Friday, August 8, 2014

Questioning Seclusion, Isolation and Solitary Confinement

Transgender individuals who are sent to prisons are punished in ways too ugly for us to imagine. Simple criminal offenses do not give the right to any facility to sexually abuse, isolate or terrorize someone in any way. Our criminal justice system is supposed to mean responsible rehabilitation, but I doubt that happens as we would wish. Instead, through force of brutality, whether by guards or inmates, they come out more damaged than when they went in. Haven't we done a wonderful job here? Shouldn't we pat ourselves on the back for breaking the spirit, if not the souls, of those individuals? Ask yourself how you reacted to the recent news about the culture of violence against young inmates at one of New York City's jails, Rikers Island. Did you read about it? What did you do?

Today, the question of transgender inmates came to the fore and it was no better than anyone could imagine. Because of their special status, they are put into a form of housing that makes brutality even more possible. How do we protect someone when they are in isolation for 23 hours a day and guards act as though they were their personal play things? True, being a prison guard can bring out the worst in some individuals especially if the guards' culture is a festering pool of ignorance and violence. Who should be locked up here?

On Rikers, the guards acted with impunity, seemingly, because there was no one to believe the inmates and no one to hold guards accountable for their crimes. What's going to be done now? I'm a firm believer in unions, but I hope their union doesn't jump to protect the brutes who abused the inmates because that's what unions sometimes do. As a matter of fact, I was once an elected union official, so I am not to be sluffed off as a no-nothing do-gooder.

Jails aren't the only place, however, where evil is permitted free rein. Psychiatric hospitals and any facility that enjoys a more-than-modest measure of freedom from prying eyes can be prime hot spots, too.  Have you ever had a fear of being admitted to a psychiatric facility? The portrayals we've seen in the media and films (think "The Snake Pit" or even "Cuckoo's Nest" or "Titicut Follies") and you get the idea quickly. Does it happen anymore? I think it very well might, but let me tell you something I heard about. Didn't happen within the past few years, but the individuals involved are probably still in their positions of authority because it pays so well and they do so little work.

A young man in a psychiatric hospital went to the ward staff in great distress. He said he was being raped nightly by another male patient on the unit. Did they believe him? Not really, but it was reported and they had to do something because someone made a chart notes and those are reviewed by JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and that means funding, friends. When money is involved, action takes place.

The in-house patient advocate didn't seem capable of marshaling an adequate defense for this young man, but an outside advocate did just that. She was a member of a group appointed by her state to monitor care of patients in these facilities and she wanted a review. Prior to the review, ward staff handled the matter by providing the man with a powerful sleep-inducing medication each evening and locking him in a seclusion room. The room had little more than a thin foam mattress on the floor, but at least he felt safe. But how do you justify putting a patient in seclusion each night? You really can't do it without a review by a psychiatrist.

The team met and the outside advocate was there, the facility's medical director, responsible ward staff and the unit psychiatrist and the ward physician. The chart was reviewed and the ward physician was instructed by the medical director to do a physical examination of the young man to determine if he was being raped. Notes were taken and everyone left. Did the ward physician do the exam? I never heard he did. What happened to the young man? He was probably shifted to another unit where it was possible he'd experience the same type of look-the-other-way staff behavior.

Seclusion, as I've seen, is at the whim of whoever is in charge and it's a rather simple matter for staff to precipitate an incident, if they are so inclined. I would think this happens in jails, nursing homes and juvenile detention facilities, too. Push a patient or an inmate far enough, know what their "buttons" are and you get what you want; punishment for them.  Nursing homes that wanted to dump problem patients would not give them their psychiatric meds. Result? They acted out and were transferred to a psychiatric hospital. When it came time to return them to the nursing home, the home refused to take them. Result? One more psychiatric patient, one less in the nursing home.

So, don't just look at prisons. Look at every facility where anyone is housed either temporarily or permanently and hold everyone accountable for their actions. I was once warned by a head nurse that if I were to report something, I could expect that my car would be keyed or worse. I've heard of staff loosening the lug nuts on someone's car or flattening all four tires. It's criminal behavior and it's done by hospital staff. No, let's not just say "hospital staff" because I'm sure it happens at other facilities, too.

All of us need to be aware of the problems and the possible remedies and hold everyone accountable for their actions.