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Drucker Decarcerating America ORIG-ENG 2018-11 Final

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Drucker Decarcerating America ORIG-ENG 2018-11 Final THEMES AND DEBATES Decarcerating America - Once Again Ernie Drucker, Professor at the New York University College of Global Health The original meaning of Decarceration nity Psychiatry and would later return to Ar- first hit me in 1964, when I was a clinical gentina as Minister of Mental Health. psychology intern in Brooklyn, at the Mai- The movement to better serve these pa- monides Hospital Department of Psychiatry tients and their families was inspired by where I first saw youthful drug users as pa- President John Kennedy whose younger sis- tients, and ( more often ) in the streets of the ter Rosemary was seriously mentally ill. De- community. This was before the “war on spite the family fortune she too had cycled drugs” was declared by Pres. Nixon in a through these same psychiatric institutions, press conference on June 17, 1971, at which and been permanently disabled by a frontal time President Nixon declared drug abuse lobotomy. From the botched care of his sister "public enemy number one." But at this point JFK concluded that this system was irreme- in history even socially oriented institutions diable – beyond any help. He (and many like Maimonides had little clinical experi- others) called for shutting them down alto- ence with drug users - and the American gether and a new policy called “de-institu- criminal justice system had yet to discover tionalization” grew apace in the US and Eu- and imprison them. rope. At that time the US prison system held The National Community Mental Health about one fifth that number of its citizens – Act of 1961 called for the transfer of mental with only a few of them there because of health care to the community, which would drugs. But prisons and mental hospitals had take over all aspects of psychiatric care at the something in common: both were what Erv- local level. Soon hundreds of thousands of ing Goffman called “Total Institutions”- mental patients were being discharged - large residential facilities where similarly supposedly “to community care” based on a diagnosed individuals were “cut off from the nationwide network of community mental wider society” with “ all aspects of their dai- health centers. While these models of Com- ly life formally controlled and routinely ad- munity Care never materialized at scale, ministrated by staff.” It would be hard to luckily for me Maimonides was one of the imagine a less therapeutic environment. few such centers established in the US. The Back then the US had close to a million “de-institutionalization” of the asylums adults and adolescents cycling through its turned out to be abandonment of this popu- mental hospitals - institutions still called asy- lation. In its wake this broken promise of lums. Fortunately I had excellent supervision community care left a million families hold- from Dr. Angel Fiasche, a psychoanalyst ing the bag with widespread inadequacy of from Argentina who came to Maimonides as the much needed care for these patients– a political refugee and supervised me as an soon to find their new identities as “the intern in the Dept of Psychiatry He was a homeless” and “drug addicts”, followed by founder of the international field of Commu- burgeoning street drug markets, neighbor- 1 Social Medicine (www.socialmedicine.info) - 1 - Volume 12, No 1 January-April 2019 hood arrests, and all too soon, the epidemic As we talk today about further decarcera- of mass incarceration in America – which I tion of America’s prisoners, the experience called A Plague of Prisons in my book on the of “deinstitutionalization” begins to sound subject (The New Press 2011) familiar. Those being “decarcerated” from In 1968 I moved to a post doctoral Fel- prisons need new systems of integrated men- lowship in Psychiatry at Montefiore Hospital tal health care and addiction treatment - with in the North Bronx, where I again found a new correctional strategies for people who large drug using population . While such pa- have broken the drug laws and served long tients were “persona non grata” to most prison sentences. Further, todays most seri- psychiatrists, I got support from the Monte- ous drug problems ( opioid pain medications fiore President, Dr. Martin Cherkasky. In and drug overdoses) now affect over 50% of 1970 we opened a methadone program at the all re-entering prisoners and produce many hospital that would go on to serve 1000 pa- preventable deaths. In the two weeks after tients over the next 20 years. My position release from prison , drug users face a 10 -12 was moved out of Psychiatry and into a new- fold increased risk of death from overdose. ly established Dept of Social Medicine, As we now face large scale decarceration whose Chairman, Dr. Victor Sidel, intro- of American prisoners, we must create effec- duced me to the field of public health and tive alternatives to the prevent the same sort community medicine. Dr. Sidel was a of predictable failure we saw in the deinstitu- founder of Physicians for Social Responsi- tionalization of mental patients – making bility and later President of the American them vulnerable to the many harms associ- Public Health Association. He and Dr. Jack ated with unsupported prison re-entry. To- Geiger (another mentor of mine) led the na- days bloated prison system in the US must tional physicians movement against nuclear be replaced with new institutions and new weapons and founded the International criminal justice goals and methods rather Physicians for the Prevention of Nuclear than punishment – goals based on public War, which won the Nobel Peace Prize in health , social justice, and human rights. 1985. The lessons learned from deinstitutional- ization of America’s mental patients should not be lost on the current movement for “decarceration” of America’s prisoners. To- day over 600,000 prisoners are discharged annually to parole and community supervi- sion. Their high rates of recidivism ( 60%) and return to prisons (often for untreated drug problems) meant extensive damage for these individuals’ children and families – an inter-generational effect where over 50% of the children of prisoners have a lifetime probability of imprisonment themselves. 1 Social Medicine (www.socialmedicine.info) - 2 - Volume 12, No 1 January-April 2019 .
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