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Recovering Inside? 

Ethics in Correctional Mental Health Care


A shadow health care system now exists behind bars in the US, with a substantial amount of behavioral health care delivered there.

There are approximately 2.6 million people incarcerated in the US, which equates, by far, to the world’s highest incarceration rate (~700/100,000 people). It is estimated that 50% of inmates of jails and prisons have a mental illness, and 15-20% have a serious mental illness. 

By convening an interdisciplinary research group that includes bioethicists, clinicians, prison reform advocates, and former inmates, we will develop a novel line of bioethics research to examine ethics and policy questions in correctional mental health care.

This pilot project is funded by the Leonard Davis Institute of Health Economics at the University of Pennsylvania

Jailers at the Bedside: Ethical Conflicts in Provision of Community Hospital Care for Incarcerated Individuals

Journal of Correctional Health Care
December 2019
Emily Moin and Dominic Sisti

Incarcerated individuals in the United States are frequently transferred to hospitals in the community setting for specialized medical care beyond the capability of on-site facilities. Despite the widespread prevalence of this practice, hospitals set their own policies for the care of these vulnerable patients, which are often in conflict with broadly accepted principles of medical ethics. This article explores common practices of community hospitals in caring for incarcerated individuals and argues for the need for further research and, ultimately, reform in this neglected area.

Read the article here

County Jail or Psychiatric Hospital? Ethical Challenges in Correctional Mental Health Care

Andrea G. Segal, Rosemary Frasso, and Dominic A. Sisti
Qualitative Health Research 
Vol 28, Issue 6, pp. 963 - 976

Guest Speakers & Collaborators

Sheriff Tom Dart

At the Cook County Department of Corrections, the Sheriff oversees a population of over 12,000 that includes inmates both housed on-site and ordered to alternative programs such as electronic monitoring. From addressing concerns surrounding general overcrowding and a growing mental health population to developing environmentally sustainable initiatives for inmates, Sheriff Dart has been hailed for his progressive reforms to improve and maintain the safety and security of all those housed and employed at the Cook County Jail.  More

Commissioner Charles Ramsey

Commissioner Ramsey began his career with the Chicago Police Department at age 18 and rose through the ranks to deputy superintendent. He served as police chief in Washington, D.C., from 1998 to 2006, where crime rates dropped 40 percent during his tenure. He joined the Philadelphia Police Department in 2008 under Mayor Michael Nutter. Ramsey led the PPD through eight years of dramatic declines in violent crime and has emerged as a major voice in a national dialogue on community policing. In 2014, he led President Obama's 21st Century Policing Task Force, which released a final report of recommendations last year to increase trust between law enforcement and communities and reduce crime.  More

Research Group Members

Kathleen Brown, PhD (Penn Nursing)
Philip Candilis, MD (St. Elizabeth’s Hospital)
Chris Feudtner (CHOP, Medical Ethics)
Renee Fox, PhD (University of Pennsylvania)
Ron Henry (Capital Strategies Group)
Samson Gurmu, MD (NJ State Corrections)
Reenie O’Brien King (Perelman School of Medicine)
Michelle Joy, MD (Perelman School of Medicine)
Jonathan Moreno, PhD (Perelman School of Medicine)
Stephanie Procell, MA (Fielding Graduate University, PhD Candidate)
Cyndi Reed Rickards, EdD (Inside-Out, Drexel University)
Andrea Segal, MS (Perelman School of Medicine)
Andrew Siegel, MD (Perelman School of Medicine)
Dominic Sisti, PhD (Perelman School of Medicine)
Phyllis Solomon, PhD (School of Social Policy & Practice)
Tyrone Werts (Inside-Out, Temple University)

A Mental Health Model of Incarceration

Thomas J. Dart, sheriff of Cook County, Ill.—and overseer of what he says is the  nation’s largest jail—believes that posterity will gaze back 100 years from now and know that we were “horrible people.”

This is because our country incarcerates mentally ill individuals in overwhelming numbers for minor violations instead of steering them into appropriate treatment, Dart said via teleconference to a group of health care providers, bioethicists, sociologists and advocates recently gathered at the University of Pennsylvania.

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