Last year in December it was reported that fourteen lives in Mississippi were lost because of the lack of available and efficient mental health treatment centers. According to Mississippi Today, an article written by Isabelle Taft and Mollie Simon called 'Jailed for their own safety, 14 Mississippians died awaiting Mental Health Treatment' stated that "jailing people with no criminal charges during the civil commitment process is common in Mississippi because many county officials see no other option when publicly funded mental health facilities are unavailable".
“They failed to act”.
The one thing that stuck out the most in this article was that there are policies, protocols, and procedures to follow that did not impact the lives of the individuals it intended to serve and protect. "Before most of the nine suicides, staff didn’t take some basic steps to prevent people from killing themselves, according to those experts and nationally accepted guidelines. And when people going through the commitment process exhibited serious medical issues, jail staff didn’t get them the help they needed, experts said after reviewing the circumstances of those deaths drawn from a Mississippi Bureau of Investigation report, depositions, and records filed in court. The staff didn’t review medical histories. They interpreted signs of medical distress as manifestations of mental illness or the influence of drugs or alcohol. They failed to act". How could jail staff house these individuals without reviewing their medical history? Why weren’t the policies, protocols, and standard procedures followed?
The Complexities of Mental Health
It is easy to blame the victim, especially when they are dismissed, judged, and condemned by traumas- past and current- that cause them to participate in intentional patterns of self-harm. We aren't excusing anyone from this table of suffering. This is an invitation to providers, supporters, and advocates to put on the lens of compassionate justice. Compassionate justice must be paired with keen urgency to gain insight into what has been easily overlooked, and uncomfortably accepted. It's truly heartbreaking to reflect on the struggles that lead to such tragic outcomes. Mental illness, addiction, and suicide are complex issues that often intertwine, making it difficult to pinpoint a single cause. It's important to recognize that these individuals often face immense internal battles, and societal stigma can exacerbate their struggles. Instead of placing blame, we should focus on understanding and supporting those in need. Regret can be a powerful emotion, but it also serves as a reminder of the importance of compassion and proactive intervention.
Protected Persons
Where there is a will, there is always a way. There are still significant challenges despite the progress being made to create access to adequate health care. Taft and Simon daringly took a further step at pointing the finger at institutions and the standards they created to ensure the protection of these individuals- who’re a protected class- but still failed to keep. According to LegalMatch.com, “a “protected class” refers to people shielded against discrimination under federal, state, or local laws. In the United States, federal anti-discrimination laws, like the Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the Americans with Disabilities Act, enumerate certain characteristics that constitute protected classes”. These institutions not only "failed to act", but failed to protect individuals who suffer from severe mental health issues. "Medical care and suicide prevention measures fell short of national standards. Staff didn’t take some basic steps to prevent [the death]" of these individuals. Who creates standards for protocol and procedure for nothing they plan on upkeeping? If that’s what is happening, then one would only be participating as far as they are required to obtain a pass with state, and federal guidelines, but in the long run, those who suffer are those it was supposed to serve.
Despite "exhibited serious medical issues, jail staff didn’t get them the help they needed, experts said after reviewing the circumstances of those deaths drawn from a Mississippi Bureau of Investigation report, depositions, and records filed in court. The staff didn’t review medical histories. They interpreted signs of medical distress as manifestations of mental illness or the influence of drugs or alcohol". Are these providers, and so many others, incompetent? Do they require more training and understanding? Do they need more funding to create intentional, effective, and efficient treatment centers? Do we need another mental health summit? Or do we hold institutions accountable?
Accountability of Inhumane Medical Care
Taft and Simon brought up another serious matter about the accountability of protected persons, their best interests being underserved or not met at all, and how easy it is for such powerful institutions to not be held accountable or responsible. "When someone dies in jail awaiting treatment, litigation is the primary way families can try to hold officials accountable. Yet none of the nine lawsuits filed over deaths since 2006 have resulted in a court ruling that held county or jail officials responsible. Four were settled. One is ongoing. The rest were dismissed or lost at trial". Taft and Simon took it further by explaining how institutions aren't held accountable because it is hard to prove that the standards created to protect these protected persons, and the staff employed to uphold them, aren't the only reason these lives were lost. "Legal experts say such suits rarely succeed, in part because it’s so hard to prove that jail medical care was so bad that it violated someone’s constitutional rights". They can’t be serious with that statement because there are dead people because of the incompetent medical care in those jails. How aren't the staff, and the protocols that were unjustly administered not the reason for the death of these individuals who required a specific treatment plan outside of the inadequate spaces they were being kept at in slow hopes the appropriate treatment centers should have been created space? Even the "Correctional health care experts said Mississippi’s practice of jailing people solely because they’re mentally ill or addicted to drugs or alcohol has caused deaths that could have been prevented". Despite the law [failing] to meet a legal standard" and taking the warning of jail administrators "doesn’t mean there isn’t a problem".
Barriers, Incompetency, and Problems
Many federal prisons face severe staffing shortages. These shortages directly impact the quality and access of medical care, and security provided to inmates. This lack of staff often leads to delays in medical treatment, increased costs, and even compromises the safety and security of the facilities. Additionally, insufficient training and inadequate assessment tools further exacerbate these issues, making it difficult to ensure the well-being of inmates who require essential medical care. Addressing these problems requires strategic recruitment, better compensation, and comprehensive training programs to improve the competency and availability of medical staff in jails. According to a report from the Department of Justice Office of the Inspector General (OIG) provides an inspection of the Federal Correctional Institution (FCI) Sheridan in Oregon. It covers various aspects such as staffing challenges, safety and security, inmate healthcare, and programming. It showed that despite increases in budget, augmentation, and over time, they are significantly limited and challenged in providing standard protection, treatment, and supervision. For example, a shortage of staff creates an unstable and unsafe environment for inmates and officers. “Most significantly, we found that, due to Correctional Officer shortages, institution management is not always able to fill all Correctional Officer posts, which has caused inmates to be minimally supervised or, in certain instances, not supervised at all. This condition creates a number of safety and security risks, including the risks of inmate self-harm; violence toward employees or other inmates; and other illicit activities, including the introduction and use of illegal drugs” (pg. 4). Augmentation- whether it is mandated or voluntary overtime- has officers working unusual hours, which creates burn-out. The report stated, “ FCI Sheridan employees performed more than 88,400 hours of work covering Correctional Officer posts—equivalent to approximately 43 full-time positions—from November 2022 to November 2023” (pg. 4). At the time FCI Sheridan’s Correctional Services Department was understaffed. “At the time of our inspection, 117 of 145 Correctional Services Department positions had been filled, which amounts to 28 vacancies” (pg. 5).
"Correctional Officers conducted less than half of the required twice-hourly rounds"
The report stated that understaffed institutions “create safety concerns” because it affects the mental health of staff. For example, “FCI Sheridan employees [reported] that excessive mandated overtime has left them exhausted. As a result, we believe that they may become less observant when conducting inmate-monitoring rounds….[it was] found that Correctional Officers conducted less than half of the required twice-hourly rounds in three housing units between 9:30 p.m. and 6 a.m….The issue of little or no inmate supervision is not limited to the MSP. In fact, we learned that on certain evenings the sole employee assigned to supervise the Camp may need to respond to the MSP or FDC in the event of an emergency. When this happens, Camp inmates are left unsupervised” (pg. 5). Employees reported that this practice happens regularly. The report shows how severe and extreme the effects of staff shortage are on the inmates who require assistance. Out of 27 positions in the health service department, 9 are vacant; out of 16 positions for drug abuse programs, only 5 are filled; the correctional services has 117 positions filled but 28 vacant and overall 290 positions are filled and 67 aren’t. Many mental health issues are associated with trauma and can be onset by drug use. Without full departments filled with competent staff in these institutions to provide individualized care and not just standard, how can we measure whether resources are being used effectively, efficiently, and intentionally? It can be inferred that the set of protocols, and procedures will not be met alone with incompetency, understaffing, systemic injustice, and cowardice. Nor can it be fixed alone with finances, resources, overtime, augmentation, and intentional blindness.
"Many staff...aren't in the best positions to administer care".
One "former Quitman County jail administrator testified that he didn’t know about any policies". Many staff that come in contact with people with serious mental health issues and substance disorders aren't in the best positions to administer care. Some of the policies practiced put individuals in the way of harm instead of safety. "David Fathi, an attorney who has worked on litigation over jail and prison conditions for more than 25 years and now serves as director of the ACLU’s National Prison Project, reviewed suicide prevention policies that were in effect at five Mississippi jails where several people died by suicide. Some, he said, were “among the worst policies I’ve ever seen.” One policy said staff could turn off the water in a cell to reduce the risk of self-harm — a practice Fathi said has resulted in deaths by dehydration of people with mental illness".
"Even with people dying in their facility, they still made no effort to enforce their standards of care".
There is a lack of concern for individuals facing deeper underlying issues. For example, there was a young man named Raymond who had a co-occurring disorder "For nearly three years after Raymond died without being screened, staff still did not conduct screenings for medical or psychiatric issues, according to depositions. Jail policy had required such screenings for years, but employees, including the former jail administrator, didn’t know that, according to depositions. It even went as far as to state that he wasn't monitored because his issue didn't "stem from a suicide attempt". I know I am not the only one asking how this happened. Even with people dying in their facility, they still made no effort to enforce their standards of care, or question staff as to why standards weren't implemented. And to further incite an attempt to look closer at requirements for monitoring individuals who have a history of mental health issues and to screen inmates for possible mental health issues. According to a report by the Department of Justice Office of the Inspector General (OIG) about issues surrounding inmate's deaths found the following conclusions:
"Suicide Represents a Significant Risk Area for the BOP (Bureau of Prisons), Which the BOP (Bureau of Prisons) Can Help Mitigate through Compliance with Existing Policies.
- Recurring policy violations and operational failures contributed to inmate suicides, which accounted for just over half of the 344 inmate deaths we reviewed.
- Identified deficiencies in staff completion of inmate assessments, which prevented some institutions from adequately addressing inmate suicide risks.
- Inappropriate Mental Health Care Level assignments for some inmates who later died by suicide.
- More than half of the inmates who died by suicide were single-celled, or housed in a cell alone, which increases inmate suicide risk.
- Institution staff failed to coordinate efforts across departments to provide necessary treatment or follow-up with inmates in distress and staff did not sufficiently conduct required rounds or counts in over a third of the inmate suicides in our scope.
- Finally, the BOP was unable to provide evidence that most of its facilities completed required mock suicide drills to prepare staff to respond to potential suicides.
- We found significant shortcomings in BOP staff’s emergency responses to nearly half of the inmate deaths we reviewed.
- These shortcomings ranged from a lack of urgency in responding, failure to bring or use appropriate emergency equipment, unclear radio communications, and issues with naloxone administration in opioid overdose cases.
- We found that the BOP was unable to produce documents required by its own policies in the event of an inmate death for many of the inmate 2 deaths we reviewed.
- We also found that the BOP requires in-depth After Action Reviews only following inmate suicides but not for inmate homicides or deaths resulting from accidents and unknown factors. The BOP’s ability to fully understand the circumstances that led to inmate deaths and to identify steps that may help prevent future deaths is therefore limited.
- Further, we found that, even when the BOP obtains insights on contributing factors and recommendations for improvement following an inmate’s death, the impact of that information is curtailed by the decentralization of the BOP’s processes.
- We found that contraband drugs or weapons contributed, or appeared to contribute, to nearly one-third of the inmate deaths in our scope, including 70 inmates who died from drug overdoses.
- In addition, one or more other longstanding operational challenges―staffing shortages; an outdated security camera system;
- staff failure to follow BOP policies and procedures;
- and an ineffective, untimely staff disciplinary process―were contributing factors in many of the inmate deaths in our scope.
These challenges continue to present a significant and critical threat to the BOP’s safe and humane management of the inmates in its care and custody”.
The Challenges of Mental Health
People with mental health and substance disorders face a hard time navigating life. Difficulties in navigating life will even be seen in trying to navigate serving a sentence behind bars. This is why it is serious to not only have standards on paper but to have intentions of enforcing the implementation of these practices. According to an organization called National Alliance on Mental Illness (NAMI) wrote an article called "Mental Health Treatment While Incarcerated" which stated that "People with mental illness who are incarcerated deserve access to appropriate mental health treatment, including screening, regular and timely access to mental health providers, and access to medications and programs that support recovery".
"People with mental illness deserve help, not handcuffs"
Taft and Simon provided depth into the reason why those victims were isolated in spaces of incarceration despite the barrier to accessing required mental health treatment. In situations like this, it is important to treat the problem, not treat the individual as the problem. NAMI took a strong stance that imprisonment is never the answer. "People with mental illness deserve help, not handcuffs. Yet people with mental illness are overrepresented in our nation’s jails and prisons. About two in five people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails). This is twice the prevalence of mental illness within the overall adult population. Given these rates, America’s jails and prisons have become de-facto mental health providers, at great cost to the well-being of people with mental health conditions".
"more than 50% of individuals who were taking medication for mental health conditions at admission did not continue to receive their medication once in prison”
Taft, Simon, and NAMI went in-depth again to assure the public that these required standards aren't being implemented, and the lifelong effects imposed on the individuals. "Despite court mandates, there is a significant lack of access to adequate mental health care in incarcerated settings. About three in five people (63%) with a history of mental illness do not receive mental health treatment while incarcerated in state and federal prisons. It is also challenging for people to remain on treatment regimens once incarcerated. In fact, more than 50% of individuals who were taking medication for mental health conditions at admission did not continue to receive their medication once in prison”. So how are institutions and administrators not held accountable when taking a person into their care? Shouldn't that mean that they are directly responsible for the upkeep of the incarcerated individual?
Incarceration or Treatment
Most importantly, if clients weren't found to have committed a crime but were kept in confinement because there weren't available beds for the treatment required, what are the standards for that? And if law enforcement can arrest and hold mental health clients who didn't commit a crime, but may be a danger to themselves or others what are the standards to be followed? And if law enforcement take it upon themselves to house mental health clients, would that also mean they are responsible for providing standard and adequate care to individuals suffering from mental health? If individuals suffering from mental health and substance disorders are mishandled intentionally, this warrants a broader discussion into the practices of all individuals being incarcerated. These institutions are responsible for holding up the standards of keeping prisoners imprisoned. So why are at least 50 percent of individuals who require medication not "receiving their medication once in prison"? Some challenges come with mental health illness and depriving individuals of their basic human rights and access to adequate care isn’t therapeutic to those facing trauma; it is the exact opposite.
Trace the Money, Pack the Jails
Is it possible that providing adequate health care would jeopardize the ability of jails and prisons to remain filled? A study by the National Institute of Corrections (NIC) called "The Growth of Incarceration in the United States: Exploring Causes and Consequences" points the finger at the structure of institutions and the power to control the dynamics of institutional racism as "the United States has gone far past the point where the numbers of people in prison can be justified by social benefits and have reached a level where these high rates of incarceration themselves constitute a source of injustice and social harm". The study states that "After decades of stability from the 1920s to the early 1970s, the rate of imprisonment in the United States more than quadrupled during the last four decades. The U.S. penal population of 2.2 million adults is by far the largest in the world. Just under one-quarter of the world's prisoners are held in American prisons. The U.S. rate of incarceration, with nearly 1 out of every 100 adults in prison or jail, is 5 to 10 times higher than the rates in Western Europe and other democracies. The U.S. prison population is largely drawn from the most disadvantaged part of the nation's population: mostly men under age 40, disproportionately minority, and poorly educated. Prisoners often carry additional deficits of drug and alcohol addictions, mental and physical illnesses, and lack of work preparation or experience".
Men of Color
It has been said to be a belief that all the good black men are most likely in jail. In fact, according to an article written by Defender called "New Study: Young Black Men Are Serving Longest Prison Sentences", states that "Not surprisingly, black men were serving the longest sentences. The Urban Institute released its report Wednesday and used inmate data from 44 states. In 35 of the 44 states included in the study, black men accounted for the majority of the prison population serving the longest sentences". These sentences not only affect the person behind bars but essentially, their loved ones are serving the sentence with them. The effects of incarceration on the family members are excruciating and long-lasting. NIC stated that there are long-lasting "consequences for families and children; consequences for communities; wider consequences for U.S. society; the prison in society-values and principles; findings, conclusions, and implications".
At times, as we can see, the cost of losing a life provides provisions for the livelihood of others. Where can we begin to address what makes life whole versus what life could never be? Who is in charge of defining these things but isn’t held accountable? It is hard to keep your emotional lights enflamed in hard times. It is hard when you lose someone you care deeply for to such extreme measures of disregard.
In memory of your loved one, please visit healthywealthythoughts and purchase our candle. Always remember to ground yourself to focus on what you desire to manifest.
Until then, keep your thoughts healthy and wealthy.
Sources:
- Taft, Isabelle, and Isabelle Taft. “Jailed for Their Own Safety, 14 Mississippians Died Awaiting Mental Health Treatment.” Mississippi Today, 8 Dec. 2023, mississippitoday.org/2023/12/07/jailed-for-their-own-safety-14-mississippians-died-awaiting-mental-health-treatment.
- Mental Health Treatment While Incarcerated | NAMI: National Alliance on Mental Illness. www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Treatment-While-Incarcerated.
- The Growth of Incarceration in the United States: Exploring Causes and Consequences | National Institute of Corrections. nicic.gov/resources/nic-library/all-library-items/growth-incarceration-united-states-exploring-causes-and.
- LegalMatch. "What Is a Protected Class under Federal Law?" LegalMatch, www.legalmatch.com/law-library/article/protected-classes-under-anti-discrimination-laws.html. Accessed 15 July 2024.
- Office of the Inspector General. (2024). *Report title*. U.S. Department of Justice. https://oig.justice.gov/sites/default/files/reports/24-070.pdf
- Office of the Inspector General, U.S. Department of Justice. (2024, February 15). *Report on inmate deaths in federal prisons*. https://oig.justice.gov/sites/default/files/2024-02/02-15-2024_0.pdf