Onah Michael E
JD candidate 2018, Boston University School of Law. I would like to thank my AJLM Editor-in-Chief Andrea-Gale Okoro, Executive Editor Nicholaas Honig, and the entire AJLM staff for publishing my Note. I thank Professor Frances Miller for her invaluable guidance in the editing process. I am forever grateful to Paula and Joseph Onah, my parents, who continue to support and encourage me to follow my convictions and my passions. I would also like to thank my fiancé, Dr. Eileen Harrigan, who inspires me in so many ways on a daily basis but specifically inspired and encouraged me to write this Note. I dedicate this Note to the memory of Deborah Danner.
Am J Law Med. 2018 Mar;44(1):119-144. doi: 10.1177/0098858818763818.
A component of the 1965 Medicaid Act, the Institutions for Mental Diseases ("IMD") Exclusion was supposed to be a remedy for the brutal, dysfunctional mental healthcare system run through state hospitals. In the years since Medicaid was created, the IMD Exclusion has instead barred thousands of those in need of intensive, inpatient treatment from receiving it. As a result, many severely mentally ill individuals are left without adequate care and without a home. They struggle in the street where they are otherized by those in their community and are susceptible to confrontational episodes with law enforcement. Many are ultimately incarcerated, where they are thrust into an abusive environment known to exacerbate mental health issues. This Note's central contention is that the IMD Exclusion creates an access gap for the poorest Americans who suffer from mental illness. Subsequently, prisons and jails fill that gap to the detriment of those individuals. The Note will proceed first by explaining the IMD Exclusion and how it applies to state-run medical care services and facilities. This Note will discuss the nationwide movement, in the 1950s through the 1960s and '70s, to deinstitutionalize notoriously abusive state psychiatric hospitals, a movement that culminated in the passage of the Medicaid Act in 1965, along with the IMD Exclusion. This Note will then shift focus to criticize the practical effects of the IMD Exclusion and its extensive role in the mass incarceration issue today. In doing so, this Note will identify the major weaknesses of the IMD Exclusion and explain how these weaknesses create an access gap for mentally ill persons, while simultaneously making them more vulnerable to contact with the police and the criminal justice system.
作为1965年《医疗补助法案》的一部分，“精神病院排除条款”本应是对由州立医院运营的残酷、功能失调的精神卫生保健系统的一种补救措施。自医疗补助制度建立以来的这些年里，“精神病院排除条款”反而阻止了成千上万需要强化住院治疗的人获得这种治疗。结果，许多严重精神疾病患者得不到充分的护理，也没有家。他们流落街头，在社区中被他人边缘化，容易与执法人员发生冲突事件。许多人最终被监禁，在那里他们被置于一个已知会加剧心理健康问题的虐待环境中。本论文的核心论点是，“精神病院排除条款”为患有精神疾病的最贫困美国人制造了获取医疗服务的差距。随后，监狱填补了这一差距，对这些人造成了损害。本论文首先将解释“精神病院排除条款”及其如何适用于国营医疗服务和设施。本论文将讨论20世纪50年代至60年代和70年代全国范围内将臭名昭著的虐待性州立精神病院去机构化的运动，这一运动最终促成了1965年《医疗补助法案》以及“精神病院排除条款”的通过。然后，本论文将把重点转向批评“精神病院排除条款”的实际影响及其在当今大规模监禁问题中的广泛作用。在此过程中，本论文将指出“精神病院排除条款”的主要弱点，并解释这些弱点如何为精神病患者制造了获取医疗服务的差距，同时使他们更容易与警察和刑事司法系统接触。
