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Mental Illness in the Prison System

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Should the mentally ill be placed in the mainstream population of a prison?

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Chances are you've never given much - if any - thought to this question. A paranoid schizophrenic kills someone because the voices in his head tell him that person is an alien trying to steal his brain. Is that schizophrenic safe in a prison? Are the other prisoners safe with him (or her) there?

A person suffering with severe bipolar disorder shoplifts an armload of clothing during an attack of acute mania. He or she is sent to prison, to co-exist with gangbangers, rapists, and murderers. Or, perhaps worse, to live in a solitary cell with no human interaction, for 23 out of 24 hours each day. The acute mania shifts to severe depression. What are the chances he or she will survive the prison term?

According to the U.S. Justice Department's Bureau of Justice Statistics, in 1998 approximately 300,000 inmates had some form of mental illness. A decade later, that number rose to 1.25 million.

The National Alliance for the Mentally Ill (NAMI) states that 16 percent of the prison population can be classified as severely mentally ill. This means that they fit the psychiatric classification for illnesses such as schizophrenia, bipolar disorder, and major depression. However, the percentage skyrockets to as high as 50 percent when altered to include other mental illnesses, such as anti-social personality disorder, and borderline personality disorder.

Two major causes attribute to the rise of mentally ill inmates:

In the 1950s, the U.S. had 600,000 state run hospital beds for those suffering from any form of mental illness. Because of deinstitutionalization and the subsequent cutting of state and federal funding, the U.S. now has just 40,000 beds for the mentally ill. The inability to get proper treatment left this segment of our population vulnerable and, consequently, many of them now land in prisons.

Deinstitutionalization hasn't worked. All this has managed to do is to shift the mentally ill from hospitals to prisons - one institution to another. We have made it a crime to be mentally ill.

The largest psychiatric facility in the U.S. isn't a hospital; it's a prison. At any given time, Rikers Island in New York City houses an estimated 3,000 mentally ill prisoners. The average inmate population at Rikers Island is 14,000. One out of every 4 to 5 inmates at this prison suffer from mental illness.

Florida judge Steven Leifman, who chairs the Mental Health Committee for the Eleventh Judicial Circuit, states that, "The sad irony is we did not deinstitutionalize, we have reinstitutionalized-from horrible state mental hospitals to horrible state jails. We don't even provide treatment for the mentally ill in jail. We're just warehousing them."

What happens to the mentally ill in an overcrowded, violent prison system with little to no psychological counseling available?

In state prisons, the mentally ill serve an average of 15 months longer than the average inmate. The very nature of most mental illnesses makes it difficult to follow prison rules. These inmates are more likely to be involved in prison fights and they tend to accumulate more conduct violations.

Prison staff often punishes mentally ill inmates for being disruptive, refusing to comply with orders, and even for attempting suicide. In other words, these inmates are punished for exhibiting the symptoms of their illness.

Gaining parole is also more difficult for the mentally ill. Their disciplinary records are often spotty, they may have no family willing or able to help, and community services are usually inadequate.

In October 2003, Human Rights Watch released a report entitled Ill Equipped: U.S. Prisons and Offenders with Mental Illness. Following two years of in-depth research, this organization found that few prisons have adequate mental health care services. Furthermore, it found that the prison environment is dangerous and debilitating for the mentally ill.

An excerpt from Ill Equipped:

"Security staff typically view mentally ill prisoners as difficult and disruptive, and place them in barren high-security solitary confinement units. The lack of human interaction and the limited mental stimulus of twenty-four-hour-a-day life in small, sometimes windowless segregation cells, coupled with the absence of adequate mental health services, dramatically aggravates the suffering of the mentally ill. Some deteriorate so severely that they must be removed to hospitals for acute psychiatric care. But after being stabilized, they are then returned to the same segregation conditions where the cycle of decompensation begins again. The penal network is thus not only serving as a warehouse for the mentally ill, but, by relying on extremely restrictive housing for mentally ill prisoners, it is acting as an incubator for worse illness and psychiatric breakdowns."

According to Fred Osher, M.D., director of the Center for Behavioral Health, Justice and Public Policy at the University of Maryland, the majority of mentally ill inmates are arrested for misdemeanors and crimes of survival. He states, "That's a whole host of folks who land in the criminal justice system because of their behavioral disorders."

Those on the fringe of society are primarily affected. These people are almost always impoverished and disabled by their illness. They have nowhere to turn, no one to help them, and so we toss them in prison. Even minor offenses keep them locked in prisons, since many cannot afford and/or do not know how to bond themselves out.

The recidivism rate among the mentally ill is higher than that among the general prison population. Prison has become a revolving door system for dealing with mental illness. By default, prisons have become the new mental hospitals. However, they lack the funding and the training to deal with these patient-inmates.

Ratan Bhavnani, executive director of the Ventura County chapter of the National Alliance on Mental Illness, states that, "In general, people with mental illness can recover when given the appropriate treatment rather than to be sent off to jail only to become more psychotic and come back and reoffend."

Michael Jung of Ventura, California suffers from bipolar and hears voices telling him that he is the devil. Over the past 10 years, Jung has been arrested a minimum of 15 times - all for relatively minor offenses. Earlier this year, Jung spent six weeks confined in G Quad, the unit where mentally ill inmates stay in their cells 23 out of the 24 hours in each day.

Cells such as those in G Quad are referred to as the "rubber rooms" because the walls are padded. There is no furniture in these rooms. The "toilet" is a grate in the floor. They are stripped naked and monitored via video camera. Inmates who are paranoid, delusional, or otherwise difficult to manage are often placed in this type of cell, whether for their own protection, the safety of the other inmates, or just plain convenience.

Susan Abril, a former inmate who suffers from bipolar disorder, was placed in this type of cell. During her confinement, Abril began hearing voices for the first time. "I didn't sleep," she said. "I mentally went insane being locked down 23 hours of 24."

We are essentially making the mentally ill inmates sicker, as well as ensuring their return to an already massively overcrowded prison system. Obviously our current system is not working. We cannot expect prison staff to function as psychiatrists. We also cannot expect the mentally ill to be "rehabilitated" in a mainstream prison system.

The Taxpayer Action Board for Governor Pat Quinn of Illinois cited annual savings in the tens of millions of dollars that could be gained by releasing thousands of non-violent offenders, closely monitoring them and providing substance abuse treatment, mental health counseling, education, job training, and employment opportunities.

For the most part, the mentally ill do not belong in prison. It would be cheaper (and smarter) for us as taxpayers to divert funding in order to provide adequate treatment programs to keep them out of prison.

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The Hormone Connection to Women's Mental health

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Do hormones really affect women' mood?

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In the past fifteen years the field of endocrinology has produced vast amounts of evidence showing that the loss of estrogen that occurs normally during menstrual cycle changes puts women at greater risk for mood, anxiety, and craving disorders. Considering the prevalence of these illnesses among women, we're fortunate to be gaining a better understanding of them.

Women are more than twice as likely to become depressed. Research shows that they're also more likely to suffer from anxiety. More develop phobias. It's the same ratio for agoraphobia: nearly 8% of women become agoraphobic, compared to only 3% of men. More succumb to post traumatic stress syndrome. Seventy percent of those with social phobia are women. What could be happening here?

The cyclic nature of estrogen secretion may account for women's special vulnerability to mood and anxiety disorders, Dr. Mary Seeman reported, in the Journal of the American Psychiatric Association, in an analysis of dozens of studies on how female hormones affect psychopathology in both men and women.

The theory of "recurrent estrogen withdrawal" proposes that a low estrogen state drives the onset, or worsening, of mood symptoms in women who are predisposed--by virtue of already low serotonin levels--to mood and anxiety disorders. In 1996, researchers at the University of Edinburgh published a report discussing the molecular level at which these changes occur. Struck by estrogen's "profound effects on mood, mental state and memory" they described the hormone as "nature's psychoprotectant." Sufficient levels of estrogen must be present in the brain, that is, if psychic stability is to be maintained. Estrogen's importance to cognitive processing and memory is not a slight matter. It's been discovered that actually buffers the brain's neurons against degeneration.

By the end of the nineties mounting evidence had begun to show a unique and persistent hormone connection to almost all mental illness in women. For example, binging and purging behaviors in bulimics worsened during the premenstruum, when estrogen levels go down. So did panic attacks in women with panic disorder. Impulse disorders, too, seemed to get worse during that week or ten days before the period begins--kleptomaniacs went on more stealing escapades, trichotillomaniacs pulled more hair, skin cutters cut more skin.. All of these illnesses are related to serotonin dysfunction, and, as we've seen, serotonin and estrogen are inextricably linked.

In the nineties a Canadian psychologist, Barbara Sherwin, was conducting very interesting studies on how estrogen loss affects cognition and memory. I went to Toronto to spend a day with Dr. Sherwin in her office at McGill University. I needed a mini-course in estrogen and she was willing to give it to me.

From early fetal life, hormone receptors are present in the hypothalamus of the brain. It is here that they begin organizing brain circuitry, setting the stage for puberty, regulating subsequent adult sexual behavior, and controlling the frequency and intensity of emotional disorders. Research in neuroendocrinology has much to tell us about the pre-menopausal malaise that used to be thought the result of women's sadness over the loss of reproductive function. Now it's known that the mood and cognitive changes experienced are physical in origin.

Low estrogen affects mood. What I hadn't known, until speaking with Dr. Sherwin, is that in order to produce serotonin the brain needs estrogen. I didn't even known that estrogen existed in the brain. "There are estrogen receptors in various organs throughout the body, the brain included," she explained. "That's why estrogen loss produces so many different bodily symptoms--loss of skin elasticity, bone shrinkage, mood and cognitive decline".

When estrogen levels rise, on the other hand, as they do in the first week of menses, their overall effect is to increase the amount of serotonin available in the spaces between the brain's nerve cells. That improves mood. Within the brain, estrogen may in fact act as a natural antidepressant and mood stabilizer.

Dr. Sherwin introduced me to the work of researchers who were doing important basic science, including Bruce McEwen at Rockefeller Institute, in New York, and Joseph LeDoux, at New York University, who were discovering the molecular changes supporting the view that estrogen had profound effects on the mind and its capacities.

It wasn't long after my visit with Dr. Sherwin that I learned of an important review of ten years' worth of studies entitled, Estrogen, Serotonin, and Mood Disturbance: Where is the Therapeutic Bridge? Two researchers in the Perinatal and Reproductive Psychiatry Program at Harvard Medical School had essentially been motivated by the same question that I had: What is the hormone connection to women's mental health? Joffe and Cohen looked at a hundred-and-twenty five studies on the relationship between women's reproductive cycle hormone changes and their mental status. In study after study they found that women with histories of depression are apparently more vulnerable to recurrent episodes during periods of "significant reproductive endocrine change".

Correlation does not prove causality. The fact that someone becomes morbidly depressed exactly on the day ovulation begins and remains that way until the day she starts bleeding doesn't prove that premenstrual drops in estrogen cause mood changes, but it damn well raised suspicions. Once information from new brain imaging techniques was added to the mix, the case for a hormone connection to women's mental vulnerabilities became as close to an open and shut case as are you're likely to get. Neuro-imaging has improved our understanding considerably, indicating lightening flashes of activity in different parts of the brain during what used to be called, dimly, "that time of the month."

It is the dance between two kinds of hormones, ovarian hormones and brain hormones, that ultimately determines how symptomatic any given woman will become during her menstrual cycle, and at other reproductive risk points as well. If, for example, a woman is genetically coded to have low, or borderline levels of brain serotonin, the estrogen drop that occurs premenstrually may be all it takes to send her serotonin spiraling below the level of optimum functioning, putting her in a mental state that, for all its upsetting symptoms, mysteriously vanishes as soon as her period starts and her estrogen levels go back up.

Why does this happen? Because serotonin needs estrogen for its metabolization in the brain. The two hormones are a dynamic duo, functioning arm in arm. As estrogen levels drop, so does serotonin. When estrogen rises (as it does, for example, once menstruation begins) serotonin levels come right back up with it, and calm is restored. The ebb and flow of womens' menstrual moods is orchestrated not by the moon but by secretions in her brain and ovaries. What we now know is that the sometimes negative outcome of these secretion changes is not inevitable. Just as science has learned to modify insulin changes and thyroid changes, it can now modify ovarian changes. If you don't want to blame your mood on your ovaries, blame it on the brain. Blame it on whatever pleases you, just don't resign yourself to the view that women were born to suffer.

To me it's fascinating that the individual pieces of this important puzzle were not available to us twenty years ago. And the dynamite effect of putting those pieces together has occurred only in the last decade. Building on previous knowledge and assembling the picture step by step, endocrinologists at places like the Neuropsychiatric Institute in California, and the Reproductive Mood Disorder Program at the University of Texas Medical Center have come to understand that women are not only vulnerable during the premenstruum, they are vulnerable at all the reproductive risk points. Moreover, a woman who suffers at one of these risk points is vulnerable to becoming symptomatic at others. If she has genetically low serotonin in her brain, estrogen drops are going to affect her, simple as that.

Things have taken a more enlightened turn since then, thank God, but we are only now coming to understand what actually happens to women's mental well-being at times of hormonal stress. Women scientists in particular, including psychiatrists and reproductive endocrinologists like Barbara Sherwin, are making a unique and important contribution to the massive surge of research that is currently shaping a whole new paradigm for understanding the role of hormonally created change in female well-being and mental status.

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The Artful Life schedule

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Why Creative Retirement?
Many 55+ population will be retiring in the next decade and they will be development choices to keep vital and young by learning new skills and exercising their minds as well as their bodies. There is a growing need to address the well being of this aging population. Programs, curriculums, withhold groups and society centers can help fulfill this need by informing, invigorating and strengthening creative skills and plying the use of the "whole brain."

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Who Are These Retirees?
From the "Retirement Source Book" written by Mary Helen and Shuford Smith, comes this timely statement: (It is) "important to refresh your mind and body, do things you enjoy, form new interest and become complicated with things you like. Take benefit of this time in your life. Retire To something! Here are some activities grouped by concepts: Rest and relaxation, self-expression, collective activity, continued learning, reasoning activity, contemplation, corporeal action and travel."

The New Horizons for learning is a Seattle-based society which studies and researches educational revision initiatives for all ages. From its website comes this statement, "As our population ages, it is captivating to note that many population who would in the past have been considered "old" do not feel or behave in that way. Many continue to take courses at universities, society college, and society centers. Many are becoming known of ways to keep mentally, emotionally and physically healthy and young

Retirement Demographics
Retirement is a multi-million dollar business. In the year 2000, there were 600 million population aged 60 and over. There will be 1.2 billion by 2025 and 2 billion by 2050. Today, about two thirds of all older population live in the developing world. By 2025 it will be 75%. In the industrialized world, the very old (age 80+) is the fastest growing population group. Over seven thousand Americans will turn sixty each day in 2006 (about three hundred and thirty an hour). It is a fact that sixty-eight percent of retirees go back to work, either because they want to or they have to because of money or condition insurance needs

The Golden Years?
Gated society advertisements portray the relinquishment dream: a luxurious paradise inhabited by happy couples playing golf or tennis, adjourning to an exclusive on site club, of relaxing in a spacious hot tub in a faux European villa. And this foresight works, to a point. But it is a cosmetic foresight that does not address the exact needs of many retirees. Although the leisurely trappings are there, it may take time for a retiree to decree into retirement. Many, especially those who have worked at a job all for a good part of their life, will find it difficult to accept recreation as their new lifestyle.

So what is foremost to think in relinquishment years? Many retirees begin to feel restless after a few months in the relinquishment abode of their dreams. Why? More than likely, they are out of touch with themselves. After years of having face military dictate their lives: jobs and raising a family, they are, confronted by large periods of leisure time, required to turn inward and gawk themselves.

Know Thyself
Successful relinquishment is achieved when one becomes, straight through introspection, re-acquainted with dreams, desires and goals set, perhaps, in a younger time when the mind was in learn mode and life was simpler. There were, no doubt, obvious things, long forgotten that were motivational. Was it drawing? Painting? Planting a garden? Playing street games? building a house? Writing a book?

Giving and Enjoying
For many retirees, a mixture of volunteer or outreach involvement and creative activities such as painting, sculpture, dancing, tennis or golf produces an enriched, fulfilling retirement. The Internet is a breathtaking resource for local groups in many areas of these exact interests.

An Artful Life Program
Retirement for this aging population can be either mean resignation, recession and relinquishment from life, or it can be forward-thinking, up beat or optimistic. It is at this point that many begin to gawk their life in a new way, finding back at what they have accomplished and finding a new future in which they can finally do what they've all the time wanted to do. With the empty nest and relinquishment at hand, many will be freed from the demands of a work program and family, ready to pursue interests and endeavors that have been put off for decades. It is a fact that sixty-eight percent of retirees go back to work, either because they want to or they have to because of money or condition insurance needs. The Artful Life program can furnish an educative and satisfying alternative to those wanting to return to the old work schedule. However, for those required to do so, The Artful Life program can inform, invigorate and advance their lives, augmenting their working program with creativity and plying the use of the "whole brain."

How An Artful Life program Works
Marian Diamond, professor of anatomy and a foremost scholar on neuroanatomy, has done allembracing study on the effects of the environment on the brain. She says, "The brain is truly a breathtaking structure, and holding it healthy for our entire existence on this earth is a goal we can and should all aspire to." (Marian C. Diamond, "Successful Ageing of the healthy Brain," record presented at the argument of the American society on Aging and The National Council on the Aging, March 10, 2001, New Orleans, La. First Join Conference). She advocates, five anti-aging factors principal because of new scientific validation: Diet, Exercise, Challenge, Newness and Human Love.

According to James E. Zull, Professor of Biology and Director of the University center for Innovation in Teaching and schooling at Case Western withhold University, the brain physically changes when we learn and the biggest changes are caused by emotion. The chemicals of emotion, such as adrenalin, serotonin and dopamine modify the synapses and this is the very act of learning. Zull states that the arts trigger emotions, changing the brain of both the originator and the consumer of the created object. Custom also changes the synapses, he says. "We learn things we repeat the most. But we repeat the things that we care about. So we enjoy the arts and repeat them over and over. This intensity of effort and focus is healthy for learning. It also changes the brain." He concludes that creativity, based on decisions made by the creator, publish chemicals that make us feel rewarded for our creative efforts. " leisure and ownership are part and parcel of the neurochemistry of the arts."

Another perspective is submitted by Dee Dickinson, in an record for New Horizons in learning called "Learning straight through the Arts." "We cultivate a captivating and honest curiosity for the world. We begin to ask why." "The improvement of curiosity and wonder creates a personal and collective consciousness that is principal for living in our culturally diverse world. By setting students on a lifelong journey with the arts, we encourage ongoing, informed perception, appreciation and association with the population of the world."

Mental Training
In an article, "Optimizing Memory in the Adult Brain for Effectiveness in a Multitasking Society," Donalee Marcus writes, " Why then are the "baby boomers" (age 40+)-who are still actively engaged at work and in their communities, who identify the value of good nutrition and healthy lifestyle-crowding into classrooms to learn how to remember strings of numbers and never forget a face or name? More than uncomplicated vanity and the refusal to grow old, these high-functioning, high-energy participants identify the demands that our multitasking society of instant messages and global networks makes on them. Their refusal to be left behind and "put out to pasture" had lead to added studies on the effectiveness of training the adult brain to function great and remember more clearly." Marcus concludes that, "Mental training that employs visualization is crucial in developing the agility to use the facts we remember in effective ways. Because the modern world demands more of us, we should not decree for less that the optimal use of our brains."

Reflexivity
Regarding the benefits of reflection, Charles D. Hayes, a lifelong learning advocate, author and publisher, writes, "We should expunge the word relinquishment from common parlance and replace it with R and R: reflection and reflexivity. Fantasize what a distinct perspective industrialized years would bring to society if, instead of saying we were finding send to retirement, we said we were eager to begin our years of reflection eager to sort the truth of our sense from society's fictions. Reflexivity is a turning back into one's sense to retake bearing and re-examine one's coordinates. If the autumn years begin at 50, real schooling begins in September."

Artful Life program Benefits
Planned for relinquishment communities and seniors, An Artful Life program can enrich the offerings to seniors in a variety of sites, locations, addressing the needs of a broad range of participants yet remaining an invigorating, captivating and satisfying sense in the lives of many.

The Need For An Artful Life Program
At present, there is no service that offers this creative container in any relinquishment communities, assisted living facilities or society colleges. Although art classes are offered, The Artful Life presents a much broader range of educative initiatives, together with large motor movement and breathing exercises at the starting of each class session, group projects captivating movement straight through drawing and painting with music, lectures on creative reasoning and qoute solving, visits to artists studios, learning the skills of critique, visits to museums and galleries and lectures on historical and modern art. The goal of The Artful Life program is that straight through learning and experiencing the full scope of the artful life, students will improve their physical, reasoning and spiritual capacities. And this leads to a healthier spirit and a longer life.

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Finding the Best Hospitals in Shanghai, China

University Hospitals - Finding the Best Hospitals in Shanghai, China

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Do you know about - Finding the Best Hospitals in Shanghai, China

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Shanghai, situated on the estuary of Yangtze River, is a prominent economic, cultural, international trade, science and technology center in East China. It is also a major tourist destination where one can see the great blend of western and oriental cultures, ancient and modern.

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About University Hospitals

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Shanghai has a number of modern, international hospitals and clinics. Many of these hospitals provide VIP or foreigners' clinics where the most sophisticated medical technology and English-speaking staff are available. In private hospitals, an advance payment is often required unless you have recognized international health insurance.

A brief description of some of the better hospitals in Shanghai is given below.

Shanghai East International Medical Center is a trusted name in Shanghai for family health care services. This hospital of diverse specialties was opened in 2003, providing world class treatment and services in all medical departments by highly experienced doctors and support staff. This hospital located at 551 South Pudong Road Pudong, Shanghai is especially well known among the international community. The hospital has excellent foreign medical facility wing run by fluent English speaking staff. Tel: (86 21) 5879-9999

United Family Hospitals and Clinics is the most prominent, international standard medical service and healthcare organization in China; Shanghai United Family Hospital and Clinics (SHU) is one of their leading centers. SHU was founded in 2004 and is a joint concern between Chindex International Inc. and the Shanghai Changning Central District Hospital group. They have established an international team of physicians to offer effective and comprehensive healthcare services in a warm, caring and service-oriented environment.

Parkway Health is at present, the largest private healthcare provider in Asia. Parkway Health is a trusted name within the international community for their superior health care services. They provide most modern treatment and services through highly professional foreign trained English speaking doctors. They have established a 24-hour customer friendly Appointment Service and have billing arrangements with more than 20 major international health insurance providers.

Global Health Care is a world famous medical and dental center that has been providing high quality patient care and services at the Shanghai branch, located at Shanghai Kerry Center, Shop 301, 1515 Nan Jing West Road, Jin An District, Shanghai. This hospital is operated by top performing doctors and dentists from countries like the US, France, Germany, Hong Kong, and Japan. Moreover the center provides specialists in areas like Cardiology, Urology, Pediatrics, Internal Medicine, General Medicine, Psychiatry, Family Dentistry, Clinical Psychology, Nutrition etc.This international group hospital is a much trusted medical center both among the domestic and foreign patients mainly due to the no-compromise attitude of the hospital towards quality and devoted service. Tel (8621) 5298-6339, (8621) 5298-5833

Huashan Hospital is one of the biggest and most reliable health care institutes in Shanghai. This comprehensive teaching hospital was founded in 1907 and is registered to Fudan university. It is the primary hospital of China Red Cross society in Shanghai. The hospital has got an exclusive center for foreigners which is a real world-class endeavor in all aspects. The Foreigners' Clinic is located at 1068 Changle Lu (Foreigner's Ward) Tel: 6248 9999 ext 2500

Renai Hospital located at the 133 Caoxi Lu, Xuhui District, Shanghai is a favorite hospital for the foreign visitors because the hospital provides communication assistance to the patients in all major languages such as Russian, Hindi, Korean, Spanish and Japanese. The hospital possesses top-of-the-line treatment facilities, lab and pharmacy systems in a patient friendly environment at affordable cost. Tel: 021 5489 3781 or 6468 8888

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