Addressing the Social Determinants of Health: Health Care and Criminal Justice: Issues and Solutions


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Sally, a surgery resident-physician called her psychiatrist colleague and stated, “Ron, I finally got it. I finally understand what you do and how important and essential it is. People should not be sent to jail for some minor misdemeanor, much less if they are already suffering from a mental illness; this is far too traumatizing.” 

Ron works as a clinician supervisor, at an agency that provides health services for individuals involved in the criminal justice system, while they are in the community instead of being in jail. After listening to his friend, Sally, he said, jokingly, “Sally, are you a new convert? Is this the result of a head trauma?” Sally, laughed, yet immediately started crying and said, “Ron, I had a dream, a terrible one.

I dreamt I was ordered by a judge to go to Rikers and stay there for an entire weekend for something totally stupid. In the dream, I started thinking to myself, “I am in residency training, I am supposed to be on call this weekend, and I have a husband and a newborn. What will happen with all this? Then I thought about my arrival to jail and how you often tell me about the fights and abuse that take place there. How would I react? How would I protect myself? Would I stay inside my cell until my release? Would I be allowed to do that? If I did, would they not say I am psychotic or depressed and then force me to be seen by mental health? 

All these things went through my head during the dream, and I said to myself that I have to write a letter to the judge, asking her to reconsider my case and plead, because my whole life would never be the same again, if I spent this weekend at Rikers. I then woke up, frightened, and frankly had a hard time going back to sleep.”

 

Ron’s response to Sally:

Ron supported Sally, attempted to find some humor in all this, and with a more serious tone, he took the opportunity to remind her that:

 
Health Care and Criminal Justice: Issues and Solutions
 

“In 2013, the US Bureau of Justice reported a total of 2,223,000 individuals in prison and jail, many of them poor and with a mental illness, and for every felony offense, 10 are a misdemeanor,  small offenses like disorderly conduct, or loitering. As clinicians and social work service workers, we are supposed to be social justice advocates. One of the best ways we can serve our patients is by promoting the need to keep them out of jail, while making sure they receive proper support in the community, addressing the social determinants of health and decreasing the likelihood that they will be trapped in this broken justice system.”

 

The story of Kalief Browder:

Health Care and Criminal Justice: Issues and Solutions

Ron continued the conversation with Sally and told her the story of Kalief Browder, who spent three years at Rikers Island without being convicted of a crime. He was only 16 years old and was falsely accused of stealing a backpack. His time at Riker’s included solitary confinement, abuse from officers and other incarcerated individuals, and several suicide attempts, which continued after his release from Rikers, leading to his demise, at age 21, survived by his mother. The night before Kalief committed suicide, he told his mother, “Ma, I can’t take it anymore.” He was referring to his intrusive thoughts about his tragic experiences at Rikers, which everyone there is subjected to.

 

The system needs repair:

Prior to the false robbery accusation, Kalief had also pled guilty to a grand larceny charge, after accused of driving and then crashing a truck. He pled guilty because, “I figured I had no defense.” He was then placed on probation, which he was still on at the time when he was falsely accused of stealing the backpack. He was held in on bail of three thousand dollars, which his family could not afford. Kalief’s family was also unable to afford a lawyer and a public defender was assigned, who perhaps was handling a hundred other cases. 

The longer you stay in jail, the more likely you will be subjected to trauma, the more difficulty reentry will become and the more likely it is to reoffend and continue this dreadful cycle. 

Health Care and Criminal Justice: Issues and Solutions
Health Care and Criminal Justice: Issues and Solutions
Health Care and Criminal Justice: Issues and Solutions
Health Care and Criminal Justice: Issues and Solutions

It takes a village; we all need to help address those social determinants of health, while working on holding all stakeholders accountable. Something has to change, and healthcare can be at the forefront of this improvement.


For more in this series of articles, check below!


SWEET Institute- Mardoche Sidor, MD

Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, coaching, and management, experience. Some of his passions are public speaking, leadership, entrepreneurship, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past-Medical Director for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.


References:

  1. Butterfield, F: Prisons replace hospitals for the nation's mentally ill. The New York Times, Vol CXL VII, March 1998.
  2. Lamb, RH, Weinberger, LE: Persons with severe mental illness in jails and prisons: A review. Psychiatric Services 49(4):483-492, 1998.
  3. Health Care Reform for Americans with Severe Mental Illness: Report of the National Advisory Mental Health Council. American Journal of Psychiatry 150(10):1447-1465, 1993.
  4. Correctional Populations in the United States: Bureau of Justice Statistics, U.S. Department of Justice, NCJ 192929, 1998.
  5. Deane, MW, Steadman, HJ, Borum, R, et al: Emerging partnerships between mental health and law enforcement. Psychiatric Services 50(1):99-101, 1999.