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Statement of Policy
America’s prisons and large city jails are now its largest mental
hospitals.1 It is axiomatic that NMHA supports effective, accessible
mental health treatment for all people in correctional facilities who need
it.
But the issue is more complex, and includes an effective classification
system to protect vulnerable prisoners and effective protection of
the human rights of prisoners with mental illness. Notwithstanding their
loss
of their liberty, prisoners with mental illness retain all other
rights, and these must be zealously defended.
Background
The NMHA has a policy on juvenile justice2 that includes the most important
considerations for all prisoners who need mental health treatment.
The material that follows tracks the juvenile justice policy.
Prisoners
with mental illness are especially vulnerable to the difficult
and sometimes deplorable conditions that prevail in jails, prisons
and other correctional facilities. Overcrowding often contributes
to inadequacy of mental health services and to ineffective classification
and separation
of prisoner classes. It can both increase vulnerability and exacerbate
mental illness. A correctional facility is a very bad place to put
a person
with mental illness, and NMHA is on record in favor of maximum reasonable
diversion.3 But more and more, America is locking up people with mental
illness.
NMHA believes that placing prisoners with mental illness
in institutions, especially correctional facilities, imposes special
obligations on
society. Jails, prisons and other correctional facilities have a
duty to provide
medical services, including mental health services, and to provide
protection from harm. These services are basic human rights of every
prisoner with
mental illness. Correctional facilities are properly expected to
exercise special vigilance in dealing with every prisoner with mental
illness because
his or her ability to assert these human rights may be impaired.
NMHA believes that these treatment obligations are greater than the
treatment rights
currently enforced by the courts as a matter of American constitutional
law.
Delivery of mental health services to prisoners in correctional
facilities is the responsibility of all professionals at a facility,
including psychiatrists, psychologists, social workers, nurses, correctional
counselors, correctional
officers, and facility administrators. NMHA believes that correctional
facilities must be sufficiently staffed with mental health professionals,
and that such professionals have special obligations to:
- advocate to correct conditions which interfere with or are
inconsistent with basic human rights;
- advocate to improve mental health services and to oppose malpractice;
- train all personnel about the signs of mental and emotional problems
and basic mental health principles; and
- oppose discriminatory treatment based on race, religion, gender,
ethnic background, mental health condition, or sexual orientation.
NMHA commits itself to protecting the human rights of people with mental
illness who are incarcerated in the criminal justice
system. This includes their rights under the U.S. Constitution,
as currently
recognized by the courts, but goes beyond. NMHA will defend the
human
rights to adequate
medical and mental health care, to protection from harm including
staff abuse, and to a facility in which the vulnerable can be
protected. If the
most vulnerable cannot be protected, they should not be confined.
NMHA and its affiliates should work to inform members of law enforcement
and correctional groups, judges and attorneys, mental
health professionals
and advocates, prisoners and their families, the community and
the media about the rights of prisoners with mental illness and
the way
in which
local and state governments are responding to the need or failing
in their duty.
NMHA also commits itself to identifying and addressing
the forces that contribute to the disproportionately high involvement
of persons from ethnic and racial minority communities in the criminal
justice
system. A system that incarcerates so many so differentially
as ours is inherently
unjust.
Treatment During Confinement
When prisoners in need of mental health treatment must be confined
in correctional facilities, certain principles should be observed:
- All prisoners should be screened upon admission by trained
personnel for mental health and substance abuse problems. When
the screening
detects possible mental health problems, prisoners should be
referred for further
evaluation, assessment and treatment by mental health professionals.
Prisoners who are already receiving treatment before they enter
should be assisted
in continuing treatment. All prisoners who are not released
within one week should have behavioral, mental health and substance
abuse evaluations completed by qualified mental health staff
by such date.
- Prisoners who suffer from acute mental disorders
or who are actively suicidal should be placed in or transferred
to appropriate medical
or mental health units or facilities and returned to general
population only with
medical clearance. Correctional facilities that do not employ
mental health staff should have written arrangements with local
medical or mental health
facilities for providing emergency medical and mental health
care.
- Mental health services should be available to prisoners
24 hours per day, seven days per week. Treatment should be
provided in an
atmosphere of empathy and respect for the dignity of the person.
It should be strengths-based
and recovery-oriented. A reasonable array of mental health
interventions
should be available, including the full range of available
medications. The type of intervention should be tailored to
meet the prisoner’s
needs, with family consultation unless the prisoner rejects
it, and should be delivered by qualified mental health staff
who are trained to deal with
crises as they arrive. When medications are used, they should
be consistent with the treatment plan and monitored by a qualified
mental
health professional.
- Special treatment should be available
to prisoners who are sexually abused, who have substance abuse
problems, health
problems, educational
problems, histories of family abuse or violence, and who are
sex offenders. Programming in facilities should be appropriate
to the person’s age,
gender and culture. Linguistically and culturally appropriate
therapy should be provided. Under no circumstances should a
prisoner be penalized
for
seeking or receiving or declining mental health treatment.
- Correctional facilities should train staff to use behavior management
techniques that minimize the use of intrusive, restrictive,
and punitive
control measures. Facilities should have written guidelines
for the use of seclusion, room confinement, and restraints.
These guidelines should be made clear to persons in custody.
Distinctions should
be
made between
the use of seclusion and restraints for custodial-administrative
purposes and those made for therapeutic purposes. When restraint
must be
used to
prevent injury to self or others, there should be stringent
procedural
safeguards, limitations on time, periodic reviews and documentation.
Generally, these techniques should be used only in response
to extreme threats to
life or safety and after other less restrictive control techniques
have been tried and failed.
- Under no circumstances should
prisoners be the subjects for medical research without proper ethical
review and informed
consent.
- Prisoners should have a discharge plan prepared
when they enter the correctional facility in order to integrate
them back into the family and the community. This plan should be
updated in consultation
with the
prisoner’s family (as appropriate) and community treatment
facilities before the prisoner leaves. It should include the
continuation of treatment, therapy and services begun in the
facility. Correctional
facilities should
take an active role in promoting continuity of treatment for
those released.
- Facilities should take extra precautions
to assure against suicide by prisoners living through mental
illness. Facilities
should have
a suicide prevention plan that includes appropriate admission
screening, staff training
and certification, assessment by qualified mental health professionals,
adequate monitoring, referral to appropriate mental health
providers or facilities, and procedures for notification of
the prisoner’s
family (unless refused).
- Facilities need to identify and
treat co-occurring disorders, and particularly substance abuse,
and to provide support in
the facility and in the transition to the community.
Specific
Rights
NMHA affirms the specific rights of people with mental illness
confined in correctional facilities listed here because they
have the most
potential to be abridged in correctional settings:
- The right to adequate medical and mental health care, to protection
from harm including staff abuse, and to a facility in which
the vulnerable can be protected: a safe, sanitary and humane environment
- The right to informed consent to treatment. Staff should discuss
with the prisoner the nature, purpose, risks, and benefits
of types of mental health treatment.
- The qualified right to refuse treatment, including psychotropic medications,
on the same basis as any other person. 4
- The right to the least restrictive environment and the
least intrusive response to an apparent need for mental health
services.
- The right to be confined in a place that can provide the treatment
needed.
- The right to confidentiality in the delivery of mental health services
and in mental health and related facility records.
- The right to have regular and timely access to medical and mental
health staff who are culturally competent and qualified to
provide adequate treatment and supervision.
- The right to be transferred to an appropriate medical or mental health
facility or unit when conditions warrant. .
- The right to be free from corporal punishment, chemical restraints,
and sexual abuse or coercion.
- The right to assert grievances, to have grievances considered in
a fair, timely and impartial manner, and to exercise rights
without reprisal.
-
The right to an individualized written treatment plan, to the treatment
specified in the plan, to periodic review and revision of the plan based
on the prisoner’s needs. The family should participate in
the development, review, reassessment and revision of both
the treatment plan and
the discharge plan, unless the prisoner refuses such participation.
| Effective Period
This policy was adopted by the NMHA Board of Directors on.
It will remain in effect for a period of five (5) years and
is reviewed as required by the NMHA Public Policy Committee.
Expiration:
March 12, 2009 |
National Mental Health Association
2000 North Beauregard Street, 6th Floor
Alexandria, VA 22311
1. United States
Department of Justice, “Mental Health and Treatment of Inmates
and Probationers” (1999).
2. NMHA Policy
Number 37, “ Children With Emotional Disorders in the Juvenile Justice
System” (2000).
3. NMHA
Policy Number 50, “In Support of Maximum Diversion of Persons
with Serious Mental Illness from the Criminal Justice System” (2003)
4. Washington v. Harper, 494 U.S. 210, 110 S. Ct. 1028, 108 L. Ed. 2d 178 (1990).
In the Washington case, a unanimous Supreme Court held that doctors in Washington's
corrections system could administer anti-psychotic medicine to a non-consenting
prisoner. The decision required the state to show, in a post-medication administrative
hearing, that the prisoner was dangerous to himself or others as a result of
serious mental illness and that the treatment was in the prisoner’s best
medical interest. |