Listen: Supporting Michigan’s Agricultural Community

No Easy Answers in Bioethics Episode 23

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This episode focuses on work being done in Michigan to support the well-being of farmers, agribusiness professionals, and the broader statewide agricultural community. Dr. Karen Kelly-Blake, assistant director and associate professor in the Center for Ethics and Humanities in the Life Sciences, is joined by Community Behavioral Health Extension Educator Eric Karbowski, and Dr. Melissa Millerick-May, who holds appointments in the Division of Occupational and Environmental Medicine, Environmental Health & Safety, and Michigan State University Extension. Mr. Karbowski shares MSU Extension resources available to farmers experiencing stress, including webinars, teletherapy, and other programs that help to reduce stigma still associated with behavioral health. Dr. Millerick-May discusses her ongoing work on farm safety, including tools developed in response to the COVID-19 pandemic. Both guests also discuss what led them to the work they are currently doing at MSU.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Center faculty and their collaborators discuss their ongoing work and research across many areas of bioethics. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

Bioethics for Breakfast: Mental Health Care Access: Making the Dollars and “Common Sense” Case for Parity

Bioethics for Breakfast Seminars in Medicine, Law and Society

Malkia Newman, Anti-Stigma Team Supervisor at CNS Healthcare, and Dr. Debra A. Pinals of MDHHS and the University of Michigan presented at the Feb. 25 Bioethics for Breakfast session, offering perspectives and insight on the topic “Mental Health Care Access: Making the Dollars and “Common Sense” Case for Parity.” Bioethics for Breakfast is generously sponsored by Hall, Render, Killian, Heath & Lyman.

People with mental health disabilities face disproportionately high rates of poverty, housing and employment discrimination, and criminalization. The upheaval caused by the coronavirus outbreak has exacerbated these disparities for those disabled prior to the crisis, while exposing more people to trauma, loss, and uncertainty. Considering mental health care from a justice and equity perspective, this session examined the following: 1) What social and ethical challenges are embedded in the current mental health epidemic? 2) How might such challenges be effectively addressed? 3) What community-based models can improve access? 4) What are the cost benefits of equitable treatment vs. cost of untreated mental healthcare in the U.S.?

Malkia Newman addressed the first question above on the social and ethical challenges embedded in the current mental health epidemic. Through sharing her personal life story, Ms. Newman focused on trauma, stigma, and disparities in behavioral healthcare. Ms. Newman defined types of trauma, focusing on inter-generational trauma. She noted that racism and social inequities are now regarded by many as a health crisis, especially in light of the COVID-19 pandemic. Stigma that individuals face can include many layers, and that stigma can exacerbate mental health and substance use disorders. With regard to mental health disparities, she shared that access to mental health care is only one piece—quality treatment, addressing the shortage of qualified providers, and the need for equitable funding of treatment for all individuals is also crucial. Many in the U.S. are facing financial insecurity, which can also exacerbate mental illness and be a barrier to accessing treatment. Bringing forth the idea of resilience, Ms. Newman ended by sharing her hope for the future, that “resilience can spring forth, and resilience can be taught.”

Dr. Debra A. Pinals provided a physician and policymaker perspective, first addressing the question: why is mental health relegated to second tier status in healthcare financing? There is a long history of viewing mental illness, including substance use disorders, as not being “real” illness—blame, stigma, and stereotypes still play a part in this attitude. Stigma “allows the discrimination of someone based on a label.” However, it is very important to understand that these are illnesses that have causes and treatments. COVID-19 may be putting more focus on mental health, and that may be one positive thing to come from the pandemic. What community-based models can improve access? Dr. Pinals discussed the problems with the current crisis system and the involvement of law enforcement when responding to a crisis, and then put forth a new model that would involve a behavioral health response, specially-trained law enforcement as a backup, and many other pieces related to community services and supports. Referencing her paper on crisis services, Dr. Pinals shared that improving access has to be accessible, interconnected, effective, and just. Dr. Pinals also discussed building out Certified Community Behavioral Health Clinics (CCBHCs) in Michigan, and the siloed nature of current services. Dr. Pinals emphasized the need to understand the existing disparities in mental health services, also discussing the prison system, the opioid epidemic, and child welfare impacts.

During the discussion portion, both speakers discussed the need to make space for people’s stories, particularly within the context of policy work. Ms. Newman shared the importance of including both behavioral health professionals and individuals with mental illness during the planning process for policies and programs, such that their input is actively included. Further discussion touched on teletherapy access and programs for youth and families.

Related Resources

About the Speakers

Malkia Newman
Malkia Newman is Anti-Stigma Team Supervisor at CNS Healthcare. Behavioral health conditions are common in Malkia’s family. Suicidal, unemployed, and homeless, Malkia accessed care at CNS Healthcare in 2004. Once stabilized, she was able to pursue a job with the CNS Healthcare Anti-Stigma Program in 2005. The Peer-Led program challenges stigma and provides community education on a number of different behavioral health topics. Using poetry, singing and other creative expressions, Malkia shows that “hope and recovery is possible.” The program has reached over 100,000 people in Detroit, Lansing, Marquette, MI; Washington, D.C., New York City, Houston, San Antonio, Las Vegas, Chicago, Phoenix, Honolulu, Hawaii, and Nova Scotia, Canada.

Debra A. Pinals, MD
Debra A. Pinals, MD, is the Medical Director of Behavioral Health and Forensic Programs for the Michigan Department of Health and Human Services, Director of the Program in Psychiatry, Law, & Ethics, Clinical Professor of Psychiatry at the University of Michigan Medical School, and Clinical Adjunct Professor at the University of Michigan Law School. Dr. Pinals’ roles have included serving as the Assistant Commissioner of Forensic Services as well as the Interim State Medical Director for the Massachusetts Department of Mental Health. She has worked in outpatient and inpatient settings, forensic and correctional facilities, emergency rooms and court clinics, has received public service awards, and has been an expert witness in many cases. She is Board Certified in Psychiatry, Forensic Psychiatry, and Addiction Medicine.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.

Philosophy, Mental Illness, and Mass Shootings

This post is a part of our Bioethics in the News seriesBioethics in the News logo

By Robyn Bluhm, PhD

Over the past month, mass shootings have occurred in Gilroy, CA, in Chicago, in El Paso, and in Dayton. Most recently, the FBI has arrested a man in Las Vegas who had been planning a shooting spree. It’s common, after such a shooting occurs, to speculate about the mental health of the shooter. In a way, this is understandable: we cannot help but feel that anyone who could do such a thing is not mentally well. We can’t imagine what it would be like to be someone who is capable of meticulously planning and carrying out a mass killing like the one in Charleston, or Parkland, or Sandy Hook, or Pittsburgh, or Las Vegas, or so very many other places in the United States.

It’s true that some of the people who have become mass shooters have been diagnosed with a serious mental illness. But there are many reasons to reject the narrative of the mentally ill mass shooter. For one thing, it does not really fit the facts: the relationship between mental illness and mass shootings is murky at best. For another, it does a grave disservice to people who have a mental illness. As Devan Stahl has shown, associating mass shooting with mental illness stigmatizes people living with mental health conditions, who already face significant stigma.

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Image description: multiple rifle-style gun are shown laying on a green surface. Image source: Phanatic/Flickr Creative Commons

Mental illness stigma is a complex phenomenon reflecting multiple beliefs. Research has shown that people tend to view those with mental illness as dangerous and unpredictable. Biological explanations of mental illness, in particular, can lead people to think that those with mental illness are fundamentally different from those who do not have such a diagnosis. Again, these beliefs are not supported by data. But they do provide people with the comforting sense that there is an explanation for mass shootings. Notably, it’s an “internal” explanation that focuses on the shooter himself, rather than on broader social and policy issues relevant to the phenomenon. And for some, that fact, too, is comforting.

How philosophy can help us think about mass shootings and mental illness

But, I think, there is another way of thinking about the link between mental illnesses and mass shootings that may actually be helpful. Rather than focusing on whether individual mass shooters (or the majority of mass shooters) are mentally ill, we can think about the similarity between mass shootings and (some) kinds of mental illness. The philosopher Ian Hacking has written about the phenomena of transient mental illness, by which he means: “an illness that appears at a time, in a place, and later fades away. It may spread from place to place and reappear from time to time. It may be selective for social class or gender, preferring poor women or rich men. I do not mean that it comes and goes in this or that patient, but that this type of madness exists only at certain times and places.”

Two aspects of his analysis may be useful here. First, he draws an analogy between these conditions and the concept of an ecological niche, which provides a place in which a species can thrive, whereas other places do not allow it to live at all.

Second, he emphasizes that categories of human beings are different from other categories: a tiger, for example, does not care whether we classify her as a tiger, whereas human beings often care deeply about how we are categorized. Because of this, categories of human beings are prone to what Hacking calls “looping effects.” He means that people and the categories into which they put them interact with and change each other. Once a category is “out there” in the world, people may come to identify with it and behave accordingly. During the 1980s, for example, mental health professionals began to see increasing numbers of people with multiple personality disorder, in part as a result of numerous books, televisions shows, and media stories that described this phenomenon. But groups of people also behave in ways that change the characteristics associated with a category. Over time, people who were diagnosed with multiple personality disorder began to exhibit more, and more differentiated, personalities.

Hacking’s analysis is useful even if we don’t think that “being a mass shooter” is a form of mental illness. (It’s also worth noting that even those who think that mass shootings are caused by mental illness don’t think that “being a mass shooter” is a kind of mental illness.) In fact, multiple personality disorder is not recognized as an illness by mental health professionals. Instead, what matters is that it was a recognizable way to behave, or, in Hacking’s words, to be a person – and also that it came into being in a particular kind of social context that, somehow, fostered this way of being a person.

Thinking about mass shootings in Hacking’s terms may help us to understand them. For one thing, mass shooters occupy a very specific niche: they exist almost uniquely in the United States during the past few decades. Appeals to mental illness as a cause can’t explain this fact. Moreover, mass shootings tend to follow a pattern – now that the category exists, members of the group tend to behave according to its rules. But (and this is the other half of the looping effect), we should also be alert to ways that the rules of the category may be changing over time. Recent mass shootings, for example, have been linked to white supremacy. It also seems to be becoming more common for mass shooters to leave a manifesto.

Perhaps most importantly, Hacking gives us a way to think about preventing mass shootings. Blaming mass shootings on mental illness implies that we can do nothing about them, especially if we view people who have a mental illness as essentially different from those who don’t have one. If men who become mass shooters do so in a very particular niche, then the way forward is to destroy the niche which lets them thrive.

Robyn Bluhm photoRobyn Bluhm, PhD, is an Associate Professor with a joint appointment in the Department of Philosophy and Lyman Briggs College. She is a co-editor of The Bloomsbury Companion to Philosophy of Psychiatry.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, August 29, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

More Bioethics in the News from Dr. Bluhm: “Ask your doctor” – or just check Instagram?Antibiotics: No Clear CourseTo Floss or Not to Floss? That’s not the question

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Mass Shootings, Mental Illness and Stigma

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Devan Stahl, PhD

Over the past two months, we have witnessed two more mass shootings in Las Vegas and Sutherland Springs, TX. Once again, these incidents bring up the debates surrounding gun legislation and access to mental health care. In reference to the Texas shooting, President Trump commented, “This is a mental health problem at the highest level. It’s a very, very sad event.” Soon after, it was revealed that Devin Kelley, the Texas shooter, had briefly escaped from a mental hospital in 2012 after he made death threats against his superiors in the Air Force. Both the president and the media emphasized the connection between mental illness and mass shootings. In fact, Johns Hopkins University found that over one-third of all news stories about mental illness were connected to violence. Psychiatric journals are also more likely to publish articles connecting mental illness with aggression than mental illness and victimhood, even though persons with mental illness are ten times more likely to be victims of violent crimes, including police shootings. It is no wonder that 63% of Americans blame mass shootings on the failure of the mental health system.

When confronted with a mass shooting, it is hard not to assume that mass shooters are mentally ill. After all, what sane person could commit such a horrible act? The media and even psychiatric professionals are quick to look for associations between mental illness and mass shootings. After Adam Lanza took the lives of twenty children and six adults at Sandy Hook Elementary School, new research on the brains of mass shooters began. More recently, the brain of Stephen Paddock, who killed 59 people in Las Vegas, was shipped to the Las Vegas coroner’s office for a neuropathological examination to look for any “mental aberrance” to explain his behavior, even though neuropathologists admit correlating brain structures with behavior is “cloudy business.”

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Image description: a cardboard sign is tied to a tree, with lettering that reads “stop gun violence :(” in blue and red. Image source: Tony Webster/Flickr Creative Commons.

Research shows us, however, that the link between gun violence and mental illness is far more complicated than it would appear. In general, it is hard to generalize about mass shooters because they are relatively rare. Although there is some evidence to show persons with severe or untreated mental illness might be at increased risk for violence when experiencing psychotic episodes or between psychiatric hospitalizations, many of these studies have been heavily critiqued for overstating connections between serious mental illness and violence. On aggregate, there is not a strong connection between mental illness and gun violence.

Close to 18% (43.4 million) of adults in the U.S. have some form of mental illness, which is on par with other countries, yet Americans are ten times more likely to die from guns than other citizens in high-income countries. The American Psychiatric Association found that around 4% of violent crimes perpetrated in America are attributable to mental illness and only 1% of discharged psychiatric patients commit violence against strangers using a gun. Persons with mental illness are less likely than those without a mental illness to use a gun to commit a crime. The vast majority of people with severe mental illness, including schizophrenia, bipolar disorder, and severe depression are no more likely than any other person to be violent. There is simply no clear causal link between mental illness and gun violence.

On the other hand, research shows that there are much stronger predictors of individual gun violence than mental illness, including: alcohol and drug abuse, domestic violence, past or pending violent misdemeanor convictions or charges, and history of childhood abuse.

There are a number of problems with associating mass shootings with mental illness. First, it stigmatizes millions of people living with mental health conditions. Research shows that negative attitudes surrounding mental illness prevent people from seeking treatment. Linking mental illness with violence threatens to restrict the rights and freedoms we afford ordinary citizens. Second, the burden of identifying would-be shooters has now fallen on psychiatrists who are not necessarily equipped to identify violent gun criminals. A number of states now mandate psychiatrists assess their patients for their potential to commit a violent gun crime, but psychiatrists are not great predictors of gun violence, and some research shows they are no more able to predict gun violence than laypersons. Psychiatrists who fail to identify mass shooters may now be held liable for crimes they fail to predict. Third, linking gun violence to mental health therapies may not help to reduce gun violence. Few of the persons who are most at risk for committing a violent gun crime have been involuntarily hospitalized, and therefore would not be subject to existing legal restrictions on firearms. Finally, the focus on mental health obscures other reasons for our nation’s gun violence problem. By focusing almost exclusively on mental health, we fail to identify the myriad of other factors, including historical, cultural, legal, and economic conditions that contribute to gun violence in our country.

It is easy to blame mass shootings on the “abnormal brain”–it is far more difficult to uncover or come to terms with the systemic causes of gun violence that wreak havoc on our communities. There are good reasons to ensure all Americans have access to mental health services, but access to such care is unlikely to stem the tide of mass shootings in our country. Mental illness has become a convenient scapegoat for politicians on both sides of the aisle when it comes to mass shootings, but it is time we begin to look more closely at other culprits.

Devan Stahl photoDevan Stahl, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development in the Michigan State University College of Human Medicine.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, November 30, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

More Bioethics in the News from Dr. Stahl: Disability and the Decisional Capacity to Vote

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Prospects, Promises and Perils of Human Mind-Reading

bbag-blog-image-logoProspects, Promises and Perils of Human Mind-Reading

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In recent years, several research groups have been able to infer the contents of subjects’ thoughts from fMRI scans. E-commerce sites are tracking customers’ purchases and making ever better predictions about what people will buy. What are the prospects for such technology to be widely used? Are there fundamental technical limitations?

We may readily imagine dystopian scenarios for such technology, where privacy as we have known it is no longer meaningful, and the powerful monitor the thoughts of everyone else. We may also imagine that therapists could better communicate with autistic or troubled people, or to detect incipient mental illness.

nov-29-bbagJoin us for Dr. Reimer’s lecture on Wednesday, November 29, 2017 from noon till 1 pm in person or online.

Mark Reimers, PhD, is an Associate Professor in the Neuroscience Program in the College of Natural Science at Michigan State University. Dr. Reimers’ research focuses on analyzing and interpreting the very large data sets now being generated in neuroscience, especially from the high-throughput technologies developed by the BRAIN initiative. He obtained his MSc in scientific computing, and his PhD in probability theory from the University of British Columbia in Canada. He has worked at Memorial University in Canada, the Karolinska Institute in Stockholm, at several start-up companies in Toronto and in Boston, at the National Institutes of Health in Maryland, the Virginia Institute for Psychiatric and Behavioral Genetics in Richmond, and since January 2015 in the Neuroscience Program at Michigan State University.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lecturesTo receive reminders before each webinar, please subscribe to our mailing list.

Environmental neuroethics: Setting the foundations

Laura Cabrera photoCenter Assistant Professor Dr. Laura Cabrera has a chapter in the new book Neuroethics: Anticipating the Future, edited by Judy Illes and published last month by Oxford University Press. Dr. Cabrera has provided the abstract of her chapter “Environmental neuroethics: Setting the foundations” below.

Abstract: The ways in which humans relate to their environments has been studied from different perspectives, including ethics, sociology, behavioral sciences and genetics. This chapter discusses an emerging approach within neuroethics – environmental neuroethics (EN) – that focuses on ethical and social implications of environmental influences on brain health and mental health. The chapter begins with an overview of different disciplinary approaches to examining the relationship between the environment and human health, followed by discussion of environmental effects on brain and mental health. The next section argues for the importance of generating normative discussion about related issues, particularly because these matters are of global concern with linked social justice implications. This section also lays the foundations for the first generation of environmental neuroethics. The chapter concludes with key questions and challenges ahead for environmental neuroethics.

New commentary from Dr. Cabrera in September ‘American Journal of Bioethics’

Laura Cabrera photoCenter Assistant Professor Dr. Laura Cabrera is co-author of a new open peer commentary in the September issue of The American Journal of Bioethics. The article, “Environmental Neuroethics: Bridging Environmental Ethics and Mental Health,” was written by Adam J. Shriver (University of British Columbia), Laura Cabrera, and Judy Illes (University of British Columbia).

The full text is available online via Taylor & Francis (MSU Library or other institutional access may be required to view this article).

Incarcerated AND Sick: At Risk for Pain, Injury, and Death

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Karen Kelly-Blake, PhD

The U.S. project of mass incarceration reveals that more than 2 million people are jail-involved at any given time. That rate far exceeds that of any other nation in the world. Incarcerated patients are sicker, bearing an increased burden of chronic disease, namely addiction, viral infections, and mental illness. Conditions often exacerbated by solitary confinement. Moreover, those incarcerated are disproportionately from communities of color suffering from historical racial discrimination. Consider the following: Whites (non-Hispanic) comprise 64% of the U.S. population, 39% of the U.S. incarcerated population, and the national incarceration rate (per 100,000) is 450; Hispanics make up 16% of the U.S. population, 19% of incarcerated population, and the national rate is 831; Blacks are 13% of the U.S. population, 40% of the incarcerated population, and the national incarceration rate is 2,306 per 100,000.

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Image description: a black and white photograph showing a person’s hands reaching through from behind metal fencing. Their hands are grasping the fence in the foreground, and the rest of the person’s body is not visible. Image source: Tiago Pinheiro/Flickr Creative Commons

In the 1976 Estelle vs. Gamble ruling the U.S. Supreme Court established that “deliberate indifference to healthcare for inmates constituted cruel and unusual punishment, and was thus prohibited by the U.S. Constitution.” In April of this year, a class action lawsuit was filed in the State of Illinois arguing, “health care inside the Illinois Department of Corrections systematically puts inmates at risk of pain, injury, and death.” In effect, Illinois has been put on notice that the correctional health care it provides (or the lack of provision), violates the 1976 Supreme Court ruling. Of course, Illinois is not the only state faced with this problem. A recent ruling found the Alabama Department of Correction’s mental health care system to be “horrendously inadequate.”

The challenges to delivering health care in correctional institutions are similar to those experienced in delivering care in any under-resourced setting that serves vulnerable patients. Overcrowding and understaffing are oft-cited explanations for the inadequacy of correctional health care delivery. An additional, deeply concerning factor is the privatization of prisons with related underbids, cost overruns, and vast gaps in the actual services provided. With increasing numbers of women cycling in and out of prison, women prisoners have specific health needs related to the increased likelihood of being victims of domestic and sexual violence. There is a pressing need for correctional health care services to address these health issues.

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Image description: a close-up photo of the bars of a prison cell, with the bars in focus in the foreground and an empty green/yellow cell visible in the background. Image source: Dave Nakayama/Flickr Creative Commons

As a matter of justice, incarcerated patients should receive the same level of care that they would receive in a community setting. Unfortunately, this notion is not politically popular. Nevertheless, work is being done to merge correctional health and public health to ensure continuity of care once prisoners are released. Significantly, the Affordable Care Act (ACA) specifically addresses the importance of ensuring that the jail-involved have access to the same benefits as the non-incarcerated. The ACA expansion of Medicaid eligibility supplies a critical opportunity to treat prisoners once released. Untreated substance abuse and mental illness among the jail-involved increases their likelihood of future imprisonment.

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Image description: a close-up photo of part of a large metal door that reads “SOLITARY.” Image source: Shannon O’Toole/Flickr Creative Commons

Health care providers often find themselves serving two masters in correction settings. Providers have a duty to provide care that is in the best interest of the patient, but equally, they are also employed by the institution that has other, often conflicting interests, namely to confine, punish, and possibly, rehabilitate. This conflict is referred to as dual loyalty. The virtual societal silence on larger issues about the nature of the institution of incarceration is problematic and makes many correctional health providers “complicit as the United States has embarked on a vast and unprecedented social program of mass incarceration.” Given this state of affairs, providers should use their professional power and work to advocate for and insist upon substantial reforms in clinical care within prisons. A key critical reform is to eliminate solitary confinement. Medical providers also must advocate for change in the criminal justice system. The current project of mass incarceration in the U.S. harms the individual health of prisoners and the public health of the community.

Because of lawsuits or the threat of lawsuits on behalf of prisoners, as well as the dedication of committed health care professionals, activists, and advocates, the quality of health care in prisons has steadily improved. Yet there remains vast room for improvement in clinical care. Physicians hold leadership and management positions in correctional institutions. Combined with the social privilege afforded them in the U.S., physicians have the power, and I would argue the obligation, to spearhead reforms in correctional health care and ensure that the incarcerated sick are at no greater risk than the non-incarcerated of pain, injury, or death.

Karen Kelly-Blake photoKaren Kelly-Blake, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Medicine at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, August 10, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

More Bioethics in the News from Dr. Kelly-Blake: White Horse, White Faces: The Decriminalization of Heroin AddictionRacism and the Public’s Health: Whose Lives Matter?Concussion in the NFL: A Case for Shared Decision-Making?

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Should psychiatric hospitals be reestablished to provide long term care?

bbag-icon-decGiving Asylum? The Ethics of Long-Term, Structured Care for People with Severe, Refractory Mental Illness

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There are hundreds of thousands of individuals in the US who have serious mental illness. Most of these individuals thrive in the community, but there remains a population who do not. Because the number of long-term psychiatric hospital beds has largely evaporated over the past 50 years, they often cycle between homelessness, acute care, and prison. Of the 2.5 million individuals incarcerated in the US, close to 20% are diagnosed with a serious mental illness. How did we get to this point? How can we correct what has become a moral stain on our society? In this talk, Dr. Sisti will argue that we need to seriously consider the reestablishment of psychiatric hospitals to provide long term care. Dr. Sisti refers not the kinds of institutions that shocked our moral sensibilities in the 1960s and 1970s, but to ones that may serve to help individuals overcome crisis or manage chronic conditions and begin or continue a life in recovery. In the parlance of the early reformers of mental health care, “asylums” were originally established to serve this purpose—they were meant to be a place of sanctuary, safety, and healing. Today we may refer to them as recovery centers or structured care settings. They offer an ethically preferable option to the current and rather disturbing state of affairs, and we need more of them.

mar-23-bbagJoin us for Dominic Sisti’s lecture on Wednesday, March 23, 2016 from noon till 1 pm in person or online.

Dominic A. Sisti, PhD is director of the Scattergood Program for the Applied Ethics of Behavioral Healthcare and assistant professor in the Department of Medical Ethics & Health Policy at the University of Pennsylvania. He holds a secondary appointment in the Department of Psychiatry. Sisti’s current research examines the ethical and philosophical dimensions of the concept of mental disorder, with a particular focus on personality disorders. He has written, taught, and presented papers on issues related to the philosophy and ethics of behavioral healthcare, clinical bioethics, and research ethics. Sisti’s writings on healthcare ethics have appeared in JAMA, Nature Immunology, the Journal of Medical Ethics, and elsewhere. He is an editor of three books, most recently Applied Ethics in Mental Healthcare (with Caplan & Rimon-Greenspan, The MIT Press, 2013). In 2008, Sisti was an Edmund D. Pellegrino Fellow at Georgetown University. Dr. Sisti earned his PhD in Philosophy at Michigan State University in 2010.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! View our archive of recorded lectures.