Tuesday, May 12, 2009

Leadership Reorganization and a Hospice Program, reported on the Receiership Newsletter

The Receivership's newsletter, Turnaround Lifeline, reports structural changes in the Receivership's leadership structure. 

[T]he executive level structure of the California Prison Health Care Services has been reorganized.  This structure, staffed with state-employed civil servants, is designed so that CPHCS will be prepared to function as an entity within the State of California once the goal of improving prison health care services to a constitutionally acceptable and sustainable level has been met.


The newsletter contains some basic facts about the Receivership, as well as the fact that that it has recently received MCE (Medical Continuing Education) accreditation. There's also an interesting piece about the Supportive Care Services - a hospice program at the California Men's Colony, which, among other things, trains prisoners to offer spiritual comfort to their dying friends. It makes a fascinating read, particularly given the rising rates of aging and chronically ill inmates. It is also a good reminder that people not only live - but also die - within walls.

4 comments:

Prison Clinician said...

If I understand this correctly, it means that medical health care workers will work under an organization outside of CDCR, once the responsibility returns to the state.

This is a very good move - CDCR is not a provider of medical or mental health, they are a custodial department.

This is exactly what also needs to take place with regards to mental health. Unfortunately, mental health is not directly under a receivership, and so the mental health clinical staff are CDCR employees. This creates a serious conflict of interest - where mental health administration end up taking on a custodial mentality, and compromise clinical consideration.

Furthermore, because CDCR is not a mental health department, they are disconnected from the larger mental health community at state and local county levels. I really really do hope that mental health will move in a similar direction, and that a similar prison mental health department will be set up that would employ the clinicians who are currently working under CDCR.

This will make prison mental health far more accountable, and will be required to comply with all relevant mental health regulations. And be in line with current mental health practices. At this time CDCR is able to get away with a lot because they are outside of the larger mental health system - and thus are also seriously behind the times with regards to treatment. Not so much because they don't have excellent clinicians, but because the administration is seriously out of touch. And their way of dealing with critique is to admonish, make threats against, and/or retaliate.

Prison Clinician said...

If I understand this correctly, it means that medical health care workers will work under an organization outside of CDCR, once the responsibility returns to the state.

This is a very good move - CDCR is not a provider of medical or mental health, they are a custodial department.

This is exactly what also needs to take place with regards to mental health. Unfortunately, mental health is not directly under a receivership, and so the mental health clinical staff are CDCR employees. This creates a serious conflict of interest - where mental health administration end up taking on a custodial mentality, and compromise clinical consideration.

Furthermore, because CDCR is not a mental health department, they are disconnected from the larger mental health community at state and local county levels. I really really do hope that mental health will move in a similar direction, and that a similar prison mental health department will be set up that would employ the clinicians who are currently working under CDCR.

This will make prison mental health far more accountable, and will be required to comply with all relevant mental health regulations. And be in line with current mental health practices. At this time CDCR is able to get away with a lot because they are outside of the larger mental health system - and thus are also seriously behind the times with regards to treatment. Not so much because they don't have excellent clinicians, but because the administration is seriously out of touch. And their way of dealing with critique is to admonish, make threats against, and/or retaliate.

Hadar Aviram said...

Thanks for these thoughtful remarks, Prison Clinician. Do you think the way to achieve this is to first place the mental health services under a Receivership, or can it be achieved otherwise?

Prison Clinician said...

Actually, if there is a way to establish a separate state department of prison mental health, without going through a receivership - then that would help alleviate a lot of the current problems. However, will custody i.e. CDCR be open to such an arrangement, or will they need arm twisting?

IF CDCR would be willing to allow a future prison mental health department to design programs, with CDCR providing only a custody role - then there would not be a need for a receivership, but if not, - and that may well be the case - then a receivership will be necessary.

The other issue here, which would make a receivership necessary, is that it may first need to be established that CDCR cannot provide mental health - this may then require a receivership, as a step towards an independent department? (am not sure of the legalities).

The way the special master relationship works (i.e. under Coleman monitors) is that they "negotiate" with CDCR what mental health programs are to be provided in the prison system. This not only has resulted in just about entirely re-inventing the mental health treatment wheel (and thus being very much behind the times with regards to treatment)- But also, it is my understanding, that getting good treatment programs established is like pulling teeth. And most often the clinical administration don't want to go through that effort. And the excellent line staff clinicians who have been recently hired end up feeling very frustrated with the entire scene - and, unless things change, as soon as the economy improves a little - i'm positive there will be a massive turnover of clinicians.