Last summer, for an elective class I was taking, I wrote a paper discussing whether a seriously mentally ill inmate can give informed consent for treatment. I know what you are thinking and the answer is yes, I am talking about this again. If you think about the three elements involved in granting informed consent – disclosure, understanding and voluntary consent – the prospect of a seriously mentally ill prisoner granting such seems bleak. To satisfy the disclosure aspect, a doctor must tell his patients  all material information about their treatment – possible side effects, alternative treatments, the whole lot. In a prison setting where cost efficiency is paramount, my guess is treatment options are incredibly limited — “if you want to get better, this is the pill that you can take.” The doctors are placed in an impossible conflict between the needs of the institution that they work for and the patients that they see. Understanding of their diagnosis and implications of treatment may be hard to come by as well when an inmate only begins receiving treatment after they have decompensated. As for voluntary consent, well…. In the case Washington v Harper, the US Supreme Court ruled that states could forcibly medicate their seriously mentally ill prisoners if the the medical practitioners on staff could demonstrate that the prisoner is a threat to themselves or others (Just FYI, outside the prison walls a judge is the only person who can rule a person incompetent and pave the way for forcible medication).  In a prison setting, one can imagine how easy it would be to determine that a prisoner is a threat to themselves and others. Disorder legitimately poses a threat to correctional officers and other inmates; being orderly in the midst of psychotic break is pretty unlikely.

Ya know, when I wrote that paper, I put a lot of thought into the logistics of informed consent, into the rights an inmate should have and how those rights were being violated but what I didn’t really think about was why an inmate might not want to be compliant with their medication.  A speaker in a different elective class that I am taking this semester provided some valuable insight on the topic. While I was aware that many seriously mentally ill individuals stop taking their medication because of side effects and a dulling of their senses, I hadn’t really thought about what those side effects could mean in a prison setting. Being over-medicated or numbed by a course of treatment while in the general population of a prison is not safe. I become then a target for predators, someone who is easily taken advantage of. I become vulnerable to sexual assault and other violent attacks.  A person might refuse their medication in that environment to survive; the symptoms of one’s mental illness may be a defense for them, perhaps a badly needed one.

While my liberal social worker self feels compelled to side with the prisoners in this debate, I absolutely see the other side of it. Having a seriously mentally ill inmate suffering from psychotic breaks or paranoid delusions who is refusing medication among the general population in a prison is a serious problem. It poses threats to the order of the correctional facility, to the staff and to the other prisoners. Its not hard to see why sometimes force needs to be used to maintain control. I do not at all believe the answer to this problem is to allow these inmates to refuse medication and decompensate. That solution isn’t good for anyone not the seriously ill inmates or the staff.  I believe the answer is to stop these individuals from entering the prison system at all. The answer is more community services, more alternative sentences, more acknowledgement of the underlying causes of crime and the creation of more programs to address such. The solution to me is an obvious one but the way that solution comes to fruition, I do not know. What I do know though is that every solution starts with acknowledging the problem. It starts with advocates; It starts with me and you and whoever else we can get ( preferably some people with access to funding. As much as I hate to admit it, money, we are for sure also going to need that…)