Yale Department of Internal Medicine的动态

The current system often ends up institutionalizing individuals within prisons, which can be counterproductive. Community-based teams could offer tailored support and resources, addressing the root causes of criminal behavior, such as mental health issues, substance abuse, and socio-economic challenges. These interventions can help prevent vulnerable individuals from entering the criminal justice system, promoting rehabilitation and integration into society. For these specialized community-based teams to be effective, they would need tailored training to handle various challenges, including behavioral health crises, substance use, and social support. Ongoing support for staff is crucial to prevent burnout and ensure their well-being, which in turn enhances the quality of care and support they provide to individuals within our communities. There's significant work needed at the state level to create a more humane and effective system. Priorities should include: Establishing regular communication channels between the criminal justice system and behavioral health agencies ensures that individuals receive the appropriate care. Allocating resources to initiatives that divert individuals from jail to appropriate community-based services can reduce recidivism and provide better outcomes. Co-Responder Model of pairing first responders with behavioral health professionals to address mental health crises more effectively on the scene. Establishing courts focused on mental health and substance abuse can ensure that individuals receive the treatment they need rather than punitive measures. Creating affordable housing options is critical to providing stability for individuals. Expanding Medicaid in states without it would increase access to healthcare for low-income individuals, including mental health and substance abuse treatment, reducing the burden on the criminal justice system. Investing in these areas can create a compassionate and effective system supports the well-being of individuals and communities. Implementing these strategies fosters a more integrated approach and a more efficient use of resources.

While this article is two years old, the problem it addresses cannot be talked about enough. We have reduced mental health treatment opportunities, especially inpatient treatment for the most acute mental illness, by significant numbers. Due to this, fewer of our neighbors and loved ones are able to access mental health care for what ails them. This often leads to higher rates of interaction with law enforcement and incarceration. Hospitals and behavioral health treatment centers are the places to help people experiencing mental illness, not jails and prisons. In fact, jails and prisons often make the problem worse. Efforts continue to be made to reduce incarceration and punishment for those experiencing mental health issues but instituting programs and facilities that can help did not occur before these efforts so instead of jails or prisons, people end up on the street. We can and must do better. We need to reexamine why we abandoned robust hospital facilities for those with mental illness and what it looks like to rebuild those systems in ways hat meet modern best practices.

May is Mental Health Awareness Month! Did you know? According to the National Alliance on Mental Illness (NAMI), about 2 in 5 individuals in prisons and jails have a history of mental illness. That's twice the prevalence compared to the general adult population! However, regrettably, many correctional facilities in America have neglected to provide sufficient healthcare for incarcerated individuals. Despite court mandates, there's a significant lack of access to proper mental health treatment in incarcerated settings. Shockingly, around 63% of those with a history of mental illness don't receive the care they need while incarcerated in state and federal prisons. Even more concerning, over 50% of individuals who were on medication for mental health conditions before admission don't continue their treatment once in prison. This lack of care not only affects individuals' well-being but also poses challenges in their interactions within the facility. Behaviors stemming from untreated symptoms can lead to harsh consequences like solitary confinement, exacerbating the cycle. It's crucial that individuals with mental illness in correctional facilities have access to appropriate care, including screenings, regular access to mental health providers, and support programs. NAMI, as part of a Consensus Workgroup on Behavioral Health Issues in the Criminal Legal System, is actively advocating for change within prisons. To learn more about their recommendations for Congress and the Administration and how you can support their efforts, check out the link below! ?? https://lnkd.in/efYuA_X3 #MentalHealthAwarenessMonth #EndTheStigma #SupportRecovery

This week, along with five other human rights organizations, we petitioned the High Court, urging the Israel Prison Service and Ministry of Health to follow standard medical procedures to control the scabies outbreak in prisons. Reports indicate that hundreds of incarcerated individuals have been infected in recent months. - Since October 2023, the IPS has imposed severe restrictions on its Palestinian population. Incarcerated Palestinians are limited to one item of clothing, prohibited from purchasing hygiene products, have restricted access to showers, and are deprived of laundry facilities. Additionally, suspending family visits has eliminated the option of receiving clean clothes and linens from visitors. - Access to prison medical clinics is blocked, and requests for medical care are often ignored. Additionally, physicians are not conducting rounds to examine incarcerated individuals and are neglecting the regular monitoring that was previously part of established procedures. The surge in the Israeli prisons’ security wings' population—from 16,353 on October 6, 2023, to over 21,000 by June 2024—has contributed to the spread of the infestation. - Moreover, deteriorating incarceration conditions and disruptions in hygiene practices have obstructed efforts to manage the outbreak, resulting in profound suffering for hundreds of incarcerated individuals and a severe infringement of their health rights. - The IPS must take immediate action to treat all infected individuals and those in close contact with them. This includes providing clean clothing and bedding, disinfecting cells and personal belongings, separating infected individuals from the general population, ensuring access to frequent showers, making hygiene products available, and allowing regular washing and disinfection of clothing.

Better health in prisons brings progress to countries? Mental health disorders are the most prevalent health condition in prisons across the WHO European Region. But that’s not the only threat for people in prisons. In fact, they are far more vulnerable in the face of numerous health risks – from cancer and cardiovascular diseases to drug use and injuries. Countries can change that. By investing in improved healthcare for incarcerated individuals, policymakers can create a ripple effect of progress and positive change, impacting everything from human rights to national economies. As an example, here are the three Sustainable Development Goals (SDGs) that will be affected by better health systems in prisons: ?SDG 3: Good Health and Well-being Better physical and mental health of incarcerated individuals strengthens public health overall and leads to less noncommunicable diseases cases and premature deaths. ?SDG 10: Reduced inequalities Improved health services in detention facilities helps to reduce inequalities and bring down social barriers. Investing in quality health care and health-promoting ecosystems in prisons that include alcohol and drug-free environments, along with the promotion of physical activity can improve mental health ?SDG 16: Peace, Justice and Strong Institutions Including detention facilities in national health care systems will support social reintegration and create more stable and prosperous communities To learn more, you can follow the WHO/Europe conference on health in detention facilities online. Streaming links available here: https://lnkd.in/duD_w2Jw

https://lnkd.in/gdx3nDN4 "Unfortunately, MAT is the least common treatment in prisons: only 1% of people with substance use disorders in state and federal prisons reported receiving MAT at any point since their admission. In North Carolina, for example, over 9,000 people admitted to state prisons in Fiscal Year 2021-22 (78% of everyone screened during intake) met the criteria for needing intermediate or long-term substance use treatment, but the clinical director of the Alcoholism and Chemical Dependency Programs reports that they are only able to treat 3,000 cases each year. The state launched a MAT pilot program in 2021, and as of January 2024, only 213 enrollees have received medications prior to release from prison. Even when correctional facilities do offer necessary treatments, their one-size-fits-all approaches can be limiting, overlooking the specific needs of different populations. For example, women in prison are often expected to participate in treatment programs originally designed for men. Advocates report that because “there are fewer incarcerated women than men… there are fewer programs available for women serving time. If support is available, it is not always effective.”

The Urgent Need to Make Medications for Opioid Use Disorder Universally Available in Jails and Prisons—and to Fund It. The evidence is clear: medications for opioid use disorder (MOUD) save lives, particularly when offered to individuals who are incarcerated. Research over the past decade has shown a dramatic reduction in opioid-related deaths when MOUD are available in correctional settings. Rhode Island’s Department of Corrections (DOC) MAT program, for example, led to a remarkable 60% decrease in opioid-related fatalities among those recently incarcerated in its first year, while a study in England demonstrated an 85% reduction in opioid deaths when these medications were accessible in prison. However, access to these treatments remains alarmingly limited. Only about 45% of U.S. jails offer MOUD, and within those facilities, just 12% of incarcerated individuals can access all three FDA-approved medications. The impact is particularly severe for Black Americans, who face disproportionately high rates of opioid overdose death. This group is also more likely to be arrested and incarcerated for drug-related offenses, despite having rates of substance use and drug selling comparable to white individuals. These disparities are deeply rooted in systemic racism, which leads to higher rates of incarceration, restricted access to essential care upon reentry, and, consequently, a devastating growth in overdose deaths. Studies have shown that access to MOUD not only reduces overdose deaths and recidivism but also leads to greater treatment engagement and pro-social outcomes post-release. We have both an ethical and public health imperative to close this treatment gap. MOUD programs in correctional settings are supported by major health organizations, including NIH, SAMHSA, NIDA, ASAM, the National Commission on Correctional Health Care, and the National Sheriffs' Association. Yet, both funding and stigma remain significant barriers, preventing these life-saving programs from reaching their full potential. Addressing this issue head-on is essential to reducing the widening racial disparities in opioid-related deaths across the United States. Let’s advocate to make MOUD programs a universal standard in jails and prisons and to secure the funding necessary to support and sustain them. #OpioidCrisis #HealthEquity #EndOverdose #MATinCorrections #AddictionRecovery #MOUD #PublicHealth

America’s Forgotten Tragedy: Preventable Deaths in Mass Incarceration On September 11, 2001, nearly 3,000 people lost their lives in an act of terrorism that shook our nation and the world. We honor and remember the victims, the heroes, and their families on this solemn day. But while we reflect on this tragedy, there’s another devastating loss of life happening quietly, year after year, within America’s mass incarceration system. Each year, thousands of people die behind bars, often from preventable causes, while trapped in a machine that holds 25% of the world’s prisoners—even though we make up only 5% of the global population. For example, in 2019, 3,853 deaths were recorded in U.S. state prisons alone. This staggering figure does not include the additional deaths in federal prisons or local jails, where conditions are often worse. When you include those, the number of preventable deaths swells even higher. These deaths aren’t just from illness or old age. Many are from medical neglect, suicide, and violence, all of which are often preventable with better oversight, healthcare, and humane policies. To put it in perspective, the mortality rate in state prisons in 2018 was 344 deaths per 100,000 incarcerated people, significantly higher than the general population. Moreover, in 2018, 1 in 6 prison deaths was ruled as “unnatural,” including suicides, homicides, and drug overdoses—deaths that could have been prevented with proper intervention. Yet, despite these shocking numbers, the country largely ignores these deaths. Society assumes these incarcerated individuals “deserve” their fate. But when you consider that many are there due to excessive sentencing, wrongful convictions, or non-violent offenses, the question arises: How many 9/11-equivalent tragedies do we allow to happen every year, in the shadows of our prison system? America needs to wake up to this silent crisis. These are human lives being lost to a broken system. We must demand accountability and reform, ensuring that no one—incarcerated or free—is left to suffer preventable death in a system built on indifference.

It was an honor to participate in the Eighth Annual Alaska Medication Assisted Treatment (MAT) Conference, which was held virtually from September 10-12, 2024. This year’s theme, “Weaving Support: Elevating MAT through Community Collaboration,” highlighted the important role of community partnerships to increase access and enhance the effectiveness of MAT. Opioid use disorder (OUD) is a chronic treatable illness and disability that is best treated in the community. Nevertheless, there is a high prevalence of OUD among people in prisons, jails, and detention centers, and thus correctional facilities have important roles to play in ensuring appropriate treatment for people with this chronic illness (Bronson et al., 2017). Scientific evidence has firmly established that medications to treat opioid use disorder (MOUD) save lives (National Academies of Sciences, Engineering, and Medicine [National Academies], 2019). By providing access to MOUD and behavioral treatment based on national standards, prisons, jails, and detention facilities can reduce deaths, improve long-term health outcomes, interrupt the cycle of recidivism (National Academies, 2019), and minimize litigation. Continuity of care is essential, and every individual being released must have at minimum medication management and counseling services available to improve outcomes.

Criminalization Of People With Mental Illness Where We Stand NAMI believes in minimizing justice system response to people with mental illness, while ensuring that any interactions preserve health, well-being and dignity. NAMI opposes laws and public policies that perpetuate the criminalization of people with mental illness. Why We Care People with mental illness are overrepresented in our nation’s jails and prisons. About 2 million times each year, people with serious mental illness are booked into jails. Nearly 2 in 5 people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails). Many people with mental illness who are incarcerated are held for committing non-violent, minor offenses related to the symptoms of untreated illness (disorderly conduct, loitering, trespassing, disturbing the peace) or for offenses like shoplifting and petty theft. Many factors have contributed to the criminalization of people with mental illness, including: Policies, such as “zero tolerance” policing, nuisance laws and mandatory sentences for drug offenses Assumptions that people with mental illness are violent The lack of a robust mental health crisis response infrastructure Jails and prisons have become America’s de-facto mental health facilities. However, they are not built, financed or structured to provide adequate mental health services. Only 3 in 5 people (63%) with a history of mental illness receive mental health treatment while incarcerated in state and federal prisons, and less than half of people (45%) with a history of mental illness receive mental health treatment while held in local jails. Public policies should invest in solutions that are evidence-based and help people with mental illness get on a path of recovery. For example, instead of charging people who are experiencing homelessness with crimes, we support policies that address the underlying need, such as providing supportive housing programs.