tentative ruling that the court supervision must continue because conditions in many California prisons still do not meet basic standards of health and safety. The human and civil rights of California prisoners are being violated, in no small part because the state is struggling with a massive prison population paired with epic budget cuts, which is pretty much a recipe for disaster.

Here’s the judge, discussing why he decided not to end the receivership:

Breyer, brother of U.S. Supreme Court Justice Stephen Breyer, went further in his proposed findings.

The inmates “are regularly verbally, physically, and sexually assaulted, exploited, and discriminated against in California prisons,” he wrote. “Developmentally disabled prisoners are punished for violating prison rules that they do not understand, and are punished at hearings which they cannot comprehend.”

They regularly have their food and property stolen, or give it up to buy protection or help from other inmates. They often lack the help they need with basic hygiene, or with getting routine medical treatment, the judge found.

At one point, Breyer suggested that the state sought to end his oversight “simply because ongoing Court supervision is annoying them.”

Billions of dollars are being spent, and it’s still not enough. Of the 17 prisons expected, only two ‘met the minimum standards for health care.’ Perhaps unsurprisingly, one of the biggest areas of failing was in preventative care. The prison environment is stressful and crowded, which tends to increase susceptibility to infectious disease while also making inmates more prone to the development of mental health problems. For intellectually and developmentally disabled inmates, prison conditions are even worse, as many prisons don’t know how to handle these inmates, don’t provide basic services they need, and essentially leave them at the mercy of the general population.

It’s not surprising that HIV, tuberculosis, and hep C infection rates are all on the rise in prisons as a result of poor preventative care and infection control. We should be asking ourselves when it was decided that a prison sentence should also came with an almost certain sentence for developing an infectious and potentially fatal disease, just as we should be asking ourselves why prison rape continues to be tolerated.

Prisoners are not receiving the health care services they need, when they need them. That’s a problem. It’s a problem when the state is imprisoning people in my name, using my tax dollars to fund it, and it can’t even promise me that those people will have access to basic health care services. It can’t promise that the people being imprisoned ‘for public safety’ will be safe themselves in prison, and this is categorically unacceptable. We owe a duty of care to prison inmates, no matter who they are, no matter what crimes they have committed, and prisoner rights is one of the most ignored areas in the human rights community in the United States. The conditions in California’s prisons can be seen elsewhere across the United States, where prisoners die because they can’t access medical care in addition to being raped, exploited, and abused.

The findings of the report on California’s prisons recommend that the most effective way to improve access to health care for California inmates is to reduce the prison population by releasing inmates. Early release has already been promoted to deal with overcrowding as well as budget problems. However, we also need to approach this from the other side; it’s important not just to reduce the prison population, but to put fewer people in prison in the first place. This requires a major overhaul of California’s mandatory sentencing laws and approach to law enforcement, both of which are long overdue.

There are also colossal intersections with race here. Nonwhite people and people of colour are far more likely to be incarcerated in the United States. This is not because members of these communities are more likely to commit crimes, despite the beliefs of some conservatives. It is because they are more likely to be profiled as criminals, more likely to be arrested and prosecuted when a white person would get a warning, more likely to get longer prison sentences, more likely to be convicted. We need to address the racialised dynamics of the ‘justice system’ in the United States to get at the bottom of why so many people are in prison.

I’m glad that the decision to continue court supervision of health services in California prisons was made. It’s clear that the prison system can’t regulate itself or provide the services it is legally and ethically obligated to provide, and I hope the court can compel it to do so. At the same time we work to secure safer and healthier conditions for prisoners now, I want to see a radical shift of the way we handle law enforcement and justice for people in the future.

What Is Justice? Incarceration of Mentally Ill Youth in the United States

The University of California, Berkeley recently released a report discussing the incarceration of youth with mental illness. Mental Health Issues in California’s Juvenile Justice System (.pdf) examines juvenile detention in California and the ways that it is falling woefully short in terms of providing adequate mental health services to incarcerated juveniles. Unsurprisingly, it is getting very limited attention in the media because it contains a trifecta of things society doesn’t want to address: rising incarceration rates, youth, and mental illness.

We cannot examine this study without considering the larger context of juvenile incarceration in the United States as a whole. The US incarcerates more youth than any other country in the world, in a prison-industrial complex that happens to be a major moneymaker for thousands of private prisons run with minimal accountability. The ‘justice’ system in the United States is deeply flawed, with stark racial and class disparities, including for incarcerated youth. Numerous regions claim to be ‘tough on youth crime’ and as with other ‘tough on crime’ initiatives, nonwhite juveniles are far more likely to be arrested, prosecuted, and imprisoned. White juveniles, when they do enter the legal system, are offered far more alternatives.

‘Tough on youth crime’ results in life in prison for teens. Like other residents of the prison system, incarcerated youth are at risk for sexual assault, rape, and physical violence. They lack access to adequate health care. Despite the fact that we have a legal and ethical responsibility to provide health services to the people we incarcerate ‘for the public good,’ prisoners are routinely denied access to their medications (content warning, this prisoner died of complications from an eating disorder), life saving medical treatments, and even the most basic of health care.

Juveniles are held in overcrowded prison environments that expose them to the risk of violence, infectious disease, and stress-related mental illness. Thanks to prison crowding and ‘tough on crime’ laws, some juveniles end up being held in adult facilities. Youths housed with adults are at increased risk of assault. They are also more likely to attempt suicide. Our prisons, for the most part, are no place for human beings, no matter what those human beings may have done, and the disparities in our justice system mean that there is no guarantee that we are incarcerating the right person for the crime.

We have too many juveniles in prison. The justice system in the United States imprisons too many people in general, with few explorations of alternatives to incarceration. ‘Justice’ plays out along racial and class boundaries and this is impossible to ignore. We cannot talk about the problems with prisoner care without talking about why and how people are incarcerated in the first place, and exploring the social attitudes that play a huge role in the construction of our justice system.

There are several problems going on with the incarceration of mentally ill youth. The first is that because community support services are limited, many youth who do not belong in prison at all are being incarcerated for ‘behaviour problems.’ Mentally ill children are not provided with support and end up being institutionalised on involuntary psychiatric holds, while their parents are told that if they want help, they should call the police (content warning, problematic framing). As a society, the United States is using the juvenile justice system as a mental health treatment program.

Who is least likely to have access to services, support, and the funds to provide adequate mental health treatment? People in poverty and nonwhite folks. Parents with disabilities caring for their mentally ill children. A vicious cycle is created where people with nowhere to turn go to the option of last resort and it ends with youth in prison because they are mentally ill. Not because they have committed crimes. Because they have mental illnesses (h/t MsFeasance for this link!). The Berkeley report shows, though, that once those youth arrive in prison, they are not provided with the mental health services that they need.

Incarcerated mentally ill youth often do not receive mental health treatment in prison. Screening of incarcerated youth is inadequate and spotty. Diagnoses are missed or disputed. Youth who have diagnoses aren’t provided with medications, therapy, and other treatments. Other youth are psychiatrised and subjected to abusive ‘treatment.’ Meanwhile, California is slashing its budget and although prison spending is one of the few areas of the budget that is increasing, that spending isn’t improving health care in prisons. It’s going to the construction of new facilities and into the pockets of prison administrators and private companies that make prison contracting a big business.

The report puts forward a number of suggestions for improving mental health services within the prison system, including establishing diversion programs to provide juvenile offenders with community-based treatment options. It also recommends taking some steps to keep mentally ill youth out of prison in the first place, by improving support and outreach so that the prison system stops being used as a dumping ground. In order to get mentally ill youth out of prisons, we need to change our attitudes as a society about mental illness and about incarceration; jails and prisons need to stop being regarded as holding facilities for people who are socially undesirable.

Lack of access to treatment and services for incarcerated youth is a symptom of a larger problem. It’s a symptom of the way mental illness in general is addressed by our society, of how we think about funding and budgeting priorities, of how we think about youth themselves.