Population Care

Immigration detainees have right to discharge plan

While two legal permanent residents—green card holders—were in an immigration detention center in Orange County, New York, medical personnel treated them for serious mental health conditions. Both were released immediately after immigration proceedings allowed them to stay in the United States.

Neither, though, received prescriptions for medications they were taking while being detained and there was no other discharge planning to address their mental health conditions when they were released. The result: The green card holders, Michelet Charles and Carol Small, both suffered mental breakdowns and required substantial medical care.

The question now before the 2nd U.S. Circuit Court of Appeals in New York is whether the former detainees had their due process rights violated when the county-run detention center released them without medical discharge plans that addressed their mental health. The appellate court is considering the question after the U.S. District Court for the Southern District of New York dismissed the claim saying that the nature of the claims were serious, but “were more akin to negligence or malpractice claims than constitutional violations.”

The Litigation Center of the American Medical Association and State Medical Societies joined the American Psychiatric Association and several other organizations in an amicus brief in the 2nd Circuit that supports the patients by laying out the importance of discharge planning in psychiatric care, including providing a sufficient quantity of medication and ensuring medical records are effectively transferred to community providers.

The brief does not take a position on the “ultimate question whether appellants have a valid claim under applicable standards.” But the brief says that “to the extent that the district court’s judgment rests on the proposition that discharge planning for individuals with serious mental illness is not integral to minimally adequate mental health care in the correctional setting, that proposition is incorrect.”

“On the contrary,” the brief states, “any evaluation of a constitutional claim in this context must give adequate weight to the consensus among mental health professionals that appropriate discharge planning is a critical part of the minimally adequate mental health care that the Constitution requires.”

Established standard in correctional settings

The AMA—along with the American Psychiatric Association, the National Commission on Correctional Health Care and others—believes discharge planning at correctional or detention facilities is essential to meeting the standard of care.

The AMA’s position is that “correctional and detention facilities should provide medical, psychiatric and substance misuse care that meets prevailing community standards, including appropriate referrals for ongoing care upon release from the correctional facility in order to prevent recidivism.”

And facilities at all levels have policies that require discharge planning. At the federal level that includes the Department of Justice’s National Institute of Corrections and the Bureau of Prisons and Immigration and Customs Enforcement.

And the majority of states—and even counties—require mental health care discharge planning for their correctional and detention centers, the Litigation Center brief notes. A 2008 survey of 43 states found that all 43 provided at least a limited supply of interim medication and that 93 percent work collaboratively with mental health agencies to provide discharge planning, according an Urban Institute Justice Policy Center study.

“Failure to provide discharge planning can place individuals with serious mental illness at risk of grave harm,” the brief states. “In the two weeks following discharge, former inmates’ risk of death is nearly 13 times higher than that for an average person; drug overdose and suicide are the two leading causes of deaths. This is of particular concern with respect to discharged inmates suffering serious mental illness, as they have higher rates of both drug abuse and suicidal thoughts and behaviors than average.”

Data shows discharge planning works

Studies have shown that detainees and prisoners with mental illness have reduced rates of recidivism with discharge planning and there is an overall cost-savings to the system, the AMA Litigation Center brief tells the court.

“Continuity of care is critical to effective mental health treatment,” the AMA Litigation Center and others tell the court.