California Inmates Receive Mental Health Care While Locked in Cages

by Cara on December 28, 2010

in disability, human rights, law enforcement

Today, the LA Times reports on the state of mental health care in California state prisons. Namely, they report on an aspect of how that care is delivered, now that the courts have mandated that treatment be provided even to inmates in maximum-security prisons: with the patients locked inside individual cages. Yes, really.

Before group therapy begins for mentally ill maximum-security inmates at California prisons, five patients are led in handcuffs to individual metal cages about the size of a phone booth. Steel mesh and a plastic spit shield separate the patients from the therapist, who sits in front of the enclosures wearing a shank-proof vest.

When the lock clanks shut on the final cage — prison officials prefer to call them “therapeutic modules” — the therapist tries to build the foundation of any successful group: trust.

The horrifying irony is enough to make one break down and cry.

The level of dehumanization here is appalling. Ultimately, of course, prison is not generally incredibly different from being locked inside a cage — the cage is just a little bit bigger. And people’s mental health conditions don’t magically just disappear when they’re not in therapy; indeed, imprisonment often has a way of exacerbating such conditions. But a critical part of responsible and effective mental health services is precisely treating its subjects as human. Being treated as human is in fact something that many people with mental health conditions, especially those who also live with other marginalized identities, are not at all used to. To rob patients who are also inmates of that vital dignity and compassion is unconscionable.

Perhaps the saddest thing of all is that with prison inmates being so disproportionately low-income, and mental health services being so inaccessible to those without insurance (and even many with), these sessions are the only form of mental health care that many of these patients can ever hope to receive. And they’re getting it not only within the racist, classist, ableist, misogynistic, transphobic, homophobic context of prison, but also while literally locked inside cages.

For some inmates, the conditions get even worse:

At institutions where space is tight, the therapy modules have been arranged in the middle of inmate living quarters with multistory cell blocks towering overhead; their bored occupants are looking down, taunting.

“You go down for therapy and there are guys screaming and yelling at you from every floor,” said Jane Kahn, an attorney who represents inmates in the ongoing litigation. Aside from making the sessions difficult, exposure to other inmates obliterates the sense of confidentiality essential for worthwhile therapy, Kahn said.

With various experts quoted in the article arguing over the merits of the treatment, I certainly can’t claim to know whether or not receiving therapy under such conditions is better or worse than nothing at all. But I do know that even under the best case scenario, in which patients genuinely are receiving some benefits despite the many enormous problems with the system, “better than nothing” is no excuse for straight up dehumanization.

It’s also impossible to divorce this dehumanization from the racism and other prejudices inherent in the prison system, and negligent to ignore the connection. Those being locked in cages are disproportionately people of color. They’re disproportionately poor. They all have mental health conditions. They are, in other words, those who the U.S. has historically treated like animals in more way than one, and this is just a particularly egregious example of how that history continues into the present day.

Further while I agree that the therapists need to be kept safe from potential violence — though I’ll note that no one mentions concern over the safety of other patients — mental health care providers are the most vocal critics of these policies. One makes a particularly astute point:

Among Stewart’s concerns is the fact that some mentally ill inmates remain in disciplinary segregation units, receiving therapy in cages, until their parole dates arrive.

“So one day you’re so dangerous that you have to be in a cage and the person talking to you is sitting at a distance wearing a flak jacket, the next day you’re sitting on a bus,” said Stewart. “That’s scary.”

While the context of his words is not entirely clear (and it’s therefore possible that the implications are ableist), I do in fact also find the scenario to be scary. Putting people in cages one day and then expecting them to interact positively with their communities the next is unrealistic and frighteningly irresponsible. Telling people that they’re so dangerous they can’t be trusted in the vicinity of other human beings, and then immediately releasing them unrestricted amongst other human beings without consideration of the potential consequences for all involved is scary. Failing to prepare people for their release with humane treatment and increased trust and responsibility is unbelievably reckless and terrifying. Treating people like this specifically because they’re inmates and then attempting to justify it is scary.

Precisely which contortions people are willing to employ for the sake of justification are also scary:

Metzner also advised prison officials to refer to the enclosures as therapeutic modules, not cages. “The name is important, because if you call them cages, people inside might feel like animals and respond accordingly,” he said.

If you have not yet clicked through to the original article, please do so now. Before reading on, take a moment to look at the photograph of precisely what we’re referring to when we say “cages” and to assess for yourself just how little of an exaggeration the term is.

What immediately strikes me is the idea that if you don’t call them cages, those inside them will somehow not realize that they’re inside cages. If we just treat the dehumanization as normal, they won’t notice that they’re being dehumanized at all.

What strikes me secondly is that the concern seems to be over the patients potentially deciding to act like animals and make life difficult for the therapists and prison officials interacting with them. There’s little concern, as far as I can gather, of what impact being treated like an animal, feeling less than human, will have on the emotional and psychological well-being of those we see fit to put inside the “therapeutic modules.”

In part, though far from entirety, this problem traces back to the overcrowding of California state prisons I wrote about last month. The reason that the release of prisoners has been ordered is because of the appalling level of medical and mental health care, and the determination that conditions would not improve without a dramatically reduced population. It is sadly true that the release of prisoners will inevitably mean that some people who are in need of mental health care will be among the released, and therefore not receive services. And that’s wrong — as I argued in the last post, while prisoners most certainly should be released, failing to support them and provide them with needed resources is not only not ideal, it’s a societal failure.

But the fact that prisons got so overcrowded in the first place is a failure, too. The fact that some inmates are being provided with mental health care while locked in cages is a failure. We’re at the point of more failures than can be counted. And when we’re at the point of putting people with mental illnesses in cages in order to “treat” them, it’s well past time to look at them honestly and make really big changes.

via @sesmithwrites

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{ 3 comments }

1 numol December 30, 2010 at 4:52 pm

Love your take on this — the big picture perspective is so horrifying but you word it well, so at least there’s clarity.

Signal-boosted this post here:
http://numol.livejournal.com/14245.html

If you’re not okay with that, I’ll take it down.

2 Social Worker January 7, 2011 at 10:39 pm

I am, sadly, very aware of this treatment issue, having several friends working as therapists in the prison system.
Your comment about therapists and social workers being among the most vocal critics of the very policies they are forced to comply with is accurate.
They have cried while telling me about trying to provide ethical care under these conditions and questioning whether doing therapy this way benefits their clients, but afraid to leave as they are concerned about the next person who may not care as much as they do.
When they’ve attempted to address these and other non-therapeutic policies, they are told that maybe they don’t have the ability to work with “these people” rather than acknowledging that the system is fucked up.
Thank you, Cara, for writing this and shining a light on yet another example of how we so easily dehumanize groups of people.

3 denelian January 11, 2011 at 1:58 am

these are, presumably, people who will be [at some point] released.

so WHO THE HELL HAD THE BRIGHT IDEA OF TREATING THEM LIKE THIS? all this is going to do is make their reciedavism [sp] even WORSE – i just

i

jesus. how many of these guys are non-violent offenders? [i.e. smoking pot] how many are desperation-offenders [i.e. FIND MONEY OR DIE type scenarios] and how many are ACTUALLY violent offenders of a real sort?
because the things that become “violent offender” are sometimes assinine! [like the 18 yo having consensual sex with his 17 yo g/f, its now rape, which is violent, so this kid who did NOTHING WRONG is being put in a cage... in the meantime, men who ACTUALLY rape? are still walking free...]

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