Barbed wire in front of blue sky.

The Struggle to Survive in the Pandemic Prison

By Jamal Spencer and Monik C. Jiménez

Prisons, jails, and other carceral facilities have been core sites of the COVID-19 pandemic, from initial outbreaks in Chinese prisons to some of the largest outbreaks in the U.S. The uniquely dangerous physical conditions within carceral facilities (i.e., overcrowding, poor ventilation, and lack of sanitation); a high prevalence of chronic diseases among incarcerated people; and high levels of physical movement through facilities, resulted in environmental conditions ripe for uncontrolled SARS-CoV-2 transmission.

As early as June 2020, the mortality rate from COVID-19 among incarcerated people was three times higher than the general population and the infection rate five times higher. Yet, despite these inequities, the human toll of COVID-19 among incarcerated people has remained behind the walls and in the shadows. Without intentionally centering the voices of those who have lived in the most extreme conditions of social and physical marginalization, we fail to understand the full toll of the pandemic and impair our ability to respond humanely to future crises. 

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Washington, D.C. skyline with highways and monuments.

COVID-19 as Disability Interest Convergence?

By Jasmine E. Harris

Some have suggested that the COVID-19 pandemic could be a moment of what critical race theorist Derrick Bell called “interest convergence,” where majority interests align with those of a minority group to create a critical moment for social change.

It would be easy to think that interests indeed have converged between disabled and nondisabled people in the United States. From education to employment, modifications deemed “unreasonable” became not only plausible but streamlined with broad support.

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Red corded telephone handset on blue background, top view. Hotline concept

To Promote Health Equity, States Must Restrict Police Intervention in Mobile Crisis Response

By April Shaw and Taleed El-Sabawi

The COVID-19 pandemic and recent increases in the incidence of televised violence against Black persons by law enforcement actors and others have contributed to the worsening mental health of these subordinated and marginalized communities. While the policy solutions needed to address this disparate impact are structural and multi-faceted, the introduction of 988, a national mental health crisis hotline, offers an opportunity to positively contribute to the overall goals of decreasing police interactions with Black and Brown communities.

The Federal Communications Commission (FCC) issued a Final Rule designating 988 as a national suicide prevention and mental health crisis hotline in September 2020. Congress later passed the National Suicide Hotline Designation Act of 2020 codifying 988 as the dialing code. Per the FCC Final Rule, states are required to implement 988 into their networks by July 2022.

States have wide latitude in how they implement 988, and though many will likely stop at the bare minimum of creating a suicide prevention hotline, 988 could be coupled with the creation of police alternative (or non-police) mobile responses that assist with de-escalation, stabilization, and connection to treatment. Non-police responses promise to decrease police interaction, excessive use of force, and criminalization of mental illness. Such non-police responses have gained in national popularity due in large part to organization and protests led by Black Lives Matters activists.

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Close-up of hands in white gloves pulling curtain away

Fostering Mentally Healthier Workplaces via Disability Advocacy: COVID-Era Strategies and Successes

By Zachary F. Murguía Burton

Can employers foster mentally healthier workplaces via theater?

Here, I discuss a mental health advocacy and inclusivity initiative built around a theatrical production, The Manic Monologues, with a particular focus on pandemic-era efforts to foster awareness, empathy, and connection around mental health challenges.

These efforts aim to promote healthier and more inclusive (and, by extension, more productive) workplaces in the face of the ongoing, escalating global mental health crisis.

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Concept: An ounce of prevention is worth a pound of cure.

The Paradoxical Legal Treatment of Preventive Medicine

By Doron Dorfman

Preventive medicine is a tool used by individual patients, primary care physicians, and governmental agencies to preempt illnesses rather than to treat them after they have arisen. Despite this salubrious aim, stigma, shame, and fear often are attached to the use of preventative care.

The stigma around preventive medicine can arise from the tendency to view such measures as a proxy for risky or otherwise socially marginalized behavior or lifestyle. Why would someone use a preventative measure if they are not at high risk as a consequence of their own choices?

Consider, for example, what I call “sexually charged” preventative health measures like the human papillomavirus vaccine or Pre-Exposure Prophylaxis (PrEP). PrEP is a highly effective daily drug regimen that prevents HIV infection, which has become specifically popular with gay and bisexual men.

As I discuss in a forthcoming paper, PrEP has been viewed by policymakers and health care professionals as a “license for promiscuity” due to the fear of risk compensation, meaning the adjustment of risky behavior by those who take PrEP to potentially have sex with more partners and with no condoms. Such views are reflected in Kelley v. Becerra, a case pending before the U.S. District Court of the Northern District of Texas, where plaintiffs wish to purchase insurance that excludes coverage for PrEP and contraception, to which they object to on religious and moral grounds.

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Healthcare concept of professional psychologist doctor consult in psychotherapy session or counsel diagnosis health.

Beyond Parity in Mental Health Coverage

By Kaitlynn Milvert

Mental health “parity” laws require insurers to provide the same level of mental health benefits as they do medical or surgical benefits.

These laws have made important strides toward reducing restrictions in an area of historically limited and inconsistent coverage. But this comparative approach also creates complexities and gaps, which reveal the need to move beyond “parity” in addressing mental health coverage restrictions.

Recent state legislative developments show a way forward. These developments build on parity laws to codify baseline requirements for coverage of “medically necessary” treatment, designed to ensure that necessary coverage is not improperly denied under overly restrictive standards for evaluating mental health care claims. Read More

New York City, New York/USA June 2, 2020 Black Lives Matter Protest March demanding justice for George Floyd and other victims of police brutality.

The Centrality of Social Movements in Addressing the Impact of the COVID-19 Pandemic

By Malia Maier and Terry McGovern

The COVID-19 pandemic resulted in higher rates of family violence. For advocates and funders, this provided important opportunities to partner with movements, including racial justice, Gender-Based Violence (GBV), Reproductive Justice, and Sexual and Reproductive Health and Rights (SRHR) movements.

We interviewed 24 GBV and SRHR service providers, advocacy organizations, and donors throughout the country to understand how the pandemic and concurrent racial justice movements were impacting critical GBV and SRHR services.

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UN United Nations general assembly building with world flags flying in front - First Avenue, New York City, NY, USA

Legal Capacity and Persons with Disabilities’ Struggle to Reclaim Control over Their Lives

The Health Law, Policy, Bioethics, and Biotechnology Workshop provides a forum for discussion of new scholarship in these fields from the world’s leading experts. Though the Workshop is typically open to the public, it is not currently, due to the COVID-19 pandemic. However, many of our presenters will contribute blog posts summarizing their work, which we are happy to share here on Bill of Health.

By Matthew S. Smith & Michael Ashley Stein

Persons with disabilities face an ongoing struggle to reclaim power and control over their lives.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is an important tool in this struggle.

In mental health care settings, the CRPD has challenged states and practitioners to reject coercive forms of care orchestrated by substitute decision-makers — be they clinicians, family members, or court appointees — in favor of modalities that preserve and privilege individuals’ direct control over their care.

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doctor holding clipboard.

Transformation of Behavioral Health Care Through Section 1115 Waivers

By John Jacobi

As the Biden administration works to improve health access and transform health delivery, behavioral health reform should be at the front of the queue.

People with severe mental illness and opioid use disorder are dying young for lack of routine health care. Much of the work that needs to be done in behavioral health is developed or developing at the state level. But the Biden administration has a powerful tool for encouraging state-level innovation in the § 1115 Medicaid waiver process.

Reform through state waivers

Section 1115 waiver authority permits the Department of Health and Human Services to approve pilots and demonstrations if they are found likely to promote the objectives of the Medicaid program. Waivers, which do not require Congressional or formal regulatory enactments, permit relatively rapid cycling of innovation, in contrast to the lumbering pace of legislative or regulatory change.

While applications for waivers originate with the states, presidents have set the agenda by signaling what categories of waivers will be looked upon favorably, offering the administration the ability to put its stamp on the development of care for low-income and disabled people.

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