How a Montana Prison Is Reforming Its Treatment of People With Disabilities

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Our criminal justice system has long struggled to accommodate persons with disabilities. So when a state prison reforms how it treats incarcerated people with disabilities, those reforms can have an immediate and vital effect. As a result of a groundbreaking settlement approved yesterday by Judge Jeremiah Lynch in our case, Langford v. Bullock, just such a set of reforms is now underway at the Montana State Prison.

While life at Montana State Prison is certainly difficult for all prisoners, it is especially hard on those who are disabled. Deaf prisoners have been punished for failing to respond to orders to stand for count issued through an intercom they could not hear. Men with mobility impairments, many of whom are elderly due to the long sentences handed down in the state, were denied access to vocational and educational programs the prison offered on the second floor of one of its buildings and in areas that were otherwise inaccessible.

Prisoners with mental disabilities have been punished for behavior that is the product of their disability, including instances where they have cut or otherwise harmed themselves. Too often prisoners with mental disabilities are placed in solitary confinement cells after sham disciplinary hearings that they were unable to understand or participate in due to their illnesses.

This is discrimination, pure and simple. It is also illegal under the Americans with Disabilities Act, a federal statute that bars disability-based discrimination and punishment and prohibits prisons and jails from denying disabled prisoners access to programs, services, and activities available to other prisoners.

The sweeping settlement agreement, when fully implemented, will turn the promise of the Americans with Disabilities Act into reality at Montana State Prison. The settlement requires prison officials to institute a reliable system to track prisoners with disabilities and accommodate them so they have equal access to all programs and services offered at the prison. It requires the creation of a viable grievance process for disability-related complaints, which will be handled by a full-time ADA coordinator responsible for overseeing an ADA compliance program.

The disciplinary process will be overhauled to bar punishment of prisoners for behavior that is the result of their disability. Hearings, classes, and other programs will be modified so those with cognitive disabilities will be able to meaningfully participate, which increases their chances for early release and parole. The building where classes are held on the second floor is now equipped with an elevator. Ramps and walkways have been built and repaired, and will be maintained, so that the entire facility is accessible to those with mobility impairments.

Americans Are Finally Waking Up About Ableism

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When The Washington Post published a piece detailing how a Starbucks employee mocked a customer for stuttering while ordering a drink at Starbucks, I wasn’t surprised. In fact, as a person who also stutters, I was resigned.

I can’t even count the number of times an interaction with a stranger has left me feeling disrespected and defeated — the banker, the customer, the men I’ve dated, just to name a few.

But the incident at Starbucks did surprise me in one way: After the barista openly mocked the customer, Sam, for his stutter — first in conversation and again by printing his drink label in a pejorative fashion (“SSSam”) — people took action.

Largely thanks to a social media post, news of Sam’s encounter gained national attention. In the end, Starbucks let the barista go, and the corporation ― already knee-deep in necessary anti-bias and sensitivity training — has confirmed there will be more training on ”additional topics in the months to follow.”

This may not seem like much to celebrate, but for those of us committed to raising awareness for the disabled population, it feels worth commemorating. Nearly 1 in 5 people in the U.S. have a disability, and yet, the activism for our movement has been an uphill battle. Recently, however, there has been more acknowledgment of the different kinds of prejudice disabled people experience and more visibility for differently abled bodies. Embracing this discussion has been a crucial development for disability advocacy.  

Despite setbacks, we can now objectively say that disability awareness is growing.

In fact, from the outside, it would seem as though the disability movement might finally be receiving the attention it deserves. Perhaps prompted by the gross disrespect and erasure by our nation’s new political leadership, it seems we are currently in “a new wave of activism by disabled Americans who want to change the way disability is viewed in the U.S.,” according to Time.

Thanks to the efforts of activists, there is now more representation of disabled characters in television and film. More disabled perspectives and opinions are being shared on the prospective ban on plastic straws ― but only because the needs of the disabled population (who often use straws out of necessity) were not taken into account. There have also been some genuine triumphs for the disability community, of course, such as the clothing brand Aerie and its recently released and incredibly inclusive ad campaign. Despite setbacks, we can now objectively say that disability awareness is growing.


The dark history of early deep brain stimulation

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 Lone Frank has written The Pleasure Shock: The Rise of Deep Brain Stimulation and its Forgotten Inventor about the early brain stimulation work of psychiatrist Robert G. Heath in the 1950s and 1960s. Frank draws well on her background as a neurobiologist to create a portrait of Heath as both a misunderstood pioneer and an overambitious opportunist that is compelling for both the layperson and the specialist. She provides an engaging first-person account of her investigation into Heath's career, and contrasts this with developments in the use of modern DBS for mental illness, punctuated with cameos by several of the current thought leaders in the field to provide scientific context for this cutting-edge field.

At Tulane University (New Orleans, LA, USA), Heath established the Department of Psychiatry and Neurology, and chaired it from 1949 to 1980. During his tenure, brain electrodes were implanted into more than 50 patients to investigate the physical manifestation of human emotion—particularly pleasure and reward—and its role in psychiatric conditions. This work preceded the discovery of antipsychotic medications, and came at a time when mental illness represented a major social burden: asylums were full and available treatments—including lobotomy, electroshock therapy, and insulin-induced hypoglycemic coma—were ineffective and troubling.

Heath focused on electrically stimulating the septum, the subcortical reward centre containing the nucleus accumbens that is widely connected to several structures that were resected during topectomy procedures. He made several interesting observations, including the careful documentation of stimulation-induced euphoria that he used to reach withdrawn patients with schizophrenia. Heath eagerly presented mixed preliminary results suggesting improvement in a subset of patients, which were met with initial interest but also harsh criticism that his methods were uncontrolled and fraught with bias. This became the prevailing critique of Heath's work: he was quick to present sensational findings without using established scientific methods to verify his conclusions.

Heath's work also raised ethical concerns. It is unclear whether legitimate informed consent for invasive brain stimulation procedures was obtained. In many cases, additional electrodes were placed throughout the brain to measure responses to septal stimulation, without therapeutic benefit to the patient. Some experiments had questionable scientific merit—most infamously, Heath attempted homosexual conversion of a gay man by stimulating the septum while the patient engaged in sexual acts with a female prostitute. In another questionable experiment, his group isolated a protein he called taraxein from people with schizophrenia that purportedly induced the disorder in prisoners; this finding was dismissed when results were not reproducible outside Heath's laboratory.

Advocates’ Guide to Accessibility in Medicaid Managed Care Grievances and Appeals

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In May 2016, the Department of Health and Human Services (“HHS”), Centers for Medicare & Medicaid  Services  (“CMS”)  promulgated  regulations  outlining  new  procedural  requirements for  managed  care  plans’  grievance  and  appeal  systems.

This document provides guidance on how States can, in the process of implementing the new federal  regulations,  ensure  that  people  with  disabilities  have equal  access  to  the  grievance and appeal and State fair hearing systems, as mandated by Section 504 of the Rehabilitation Act  (“Rehab  Act”),  the  Americans  with  Disabilities  Act  (“ADA”),  and  Section  1557  of  the Affordable Care Act (“ACA”). It provides advocates with an outline of potentially problematic areas  in  the  appeals  process  and  provides  suggested  language  for  the  content  of  State.