Disability and Imprisonment

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onlinediscountanvils
Disability and Imprisonment

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onlinediscountanvils

[url=http://guelphpeak.org/vol51/2012/08/incarceration-and-institutionalizati... and Institutionalization: Disability and Imprisonment[/url] by AJ Withers

onlinediscountanvils

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Just to give you an idea about rates of disability in Canada: estimates of the number of federal prisoners who are considered to have psychiatric disabilities are as high as twenty five percent. HIV/AIDS transmission rates are ten times higher in prisons than in the general population with almost four percent of women and two percent of men being HIV positive. And, twenty to thirty percent of criminalized people are intellectually disabled. But, in addition to prisons, there are also institutions which hold primarily intellectually and psychiatrically disabled people against their will. But, this isn’t to erase the many physically disabled people who are forced into nursing homes or other involuntary institutions.

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Psychiatrized and intellectually disabled people are disproportionately incarcerated in the prison system today (and this is likely the case for physically disabled people but there is a lack of good research on this). This may well be the case for physical disability but there simply isn’t a lot of research about disability in Canadian prisons.

The primary reasons for over-representation are tri-fold:

1. systemic discrimination which leads to a lack of employment opportunities available and the inadequacy of income and other supports

2. the disablism in the judicial system which makes it difficult for disabled people to get adequate representation and a fair trial

3. the fact that many disabled people face greater barriers to getting parole so they are held in prison longer.

Now I want to talk a bit about what the experiences are for disabled people in prison. In doing this, I want to be clear that I think prison is a horrible and unjust experience for everyone and I am not minimizing that by highlighting disabled people’s experiences. And, please keep in mind when I talk about disabled people in prison that prison populations are disproportionately disabled and that these numbers are going to increase dramatically with Omnibus legislation that the Tories (Conservatives) are trying to implement.

There are a lot of ways that disabled people can be profoundly impacted by disablism in the prison system. Here are a few:

many disabled people will be put into medical or administrative segregation which can mean, among other things: no television, restricted phone access, no programming, no interaction with other people unless they are guards or occasionally, cell-mates, restricted yard access, restricted shower and laundry access, restricted or no library or book access.

Assistive devices will likely be taken away from people so if somebody needs a cane, wrist braces, back brace, etc. generally speaking they just won’t have access to them. Or if they require equipment like a sleep apnoea machine, they will not have access to it.

People can be put in a higher security stream to save money on accessibility. For example, if there are five blind prisoners, one in maximum security, one in medium security and three in minimum security, in order to offer programming to all of the prisoners, they would all be kept in maximum security. So, in this example, there are four prisoners who would have had more privilege who don’t, specifically because they are disabled In fact, the federal “Custody Rating Scale” and provincial “Level of Supervision Inventory” explicitly bases criteria for security streaming disability implying that disabled people are inherently dangerous.

Lack of attendant care – which may mean having to wait hours to go to the bathroom or not going at all.

Lack of language interpretation services, including ASL (American Sign Language)

prison doctors can overrule anything a doctor on the outside orders so accommodations or medical needs can simply be disregarded.

Medication is distributed arbitrarily. If the prison nurse does rounds three times a day, you get your medication three times a day even if you need it five times a day.

Sineed

Do you have a link for your statement about prison health care? This is a topic about which I am knowledgeable. 

Your stats are, unfortunately, correct. Many people are in prison who should not be, and one of the reasons for this is that psychiatric hospitals can turn patients away on the basis of having no more space, but jails can't do that.

But the last bit has some inaccuracies (off to work; must go).

 

onlinediscountanvils

Sineed wrote:
Do you have a link for your statement about prison health care?

 

Those quotes are from the link in post #1. I just put it in a separate post because of formatting. It's the text from AJ's talk, and doesn't include footnotes to source material.

Sineed

Yes; now I see it. This morning I didn't have time to read the link.

I can't speak to security issues but I can talk about health care in a general way.

AJ Withers wrote:
many disabled people will be put into medical or administrative segregation which can mean, among other things: no television, restricted phone access, no programming, no interaction with other people unless they are guards or occasionally, cell-mates, restricted yard access, restricted shower and laundry access, restricted or no library or book access.

Depends on the institution and the nature of the disability; there may be a medical wing where disabled inmates will stay and it's just like other ranges, same social interactions and access to whatever services.

AJ Withers wrote:
Assistive devices will likely be taken away from people so if somebody needs a cane, wrist braces, back brace, etc. generally speaking they just won’t have access to them. Or if they require equipment like a sleep apnoea machine, they will not have access to it.

CPAP (sleep apnea machines) are made available. Other things may be taken for security reasons ie if they have metal in them.

AJ Withers wrote:
People can be put in a higher security stream to save money on accessibility.

Uh, no. Also, it's extremely unusual for blind people to be incarcerated.

AJ Withers wrote:
Lack of attendant care – which may mean having to wait hours to go to the bathroom or not going at all.

Again, it's rather unusual for someone with this level of disability to be incarcerated.

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Lack of language interpretation services, including ASL (American Sign Language)

Not true, though they may have to send out for an interpreter.

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prison doctors can overrule anything a doctor on the outside orders so accommodations or medical needs can simply be disregarded.

This is true, but it isn't necessarily a bad thing. People who frequently end up in jail tend to receive fragmented or poor care in the community. Medical needs are not disregarded, but the jail dr may disagree with the judgement of an inmate's community physician, just as any drs may have differences of opinion.

Truth is, (and it's a rather sad truth), AIDS community clinics find that their patients do better when they are in jail: their viral load (the virus count) goes down, their CD4 (the affected T-cells) goes up, and their nutritional status improves because they are taking their meds and getting properly fed.

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Medication is distributed arbitrarily. If the prison nurse does rounds three times a day, you get your medication three times a day even if you need it five times a day.

In federal pens, this isn't true at all: inmates get 2 weeks' worth of medications at a time in punch cards. Provincial jails may be more like the above, though most meds for chronic disease only need to be given only once or twice a day. 

I deplore our Prime Minister's legislative efforts to increase incarceration. Putting more people in jail is crap social policy. That said, jail health care is run by the same physicians and nurses who work in hospitals or community clinics. As many people (like myself) who work with vulnerable people can say, jail health care saves lives. 

 

 

Corrections Canada officially estimates that 1/3 of incarcerated individuals live with severe mental health disabilities. The overwhelming majority of these I individuals live with concurrent severe mental health and severe addiction related disabilities.

Further the Drummond report documents that in Ontario there are more people in pretrial detention than those serving provincial sentences. Overwhelmingly individual who live with mental health and addictions do not qualify for bail because their records include many breach convictions. The breach convictions are at least "substantially" relateded to the cognitive and perceptual impairments that make remembering when to be where very difficult.

Considering the proportion of incarcerated individuals with severe mental health and addiction related disabilities, the lact of treatment while in custody and the lack of long term supports after discharged many individuals are discharged to the same life situations that gave rise to the original offence. Breaches of probations and new offences are almost predictable.

Corrections Canada officially estimates that 1/3 of incarcerated individuals live with severe mental health disabilities. The overwhelming majority of these I individuals live with concurrent severe mental health and severe addiction related disabilities.

Further the Drummond report documents that in Ontario there are more people in pretrial detention than those serving provincial sentences. Overwhelmingly individual who live with mental health and addictions do not qualify for bail because their records include many breach convictions. The breach convictions are at least "substantially" relateded to the cognitive and perceptual impairments that make remembering when to be where very difficult.

Considering the proportion of incarcerated individuals with severe mental health and addiction related disabilities, the lact of treatment while in custody and the lack of long term supports after discharged many individuals are discharged to the same life situations that gave rise to the original offence. Breaches of probations and new offences are almost predictable.

Sineed

People with mental illnesses do get treated in jail, often by the same psychiatrists they might see in the community. It's a myth that they are not treated.

Unlike psychiatric hospitals, jails cannot force treatment. Right now there is the Ashley Smith inquest going on, about the absolutely disgraceful treatment of a teenager in federal custody. I imagine (and hope) they are in lots of trouble for involuntarily medicating her, as they aren't allowed to do that.

With respect it isn't what I see everyday. I work in the mental health criminal law system in Toronto. A significant proportion of the clients I work with have significant difficulty accessing appropriate general health care. And mental health treatment specifically while in custody. Today an accused fell in a seizure in court. An ambulance was called. The guards at the detention centre did not believe that the disorder was real. After counsel called the detention medication was provided but not on the schedule given by his treating specialists. It was provided when it could be fitted into the corrections schedule. Today he collapsed in custody and was taken to hospital. I call detention centres every week trying to get treatment for my clients. We tried to sue corrections over this issue in Rhora v Ontario but lost. In most detention centres if my clients get mental health treatment it consists only of medication, usually celexa,

onlinediscountanvils

http://rabble.ca/blogs/bloggers/mandy-hiscocks/2012/05/bored-not-broken-...

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Medium security is not wheelchair accessible. If you have a mental health disability that has you processed differently, need to ask a lot of questions, have highs or lows, or just generally do not fit in to the 'good prisoner' model, well, you're shit out of luck too. Stay on maximum. You're 'hard to manage'.

Sineed

Is this the case?

Rhora versus Ontario

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He was taken to jail.  His family told the jail that he was sick and should be in a hospital, not a jail.  The jail put him in a psychiatric unit in a cell with two other inmates.  During the night, Rhora killed one of them.

Rhora was charged with first degree murder and after a trial he was found not criminally responsible by reason of mental disorder.  He was confined to a mental hospital for eight years and then released.

Here’s where it gets funny.  Rhora sued the police and the province for his ordeal.  How, you ask?

He claimed that the police and jail should have recognised that he was unstable and that, by failing to keep him in isolation, they were to blame for his murder of the inmate.  It was, therefore, their fault that he went through a criminal trial and spent eight years in confinement.  He sued for damages for having been in jail and the eight lost years at the mental hospital. Thankfully, the trial judge, after three and a half weeks of trial, dismissed the case.  The judge’s reasons are detailed and go through the law of negligence and the reasonable expectations of the jail staff in dealing with Rhora.  The judge found that there was no reason for the authorities to suspect that Rhora was going to be violent with anyone, let alone kill anyone. 

http://www.whitbylawyers.com/archives/criminal-law/rhora-v.-ontario-is-r...

Here's a link that supports the other side:

http://dir.groups.yahoo.com/group/stop-polabuse/message/17732

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Mr. Rhora’s family informed the police and HWDC of Mr. Rhora’s diagnosis and a number of other inmates complained that they did not feel safe in Mr. Rhora's presence. He was not moved into a separate cell and during a manic episode on April 1, 1991 he killed one of his cellmates. He was found not criminally responsible and spent approximately 8 years in various psychiatric facilities.

Surely mental health advocates don't want Corrections to assume that all mentally-ill inmates are violent and need to go into segregation. The vast majority of people with bipolar disorder are not violent. 

The problem with mentally-ill people who end up in jail is the difficulty in getting them stable when they go between jail and the community frequently. Complicating the picture, many mentally-ill people abuse drugs in the community; for instance, observational studies have found that 67% of people with bipolar disorder abuse drugs or alcohol or both. So the jail has to deal with people going through withdrawal on top of the psychiatric problems.

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I call detention centres every week trying to get treatment for my clients.

What would be really helpful is to get your clients' physicians to call or fax the jail with a complete list of medications and required treatments.

On Rhora all that is true and more. In essence the police were called because Mr. Rhora was in a psychotic crisis. In stead of taking him to the hospital the police arrested him. His family repeatedly told the police and the detention that he was off his medication and in a severe psychotic crisis. The crisis kept intensifying, including when his family were visiting. They spoke to everyone who would talk to them. they family was told that because it was evening there was only a nurse on duty and that because it was a weekend the facility cou
D not get a psychiatrist to the detention centre until monday.

He was screaming that someone was going to attack him. If my memory serves me at this point he had been in custody for over 18 hours.In this state they put him in a double bunk situation, which means that two prisoners are put in a cell designed for one person . His delusions escalated and he believed the other man was attacking him. He attacked and killed him. After the assault they finally took him to a psychiatric hospital and he was medicated. He was convicted, found NCR and served 8 years in Penatang. Remember the NCR....all this occurred while he was in custody and after the family repeatedly told many people about the issues.

Further doctors do not call jails because they do not know that a patient is in custody. Family doctors and treating psychiatrists do not keep daily tabs on people. the point is that neither jails not other detention facilities are obligated to call treating family doctors. The list is endless. It is also often reported in the Corrections Canada ombudsman's reports

Further in my experience Corrections' staff often replies that something bad happened because THEY were not told about medical issues. If someone is in their custody it is their fiduciary duty to provide the appropriate care.

Isn't that the essential point of the CURRENT ASHLEY INQUEST?

Sineed

[email protected] wrote:
Further in my experience Corrections' staff often replies that something bad happened because THEY were not told about medical issues.
  

That is all too often the case. Privacy legislation makes it extremely difficult to get medical information if the inmate refuses to divulge his/her doctor's name or contacts. If we had eHealth in Ontario, this would be a huge help for providing continuity of care.

If you have a psychotic person in front of you, there could be several possible causes, including a cocaine-induced psychosis, acute psychosis of schizophrenia, or bipolar psychotic mania. They all look the same. And in Corrections, medical personnel are forbidden from involuntarily medicating, so they can't treat someone who refuses care.

Part of the problem is that hospitals can refuse to take people because they are full, but jails can't do that.

 

Telephone calls to outside treating physicians by detention staff and listening to the individual would be a huge help.

Telephone calls to outside treating physicians by detention staff and listening to the individual would be a huge help.

Sineed

[email protected] wrote:
Telephone calls to outside treating physicians by detention staff and listening to the individual would be a huge help.

How do the jail health care staff find out who the outside treating physician is exactly, if the inmate doesn't or won't divulge it? There's no place to look up this information. It's not like you can google it.

Many will...maybe you could start with those?  It seems to me that there is always an excuse for doing very little.

Sineed

I think you are conflating corrections with medical care. The physicians and nurses who work in jails are the same ones that work in the community. They aren't special lazy-ass Corrections doctors and nurses.

Corrections health care saves lives. From my first post:

I wrote:
Truth is, (and it's a rather sad truth), AIDS community clinics find that their patients do better when they are in jail: their viral load (the virus count) goes down, their CD4 (the affected T-cells) goes up, and their nutritional status improves because they are taking their meds and getting properly fed.

Same is true for psychiatric patients, who get stabilized in jail and then destabilize when they are released because of lack of community support, which is the real problem here.

Activism needs to be directed towards the lack of community supports for many vulnerable people. That way you wouldn't have people deliberately committing crimes in order to get into jail, which is another sad reality to which many activists turn a blind eye.

Francesca Allan

Sineed wrote:

 Many people are in prison who should not be, and one of the reasons for this is that psychiatric hospitals can turn patients away on the basis of having no more space, but jails can't do that.

 

I think the average person would be better off in jail than in a psych hospital.  Psych wards are worse because the term is indefinite and you're easily subjected to forced drugging and forced electroshock.  

Sineed

Francesca Allan wrote:

Sineed wrote:

 Many people are in prison who should not be, and one of the reasons for this is that psychiatric hospitals can turn patients away on the basis of having no more space, but jails can't do that.

 

I think the average person would be better off in jail than in a psych hospital.  Psych wards are worse because the term is indefinite and you're easily subjected to forced drugging and forced electroshock.  

Hmm.....even though I'm the first to say that health care in prisons and jails is not as bad as purported, I don't think I agree. When mentally ill people wind up in jail, it reflects a failure of the health care system to look after the most vulnerable and sickest.

So nice to see you again, Francesca!

There's an interesting editorial in the March 5, 2013 issue of the Canadian Medical Association Journal, "Let Us Get Prison Health Care Out Of Jail," written by a physician who worked in the federal system. Unfortunately it's behind a subscriber firewall. If I remember, I might bring the issue home and summarize over here, if folks would like.

Francesca Allan

Sineed wrote:

Francesca Allan wrote:

I think the average person would be better off in jail than in a psych hospital.  Psych wards are worse because the term is indefinite and you're easily subjected to forced drugging and forced electroshock.  

Hmm.....even though I'm the first to say that health care in prisons and jails is not as bad as purported, I don't think I agree. When mentally ill people wind up in jail, it reflects a failure of the health care system to look after the most vulnerable and sickest.

But our mental health care system doesn't look after our most vulnerable and sickest.  All they do is drug you up to your eyeballs and make you agree that you're a defective.  If you accept your diagnosis and take the pills, you can get out a lot quicker.  

A few years ago, I was really struggling with bipolar disorder and had an unbelievable manic episode.  I got in a little trouble with the law (dialling 911 repeatedly, throwing a coffee cup at a psych nurse, generally being a nuisance) and was processed through the criminal justice system.  I wasn't in jail exactly but I did spend time in the remand centre and was transported back and forth to court in a police van.  Eventually, they realized I was really ill and sent me to a forensic psych hospital.  It was a nightmare.  I would have much preferred to stay in the remand centre.

Talking about all this reminds me though.  At the time of these crimes, I was out of my mind and everybody around me knew it. And when I went to court, I was still psychotic and incapable of instructing counsel.  I pled guilty to the charges and was given a suspended sentence which included a condition that I be under the care of a community treatment team.  I was very skeptical but they turned out to be a great bunch of people.  I still meet with their support workers a couple of times a week and see my doctor once a month or so.  It's completely voluntary now and I intend to participate as long as they'll have me.  They're reasonable and open to dialogue and helpful and supportive.  If I had care like this at the beginning of my troubles, my whole life could have turned out differently.

Anyway, I want to appeal my convictions.  I'm getting my life back together (finally!) and a lot of volunteer work and regular work requires a clean criminal record.  I consulted a criminal lawyer who thinks I certainly have a case but it would cost between $20K and $30K.  Good lord!  That's a down payment on a condo.

kropotkin1951

Our prisons are crammed with people who have fetal alcohol spectrum disorders (FASDs) because our justice system deals with them rather than our health care system.

Sineed

kropotkin1951 wrote:

Our prisons are crammed with people who have fetal alcohol spectrum disorders (FASDs) because our justice system deals with them rather than our health care system.

And FASD relates to a whole chain of societal failures, and disproportionately affects FN. People with FASD can be very difficult. They aren't just cognitively impaired; they have poor impulse control and are impatient with a low tolerance for frustration. I recall an FASD client at the methadone clinic where I used to work who would sometimes arrive at a busy time, and finding himself at the end of a long (fast-moving) line, would react angrily, shouting obscenities at the inconvenience of not being served his methadone instantly. I knew what his problem was, and would try and talk him down, but the other patients didn't know, and he often got into fights. At the clinic where he is currently taking his methadone, his physician actually got his permission to divulge his condition to the other patients so that when he acts up, they say, "Oh that's just John; he can't help it." 

Francesca, thanks for sharing, and I'd like your opinion on Harper's proposed reforms to the legislation governing verdicts of Not Criminally Responsible, where people found NCR will be incarcerated in forensic units longer. Harper has been bolstering the case for his reforms by citing rare, high-profile and shocking cases, as if people were being beheaded and cannibalized on Greyhounds every other week, when the fact is that people found NCR tend to re-offend at lower rates than those found guilty and sent to jail.