Effective drug and mental health therapy requires sincerity and trust. But prison is not a trustworthy environment for inmates. For example, all “therapeutic” prison spaces are recorded.
Improved drug and mental health services were demands of the 2018 National Prison Strike in the U.S. and Nova Scotia. Just ask Isa, age 50, who is held in the federal prison system in Georgia. Why was better rehabilitative programming among the prisoner demands? Because confinement mixed with authoritarian corrections culture and dollar-driven bureaucratic mandates present almost insurmountable conditions for people seeking recovery from substance use disorder or mental health conditions.
“Rehabilitation is used as behavior modification program where they (prison authorities) want to mold the inmate into being a better inmate against the greater good,” Isa told The Fix. “It’s a control mechanism in every facility.”
Prisoners’ rehabilitative programming looks good on paper, he said, but is less so in practice. Why? Effective drug and mental health treatment requires sincerity and trust, according to Isa. Prisoners can and do see the lack of both. “They are not stupid,” he said.
While the notion of rehab in prison appears noble, below the surface we find that there’s a fundamental structural “conflict of interest” between prison administration and prisoner rehabilitation. According to Isa, prison is not a trustworthy environment for inmates. The simple fact of inmates divulging information to staff about their lives can be as problematic as the fact that all “therapeutic” prison spaces are recorded. For example: you would probably not talk in a support group about the fact that your whole family does opioids because you don’t want to risk putting them on law enforcement’s radar.
Another example of the structural silencing of prisoners is that Isa participated “morally” (meaning in a less proactive fashion) in the 19-day 2018 prisoner strike due in part to fear of retribution. It’s no exaggeration to note that authorities in the federal prison system have a history of retribution against organized resistance.
Speaking of relevant U.S. prison history, September 9, 1971 was the day the Attica prison riots began in upstate New York to honor fallen prison activist George Jackson, who perished in San Quentin after a battle with prison officials. On that day, Attica prisoners took control, leading to a four-day stand-off with authorities that saw 42 staff taken hostage. In the end, 33 prisoners and 10 officers and prison employees died as a result of the Attica authorities’ armed assault.
In 2018, 47 years later, this infamous prisoner rights anniversary is recognized as the official end of the National Prison Strike that involved at least 10 states in work and pay stoppages as well as hunger and medical strikes at facilities in U.S. detention centers and locations in Nova Scotia. The inclusion of Nova Scotia speaks to the far-reaching appeal of striking for North American prisoners: inmates shared similar demands across national boundaries.
Prisoner strike demand numbers 7 and 8 on the list of ten are crucial: “No imprisoned human shall be denied access to rehabilitation programs at their place of detention because of their label as a violent offender” and “State prisons must be funded specifically to offer more rehabilitation services.”
The demand to provide prisoners with mental health services, including drug rehabilitation, is pervasive throughout the prison system and prison reform movements globally. In fact, the word “rehabilitation” has become such a prison industry buzzword as to have all but lost its legitimacy; unfortunately, we lack a better way to describe the improved facilities that prisoners and their supporters are fighting for.
Anyone familiar with current prison conditions will laugh at the notion that today’s prisons are aspiring progressive rehab centers. In Live from Death Row and other works, author and political prisoner Mumia Abu-Jamal describes these current penal conditions as variations on a theme of death sentences, including the physically and sexually abusive climate, austere conditions and filth of the facilities, the low quality of food, water, and medical services, and the lack of cultural and educational opportunities for the incarcerated.
Now for the fight.
Rehabilitation automatically leads to discussions of drug use and abuse. Some drug use is recreational, but some people use drugs in order to self-medicate, to treat mental or other conditions. Therefore, we end up with a lot of prisoners who directly or indirectly require drug rehabilitation. If charges are drug-related, generally, incarcerated individuals have a better chance of qualifying for in-house or court-ordered outpatient rehab programs.
But unfortunately, budget cuts and a lack of commitment to prisoners’ well-being have led to understaffed or nonexistent programs. Sometimes, you’re lucky if you’re able to attend a weekly Narcotics Anonymous (NA) or Alcoholic Anonymous (AA) meeting.
It seems like there are at least three levels of needs here.
The first is the need for specific programs targeting immediate and more emergency-based drug abuse issues. These kinds of programs would mean that a person entering with a drug addiction or mental health issue would immediately receive relevant services. Columbia University’s National Center on Addiction and Substance Abuse estimates that 90 percent of addicted inmates do not receive substance abuse treatment.
The second level would be something like general wraparound services to incorporate mental health into a larger healthcare paradigm. Inmates who do not use drugs would have an opportunity to get support at this level. These rehabilitation services, like counseling, educational events and support groups, may be voluntary, but they would be well-funded enough to attract inmates and encourage sustained involvement.
The third level would restructure the entire prison facility so that it becomes a rehabilitative atmosphere instead of a simple list of programs tacked onto a bulletin board with a signup sheet. Much easier said than done. This is the most utopian category because it requires a fundamental restructuring of mental health and wellness concepts. Prison abolitionism argues for the eradication of modern prisons because they are inherently unhealthy. It is virtually impossible to rehabilitate an atmosphere that is predicated on the social engineering, racism, sexism and the maximization of profit in a punitive climate marked by what some equate to slave labor conditions. Where the profit motive begins, quality rehabilitative programming in the federal prison system tends to end, according to Isa.
Demands 7 and 8 relate to the first two levels described above.
According to the Center for Prisoner Health and Human Rights, “Approximately half of prison and jail inmates meet DSM-IV criteria for substance abuse or dependence, and significant percentages of state and federal prisoners committed the act they are incarcerated for while under the influence of drugs.”
At arrest, almost three quarters of arrestees have drugs in their system — especially marijuana and cocaine. In 2000- 2013, we saw the increase of opioids and methamphetamines. Considering that currently only 11 percent of inmates receive any form of drug rehab, any improvements in this area are welcome. At present, many inmates don’t even get the prescribed medication needed to overcome addictions or treat mental illnesses; increasing the availability of prescribed drugs would be an automatic improvement in any facility.
Let’s take a look at the recidivism rates for jailed inmates: “… in the two weeks after release, inmates are 12 times more likely to die — and 129 times more likely to die of an overdose — than the general population.” If drug use rates are that high, then crimes associated with drug use are also more likely to occur just after release.
Providing methadone or Suboxone to opioid-addicted inmates before release, and then “connecting them with providers in the community who can continue to prescribe the medication when they leave” considerably increases the inmates’ survival chances and also decreases the likelihood of crimes related to drug use on the street.
A good sense of the rehab climate can be found in our state and federal facilities. The Federal Bureau of Prisons offers Drug Abuse Education classes to inmates. It also offers nonresidential, residential, and community-based treatment programs. While this list seems comprehensive, as it allows for variation inside as well as community-based treatment, we must consider that overcrowding, staff shortages, and limited funding impair inmates’ access to existing services.
It’s these obstacles and others that led prisoners to strike this month.
In all, such obstacles function as contradictions that render “prison rehabilitation” an oxymoron. The prison structure provides such a specific type of authoritarian environment; these conditions of confinement cannot structurally provide necessary skills and training. Sure, inmates can be taught life or job skills, or learn about themselves and their own addictions so they can function better. However, confinement itself is viewed by prison abolitionists as inhumane and therefore a non-rehabilitative climate. We are expecting inmates to learn and retain information about their own health in a place where their main focus is frequently just on daily survival. Inmates are expected to “recover” in structures designed to maximize their status as incarcerated people who are subject to the whim of prison authorities.
As an example, Isa explained that the prison warden had effectively dismantled the mental health services for prisoners. How? He moved prisoners receiving mental health services to new locations throughout the detention facility. As a result, their mental health issues worsened as their housing changed. They suffered more. “A lot of these prisoners cycled back in and out of segregation, including solitary confinement,” Isa said.
When we compare prison reformers’ vision of rehabilitation with the prison abolitionist credo that if prisons reformed people they wouldn’t be prisons, we see that they meet in the middle when it comes to drug and mental health issues. Rehabilitation is a marketing concept that redirects fundamentally critical views on prison conditions towards new programs and therapeutic services. That these services are delivered in a hostile environment, where inmates cannot be expected to trust therapy and health staff, is one problem. Another problem is that outside staff unfamiliar with the overall facility operations do not have an obligation to their patient/prisoners once the prisoners complete a program.
Working with what is available in conditions of aggression and scarcity, one would expect all available avenues to be on the table. Two that loom large are to ensure continuity of care and the safekeeping of inmates. However, given the fundamental conflicts of interests involved, prisoners’ health and safety get short shrift time and time again.
So much for rehabilitation?