Monday, January 21, 2013

Out of the Blue and into the Black: The Global Incarceration of the Mentally Ill.

"I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens!  Chained, naked, beaten with rods, and lashed into obedience."
      -Dorothea Dix, Memorial to the  legislature of Massachusetts, 1843

               The red, sun baked earth crunches under the boots of a security guard outside a ward of the Enugu Prison, in the southeastern portion of Nigeria.  Unlike other sections of this prison, this portion of the prison has been set aside for people the government has listed as "civil lunatics".  According to the BBC, thanks to legislation from British era administration, the government can incarcerate individuals based on their perceived mental illness, often indefinitely.  In similar ways to asylums and hospitals in 1960's America, both family members and police can request an individual be sent to the ward without sufficient evidence of a crime or dangerous behavior.  More often than not, the request is granted.

              On January 7th, Idaho Governor, C.L (Butch) Otter gave his State of the State address to the Idaho legislature.  Otter, who is an outspoken critic of the Affordable Care Act, provided an extensive outline of his ideas to bring quality health care to the residents of the state.  One such recommendation, stemming from a request from the Department of Corrections was to build a $70 million, 579 bed, secure "mental health facility".  This is the Governor's second attempt to create such an institution for the incarcerated mentally ill.  The Department of Corrections and the contracted Corrections Corporation of America came under fire in 2010 with an ACLU exposé on prison conditions that foster extreme prisoner to prisoner violence. "Marlin Riggs, one of six named plaintiffs in the lawsuit, entered ICC in May 2008 and was targeted by a group of prisoners he believed were associated with a gang that prison officials knew had a history of threatening and extorting money from other prisoners. Despite his pleas, prison officials refused to move Riggs to a safer living area and he was violently assaulted and left lying in a pool of his own blood with a broken nose and a crushed cheekbone." 
                In 2003, the Hartford Courant published a story about the mentally ill in Connecticut's prisons.  They report that at Garner Correctional Institution in Newtown (the same town that a young man living with mental illness opened fire on an elementary school) "a schizophrenic man with a long history of severe psychiatric illness was intentionally deprived of his medication, became agitated and was fatally asphyxiated while being shackled by guards." The article goes on to state that "one inmate at this state's maximum-security facility was intentionally denied anti-psychotic medication that had been ordered by his psychiatrist and then tied to a steel bed frame for 22 hours. Another young schizophrenic man at the Hartford Correctional Center was asphyxiated by guards and then- while unconscious and dying- injected with powerful sedatives, shackled to a bed and left in a cell, naked and alone. He was discovered dead several hours later."
              From Canada to the United Kingdom, Japan to South Africa individuals living with mental illness are warehoused in prisons that are overcrowded, isolated from social supports, and a lack of evidenced based treatments.  According to the World Health Organization, an estimated 450 million people are living with mental illness at any given time.  In prisons however, individuals with mental illness are disproportionally represented compared to the general population in the countries where they live.  The WHO has identified that prison environments are in fact an impediment for the treatment of psychiatric disorders, even for those who committed serious crimes while ill.  Despite the availability, knowledge and resources of effective treatments, governments around the world continue to penalize the mentally ill whether they committed a crime or not.
              Most countries around the world carry puritanical ideologies regarding individuals who break the social contract of the culture that they find themselves. Even in countries that guarantee freedom from cruel and unusual punishment, conditions in prisons and jails lack basic structures to maintain the dignity and worth of the individuals housed there.  However, for individuals who are living with severe and persistent mental illness, they are often not only deprived of their civil rights, but their ability to connect to others as they are forced into isolation in solitary confinement despite evidence that this in fact worsens or creates mental illness.  The stigma of having mental illness and committing a crime are often compounded by racism, anti-gay, anti-transgender, and anti-poor sentiment.
             Social workers can utilize the strategies outlined by the World Health Organization to improve the lives of individuals living with mental illness as well as their families.  Regardless of the abundance of resources, each country has mental health systems in place that can be utilized and expanded to prevent the incidents that cause the incarceration of the mentally ill.  If in prison or jail, providing immediate, comprehensive, evidence based treatment in lieu of punishment would shorten the time an individual is locked up and save valuable tax dollars.  Providing adequate training for all staff on mental illness and treatment would reduce stigma and increase positive outcomes for prisoners.  Lastly, the WHO recommends that all legislation take a human rights perspective when directing legislative agendas for the mentally ill.
            The quote at the beginning of this post is taken from testimony from Dorothea Dix, a nurse and social reformer who sought to improve the lives of individuals living with mental illness from the squalor and penal environments that they lived.  More than 150 years since she spoke in the Massachusetts General Court, individuals around the world and here in America continue to live in the same conditions she sought to correct.  As social work professionals we can honor her memory to finish the fight she started so long ago.  Indeed, we must to stay true to our commitment to the dignity and worth of all peoples.

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