A discussion in the light of World Mental Health Day, 10 October 2014
The Medical Action Group (MAG) has recently received a query from AB Communication undergraduate students of the Ateneo de Manila University (ADMU) who are conducting a study on the health condition of mentally-ill inmates in the New Bilibid Prison (NBP) as part of their academic requirements. An SMS and later a formal letter was sent and addressed to Dr. Amy Ng Abcede, Head of the Documentation and Services Program.
To make our response institutional, the MAG staff members have discussed and deliberated the issue and come up with the following insights.
We are posting this response in order to further encourage a discourse on the issue and clearly shape up MAG’s official position.
“Do mentally ill patients share the same rights and limitations as regular prisoners? Is it humane to keep them imprisoned if they are in a mentally delicate condition?”
MAG subscribes to the World Health Organization (WHO) assessment recognizing imprisonment by its very nature has an adverse effect on mental health.
Prison conditions have adverse impact on mental health in general, because of overcrowding, nature of violence, isolation from families and friends, uncertainty of life after prison, and of course, inadequate health services. The impact of these problems is even worse for prisoners who are already mentally and emotionally impaired which may have pushed them to commit a crime.
Considering that prison system operates according to a certain system of rules, policies, and procedures that regulate the conduct of all inmates, it will definitely run in constant tension with the vulnerabilities of prisoners who have mental illnesses for they are more likely to break any of these rules and may be subjected to inhuman and degrading treatment and punishment.
Given that most prison systems especially in the Philippines do not provide correctional officers with proper trainings in dealing with mentally ill inmates. The jail officers, who are usually trained like police officers whose main goal is to enforce the rules, do not understand and can’t distinguish normal social behavior to that of mentally ill. This may result to mishandling of mentally ill inmates that may constitute to human rights violations.
The United Nations Standard Minimum Rules for the Treatment of Prisoners (Standard Minimum Rules), adopted by the Economic and Social Council in 1957, although not a treaty, imposes obligations to the states to humanely treat prisoners—including providing mental health care to those who need it.
(1) At every institution there shall be available the services of at least one qualified medical officer who should have some knowledge of psychiatry. The medical services should be organized in close relationship to the general health administration of the community or nation. They shall include a psychiatric service for the diagnosis and, in proper cases, the treatment of states of mental abnormality.
(2) Sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals. Where hospital facilities are provided in an institution, their equipment, furnishings and pharmaceutical supplies shall be proper for the medical care and treatment of sick prisoners, and there shall be a staff of suitable trained officers.
In fact, the Standard Minimum Rules go beyond providing health care and treatment services but rather recognize that prisoners with serious mental illness should not be confined in prisons at all. They should be put in mental institutions, where they can be properly observed and treated by mental health professional. It further clarifies that while they are still considered as prisoners, they shall be placed under the special supervision of a medical officer.
While we do recognize the existing efforts of the government to improve the health facilities including provision of psychological wards particularly in the National Bilibid Prison (NBP) to meet the internationally accepted Standard Minimum Rules for the Treatment of Prisoners, sad to say, the general prison condition is still far below these standards. While the NBP, one of the biggest correctional facilities in the country is in a better situation than the others, it is still being confronted with various even perennial problems. Not to mention that the controls and supervisions of jail facilities are at various levels given the devolution of authority of central government to the local government units. Political dynamics usually plays around the layered bureaucracy.
The most common problem of prisoners or detainees is the insufficiency or lack of food provision due to the delay in release of food allotment and inadequate or unsanitary food preparation. In some instances, relatives of inmates have to supply them with food.
Over-crowded or prison congestion is still a major concern as there are no enough shelter/living space or worse it is not even suited for human existence. Some prisoners have to take turn for their sleeping schedule because there is a lack of sleeping paraphernalia and the undersized cells have poor ventilation. Unsanitary conditions are compounded by defective comfort rooms and lack of potable water system. In NBP, prisoners have to draw water from a deep well.
Due to these old prevailing problems, inmates have easily acquired different kinds of diseases. This is in spite the fact that the NBP Infirmary has a capacity of 500 patients. But apparently it is not being fully utilized because of the absence of sufficient medical supplies and laboratory facilities.
This is attributed to the abysmal low budget for prison improvement. Take note, each inmate has a budget of three pesos only earmarked for medicine, except for major medical problems which would need referrals with the Department of Health (DOH) for the needed medical treatment. More often than not, only those rich and influential inmates who are given VIP treatments can avail such services because they can afford to pay for their own medical expenses. Take for example the case of former Batangas Gov. Leviste and just recently Atty. Gigi Reyes, Sen. Enrile’s former Chief of Staff who can immediately go out of NBP escorted by the police to have their own medical checkups.
While poor, ailing and aging prisoners are usually just left to wait for their time. Just like what happened to the political prisoner Mariano Umbrero, who passed away two years ago as a result of his deteriorating medical condition and lack of medical care.
So how do we expect for our correctional system to address the need of the mentally ill inmates?
Prison time can only exacerbate the psychological problems of mentally ill prisoners. Given the fact that they are incarcerated and removed from the general public and separated with their families is already psychologically stressful. Usually they are likely to turn to negative coping mechanisms to survive in jail.
Although, insufficient funding is not the only reason why mentally ill prisoners do not receive the treatment they need, the existing prison conditions in the country are not rehabilitative in nature and further undermine the prisoners’ mental health.
Putting mentally ill inmates into segregation may be an option depending on their specific behaviors, but they should also be housed in specialized secure units where they can still participate in meaningful human activities, especially to have human interaction, and receive the proper mental health services.
However, MAG believes that whatever improvements are made, prisons will never be a good place for the mentally ill.
The rights based approach to health affirms that the end-goal of any medical and health interventions should enhance the ability of the mentally ill prisoners in particular to lead a productive and law-abiding life as possible upon their return to society.
A restorative understanding of justice opens new pathways for both the response to crime and treatment of offenders. While most restorative processes take place in community settings, the underlying framework of the right to health is creating prison environments that contribute to rehabilitation, healing and change. It is for this reason that MAG together with other human rights NGOs is pushing for prison reforms in accordance with international human rights standards.