Mentally ill people in United States jails and prisons

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Mentally ill people are over represented in United States jail and prison populations relative to the general population. There are three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States. The exact cause of this over representation is disputed by scholars; proposed causes include the deinstitutionalization of mentally ill individuals in the mid-twentieth century; inadequate community mental health treatment resources; and the criminalization of mental illness itself. The majority of prisons in the United States employ a psychiatrist and a psychologist. While much research claims mentally ill offenders have comparable rates of recidivism to non-mentally ill offenders, other research claims that mentally ill offenders have higher rates of recidivism. Mentally ill people experience solitary confinement at disproportionate rates and are more vulnerable to its adverse psychological effects. Twenty-five states have laws addressing the emergency detention of the mentally ill within jails, and the United States Supreme Court has upheld the right of inmates to mental health treatment.

Prevalence

There is broad scholarly consensus that mentally ill individuals are over represented within the United States jail and prison populations. In the 2010 study titled "More mentally ill persons are in jails and prisons than hospitals: a survey of the states", researchers concluded that, based on statistics from sources including the Bureau of Justice Statistics and the U.S. Department of Health and Human Services, there are currently three times more seriously mentally ill persons in jails and prisons than in hospitals in the United States, with the ratio being nearly ten to one in Arizona and Nevada. "Serious mental illness" is defined here as schizophrenia, bipolar disorder or major depression. Further, they found that sixteen percent of the jail and prison population in the U. S. has a serious mental illness (compared to 6.4 percent in 1983), although this statistic does not reflect differences among individual states. For example, in North Dakota they found that a person with a serious mental illness is equally likely to be in prison or a jail versus hospital, whereas in states such as Arizona, Nevada and Texas, the imbalance is much more severe. Finally, they noted that a 1991 survey through the National Alliance for the Mentally Ill concluded that jail and/or prison is part of the life experience of forty percent of mentally ill individuals.

A separate research study "The Prevalence of Mental Illness among Inmates in a Rural State" noted that national statistics like those previously mentioned primarily pull data from urban jails and prisons. In order to investigate possible differences in rural areas, researchers interviewed a random sample of inmates in both jails and prisons in a rural northeastern state. They found that in this rural setting, there was little evidence of high rates of mental illness within jails, "suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas." However, high rates of serious mental illness were found among the rural prison inmates.

A 2017 report issued by the Bureau of Justice Statistics used self-report survey data from inmates to assess the prevalence of mental health problems among prisoners and jail inmates. They found that 14% of prisoners and 25% of jail inmates had past 30-day serious psychological distress, compared to 5% of the general population. In addition, 37% of prisoners and 44% of jail inmates had a history of a mental health problem.

In 2015 lawyer and activist Bryan Stevenson claimed in his book Just Mercy that over fifty percent of inmates in jails and prisons in the United States had been diagnosed with a mental illness and that one in five jail inmates had a serious mental illness. As for the gender, age, and racial demographics of mentally ill offenders, the 2017 Bureau of Justice Statistics report found that female inmates when compared to male inmates had statistically significant higher rates of serious psychological distress (20.5% of female prisoners and 32.3% of female jail inmates had serious psychological distress, versus 14% of male prisoners and 25.5% of male jail inmates) and a history of a mental health problem (65.8% of female prisoners and 67.9% of female jail inmates compared to 34.8% of male prisoners and 40.8% of male jail inmates). Significant differences between race and ethnicity were also observed. White prisoners and jail inmates were more likely than black or Hispanic inmates to have serious psychological distress or a history of a mental health problems. For example, in local jails, 31% of white inmates compared to 22.3% of black inmates and 23.2% of Hispanic inmates had serious psychological distress. Finally, with regards to age, there were virtually no statistical differences between age groups and the percentage who has serious psychological distress or a history of a mental health problem .

Causes

Deinstitutionalization

Researchers commonly cite deinstitutionalization, or the emptying of state mental hospitals in the mid-twentieth century, as a direct cause of the rise of mentally ill people in prisons. In the 2010 study "More mentally ill persons are in jails and prisons than hospitals: a survey of the states," researchers noted, at least in part due to deinstitutionalization, it is increasingly difficult to find beds for mentally ill people who need hospitalization. Using data collected by the Department of Health and Human Services, they determined there was one psychiatric bed for every 3,000 Americans, compared to one for every 300 Americans in 1955. They also noted increased percentages of mentally ill people in prisons throughout the 1970s and 1980s and found a strong correlation between the amount of mentally ill persons in a state's jails and prisons and how much money that state spends on mental health services. In the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals, researchers note that while deinstitutionalization was carried out with good intentions, it was not accompanied with alternate avenues for mental health treatment for those with serious mental illnesses. According to the authors, Community Mental Health Centers focused their limited resources on individuals with less serious mental illnesses, federal training funds for mental health professionals resulted in lots more psychiatrists in wealthy areas but not in low-income areas, and a policy that made individuals eligible for federal programs and benefits only after they'd been discharged from state mental hospitals unintentionally incentivized discharging patients without follow-up.

In the article "Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate" researchers Steven Raphael and Michael A. Stoll discuss transinstitutionalization, or how many patients released from mental hospitals in the mid-twentieth century ended up in jail or prison. Using U.S. census data collected between 1950-2000, they concluded that "those most likely to be incarcerated as of the 2000 census experienced pronounced increases in overall institutionalization between 1950 and 2000 (with particularly large increases for black males). Thus, the impression created by aggregate trends is somewhat misleading, as the 1950 demographic composition of the mental hospital population differs considerably from the 2000 demographic composition of prison and jail inmates." However, when estimating (using a panel data set) how many individuals incarcerated between 1980 and 2000 would have been institutionalized in years past, they found significant transinstitutionalization rates for all men and women, with the largest rate for white men.

Criminalization

A related cause of the disproportionate amount of mentally ill people in prisons is criminalization of mental illness itself. In the 1984 study "Criminalizing mental disorder: The comparative arrest rate of the mentally ill", researcher L. A. Teplin notes that in addition to a decline in federal support for mental illness resulting in more people being denied treatment, mentally ill people are often stereotyped as dangerous, making fear a factor in action taken against them. Bureaucratic and legal impediments to initiating mental health referrals means arrest can be easier, and in Teplin's words, "Due to the lack of exclusionary criteria, the criminal justice system may have become the institution that cannot say no." Mentally ill people do indeed experience higher arrest rates than those without mental illness, but in order to investigate whether or not this was due to criminalization of mental illness, researchers observed police officers over a period of time. As a result, they concluded "within similar types of situations, persons exhibiting signs of mental disorder have a higher probability of being arrested than those who do not show such signs."

The authors of the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals claim that nationwide, 29% of jails will hold mentally ill individuals with no charges brought against them, sometimes as a means of 'holding' them when psychiatric hospitals are very far away. This practice occurs even in states where it is explicitly forbidden. Beyond that, according to the authors, the vast majority of people with mental illnesses in jails in prisons are held on minor charges like theft, disorderly conduct, alcohol/drug related charges, and trespassing. These are sometimes "mercy bookings" intended to get the homeless mentally ill off the street, a warm meal, etc. Family members have reported being encouraged by mental health professionals or police to get their loved ones arrested as a means of getting them treatment. Finally, some mentally ill people are in jails and prisons on serious charges, such as murder. The authors of Criminalizing the Seriously Mentally Ill claim many such crimes wouldn't have been committed if the individuals had been receiving proper care.

Mental health care in prisons and jails

Psychologists report that one in every eight prisoners were receiving some mental health therapy or counseling services by the middle of the year in 2000. Inmates are generally screened at admission and depending on the severity of the mental illness they are placed in either general confinement or specialized facilities. Inmates can self report mental illness if they feel it is necessary. In the middle of the year in 2000, inmates self reported that State prisons held 191,000 mentally ill inmates. A 2011 survey of 230 correctional mental health service providers from 165 state correctional facilities found that 83% of facilities employed at least one psychologist and 81% employed at least one psychiatrist. The study also found that 52% of mentally ill offenders voluntarily received mental health services, 24% were referred by staff, and 11% were mandated by a court to receive services. Although 64% of providers of mental health services reported feeling supported by prison administration and 71% were involved in continuity of care after release from prison, 65% reported being dissatisfied with funding. Only 16% of participants reported offering vocational training, and the researchers noted that although risk/need/responsivity theory has been shown to reduce the risk for recidivism (or committing another crime after being released), it is unknown whether it is incorporated into mental health services in prisons and jails. A 2005 article by researcher Terry A. Kupers noted that male prisoners tend to under report emotional problems and don't request help until a crisis, and that prison fosters an environment of toxic masculinity, which increases resistance to psychotherapy. A 2017 report from the Bureau of Justice Statistics noted that 54.3% of prisoners and 35% of jail inmates who had past 30-day serious psychological distress has received mental health treatment since admission to the current facility; and 63% of prisoners and 44.5% of jail inmates with a history of a mental health problem said they had received mental health treatment since admission.

Finally, the book Criminalizing the Seriously Mentally Ill: The Abuse of Jails As Mental Hospitals points out that 20% of jails have no mental health resources. In addition, small jails are less likely to have access to mental health resources and are more likely to hold individuals with mental illnesses without charges brought against them. Jails in richer areas are more likely to have access to mental health resources, and jails with more access to mental health resources also dealt less with medication refusal.

Recidivism

Research shows that rates of recidivism, or re-entry into prison, are not significantly higher for mentally ill offenders. A 2004 study found that although 77% of mentally ill offenders studied were arrested or charged with a new crime within the 27-55 month follow-up period, when compared with the general population, "our mentally ill inmates were neither more likely nor more serious recidivists than general population inmates." In contrast, a 2009 study that examined the incarceration history of those in Texas Department of Criminal Justice facilities found that "Texas prison inmates with major psychiatric disorders were far more likely to have had previous incarcerations compared with inmates without a serious mental illness." In the discussion, the researchers noted that their study's results differed from most research on this subject, and hypothesized that this novelty could be due to specific conditions within the state of Texas.

A 1991 study by L. Feder noted that although mentally ill offenders were significantly less like to receive support from family and friends upon release from prison, mentally ill offenders were actually less likely to be revoked on parole. However, for nuisance arrests, mentally ill offenders were less likely to have the charges dropped, although they were more likely to have charges dropped for drug arrests. In both cases, mentally ill offenders were more likely to be tracked into mental health. Finally, there were no significant differences in charges for violent arrests.

Solitary confinement

A broad range of scholarly research maintains that mentally ill offenders are disproportionately represented in solitary confinement and are more vulnerable to the adverse psychological effects of solitary confinement. Due to differing schemes of classification, empirical data on the makeup of inmates in segregated housing units can be difficult to obtain, and estimates of the percentage of inmates in solitary confinement who are mentally ill range from nearly a third, to 11% (with a "major mental disorder"), to 30% (from a study conducted in Washington), to "over half" (from a study conducted in Indiana), depending on how mental illness is determined, where the study is conducted, and other differences in methodology. Researchers J. Metzner and J. Fellner note that mentally ill offenders in solitary confinement "all too frequently" require crisis care or psychiatric hospitalization, and that "many simply won't get better as long as they are isolated." Researchers T. L. Hafemeister and J. George note that mentally ill offenders in isolation are at higher risk for psychiatric injury, self-harm and suicide. A 2014 study that analyzed data from medical records in the New York City jail system found that while self-harm was significantly correlated with having a serious mental illness regardless of whether or not an inmate was in solitary confinement, inmates with serious mental illness in solitary confinement under 18 years of age accounted for the majority of acts of self-harm studied. When brought before federal courts, judges have prohibited or curtailed this practice, and many organizations that deal with human rights, including the United Nations, have condemned it.

In addition, scholars argue the conditions of solitary confinement make it much more difficult to deliver proper psychiatric care. According to researchers J. Metzner and J. Fellner, "Mental health services in segregation units are typically limited to psychotropic medication, a health care clinician stopping at the cell front to ask how the prisoner is doing (i.e., mental health rounds), and occasional meetings in private with a clinician." One study in the American Journal of Public Health claimed that health care professionals must "frequently" conduct consultation through a slit in a cell door or an open tier that provides no privacy.

However, some researchers disagree with the scope of claims surrounding the psychological effects of solitary confinement. For example, in 2006 researchers G. D. Glancy and E. L. Murray conducted a literature review in which they claimed that many frequently-cited studies have methodological concerns, including researcher bias, the use of "volunteer non-prisoners, naturalistic experiments, or case reports, case series, and anecdotes" and concluded "there is little evidence to suggest the majority...kept in SC...experience negative mental health effects." However, they did support claims that inmates with preexisting mental illnesses are more vulnerable and do suffer adverse effects. In their conclusion they claim "we should therefore be concerned about those with pre-existing mental illness who are housed in segregation because there is nowhere else to put them within the correctional system."

Legal aspects

Emergency detention

One major area of legal concern is the emergency detention of the non-criminal mentally ill in jails while waiting for formal procedures for involuntary hospitalization. Twenty-five states and the District of Columbia have laws that specifically address this practice; eight of these states as well as D. C. explicitly forbid it. Seventeen states, on the other hand, explicitly allow it. Within this set, the criteria and circumstances necessary differ by state, and most states limit the detention periods in jails to one to three days. One distinguishing factor of this practice is that it is often initiated by a non-medical professional such as a police officer. In many states, especially those in which a non-public official such as a medical health professional or concerned citizen can initiate the detention, a judge or magistrate is required to approve it before or soon after the initiation.

When emergency detention in jails has been brought to court, judges have generally agreed that the practice itself is not unconstitutional. One notable exception was Lynch v. Baxley; however, later cases, particularly Boston v. Lafeyette County, Mississippi, have connected the ruling of unconstitutionality in that case with the conditions of the jails themselves rather than the fact that they were jails. That being said, the Supreme Court of Illinois has stated that this practice is unconstitutional if the person being detained doesn't pose an imminent threat to himself or others.

Supreme court cases

Several landmark Supreme Court cases, notably Estelle v. Gamble, have established the constitutional right of prison inmates to mental health treatment. Estelle v. Gamble determined that "deliberate indifference to serious medical needs" of prisoners was a violation of the Eighth Amendment to the U.S. Constitution. This case was the first time the phrase "deliberate indifference" was used; it is now a legal term. In order to determine "serious medical need" later cases would use tests such as the treatment being mandated by a physician or an obvious need to a layman. On the other hand, other cases, notably McGukin v. Smith, used much stricter terms, and in 1993 researchers Henry J. Steadman and Joseph J. Cocozza commented that "serious medical need" had little definitional clarity. Langley v. Coughlin involved a prisoner "regularly isolated without proper screening or care" and clarified that a single, distinctive act is not necessary to constitute deliberate indifference but rather "if seriously ill inmates are consistently made to wait for care while their condition deteriorates, or if diagnoses are haphazard and records minimally adequate then, over time, the mental state of deliberate indifference may be attributed to those in charge."

The landmark case Washington v. Harper determined that although inmates do have an interest in and the right to refusal of treatment, this can be overridden without judicial process even if the inmate is competent provided there this act is "reasonably related to legitimate penological interest". Washington's internal process for determining this need was seen as affording due process. In contrast, in Breads v. Moehrle, the forcible injection of drugs in a jail was not upheld because sufficient procedures were not taken to ensure "substantive determination of need".

Court cases

George Daniel, mentally ill man on Alabama's death row was arrested and charged with capital murder. In jail, George became acutely psychotic and couldn't speak in complete sentences. Daniel, had been on death row until several years later, Lawyer Bryan Stevenson uncovered the truth of the doctor who lied about the examination of Daniels mental illness. Daniel's trial was then overturned and has been in a mental institution. Another mentally ill man, Avery Jenkins, was convicted of murder and sentenced to death. Throughout Jenkins's childhood, he had been in and out of foster homes and developed a serious mental illness. Jenkins erratic behavior didn't change, so his foster mother decided to get rid of him by tying him to a tree and left him there. Around the age of sixteen he was left homeless and started to experience psychotic episodes. At the age of twenty, Jenkins had wandered into a strange house, and stabbed a man to death as he perceived it to being a demon. He then was sentenced to death and spent several years in prison as if he had been sane and responsible for his actions. Jenkins the got off death row and was put into a mental institution.

Prison reform

From Wikipedia, the free encyclopedia

 

Prison and Asylums Reform is the attempt to improve conditions inside prisons, establish a much more effective penal system, or implement alternatives to incarceration.

 

In modern times the idea of making living spaces safe and clean have spread from the civilian population to include prisons, on ethical grounds which honor that unsafe and unsanitary prisons violate constitutional (law) prohibitions against cruel and unusual punishment. In recent times prison reform ideas include greater access to legal counsel and family, conjugal visits, proactive security against violence, and implementing house arrest with assistive technology.

History

Prison populations of various countries in 2008

 

Prisons have only been used as the primary punishment for criminal acts in the last few centuries. Far more common earlier were various types of corporal punishment, public humiliation, penal bondage, and banishment for more severe offenses, as well as capital punishment. 

Prisons contained both felons and debtors – the latter of which were allowed to bring in wives and children. The jailer made his money by charging the inmates for food and drink and legal services and the whole system was rife with corruption. One reform of the sixteenth century had been the establishment of the London Bridewell as a house of correction for women and children. This was the only place any medical services were provided.

United Kingdom

During the eighteenth century, British justice used a wide variety of measures to punish crime, including fines, the pillory and whipping. Transportation to The United States of America was often offered, until 1776, as an alternative to the death penalty, which could be imposed for many offenses including pilfering. When they ran out of prisons in 1776 they used old sailing vessels which came to be called hulks as places of temporary confinement. 

The most notable reformer was John Howard who, having visited several hundred prisons across England and Europe, beginning when he was high sheriff of Bedfordshire, published The State of the Prisons in 1777. He was particularly appalled to discover prisoners who had been acquitted but were still confined because they couldn't pay the jailer's fees. He proposed that each prisoner should be in a separate cell with separate sections for women felons, men felons, young offenders and debtors. The prison reform charity, the Howard League for Penal Reform, takes its name from John Howard.

The Penitentiary Act which passed in 1779 following his agitation introduced solitary confinement, religious instruction and a labor regime and proposed two state penitentiaries, one for men and one for women. These were never built due to disagreements in the committee and pressures from wars with France and jails remained a local responsibility. But other measures passed in the next few years provided magistrates with the powers to implement many of these reforms and eventually in 1815 jail fees were abolished.

Quakers such as Elizabeth Fry continued to publicize the dire state of prisons as did Charles Dickens in his novels David Copperfield and Little Dorrit about the Marshalsea. Samuel Romilly managed to repeal the death penalty for theft in 1806, but repealing it for other similar offenses brought in a political element that had previously been absent. The Society for the Improvement of Prison Discipline, founded in 1816, supported both the Panopticon for the design of prisons and the use of the treadwheel as a means of hard labor. By 1824, 54 prisons had adopted this means of discipline. Robert Peel's Gaols Act of 1823 attempted to impose uniformity in the country but local prisons remained under the control of magistrates until the Prison Act of 1877.

The American separate system attracted the attention of some reformers and led to the creation of Millbank Prison in 1816 and Pentonville prison in 1842. By now the end of transportation to Australia and the use of hulks was in sight and Joshua Jebb set an ambitious program of prison building with one large prison opening per year. The main principles were separation and hard labor for serious crimes, using tread wheels and cranks. However, by the 1860s public opinion was calling for harsher measures in reaction to an increase in crime which was perceived to come from the 'flood of criminals' released under the penal servitude system. The reaction from the committee set up under the commissioner of prisons, Colonel Edmund Frederick du Cane, was to increase minimum sentences for many offences with deterrent principles of 'hard labour, hard fare, and a hard bed'. In 1877 he encouraged Disraeli's government to remove all prisons from local government and held a firm grip on the prison system till his forced retirement in 1895. He also established a tradition of secrecy which lasted till the 1970s so that even magistrates and investigators were unable to see the insides of prisons. By the 1890s the prison population was over 20,000.

In 1894-5 Herbert Gladstone's Committee on Prisons showed that criminal propensity peaked from the mid-teens to the mid-twenties. He took the view that central government should break the cycle of offending and imprisonment by establishing a new type of reformatory, that was called Borstal after the village in Kent which housed the first one. The movement reached its peak after the first world war when Alexander Paterson became commissioner, delegating authority and encouraging personal responsibility in the fashion of the English Public school: cell blocks were designated as 'houses' by name and had a housemaster. Cross-country walks were encouraged, and no one ran away. Prison populations remained at a low level until after the second world war when Paterson died and the movement was unable to update itself.

Some aspects of Borstal found their way into the main prison system, including open prisons and housemasters, renamed assistant governors and many Borstal-trained prison officers used their experience in the wider service. But in general the prison system in the twentieth century remained in Victorian buildings which steadily became more and more overcrowded with inevitable results.

United States

In colonial America, punishments were severe. The Massachusetts assembly in 1736 ordered that a thief, on first conviction, be fined or whipped. The second time he was to pay treble damages, sit for an hour upon the gallows platform with a noose around his neck and then be carted to the whipping post for thirty stripes. For the third offense he was to be hanged. But the implementation was haphazard as there was no effective police system and judges wouldn't convict if they believed the punishment was excessive. The local jails mainly held men awaiting trial or punishment and those in debt.

In the aftermath of independence most states amended their criminal punishment statutes. Pennsylvania eliminated the death penalty for robbery and burglary in 1786, and in 1794 retained it only for first degree murder. Other states followed and in all cases the answer to what alternative penalties should be imposed was incarceration. Pennsylvania turned its old jail at Walnut Street into a state prison. New York built Newgate state prison in Greenwich Village and other states followed. But by 1820 faith in the efficacy of legal reform had declined as statutory changes had no discernible effect on the level of crime and the prisons, where prisoners shared large rooms and booty including alcohol, had become riotous and prone to escapes. 

In response, New York developed the Auburn system in which prisoners were confined in separate cells and prohibited from talking when eating and working together, implementing it at Auburn State Prison and Sing Sing at Ossining. The aim of this was rehabilitative: the reformers talked about the penitentiary serving as a model for the family and the school and almost all the states adopted the plan (though Pennsylvania went even further in separating prisoners). The system's fame spread and visitors to the U.S. to see the prisons included de Tocqueville who wrote Democracy in America as a result of his visit.

However, by the 1860s, overcrowding became the rule of the day, partly because of the long sentences given for violent crimes, despite increasing severity inside the prison and often cruel methods of gagging and restraining prisoners. An increasing proportion of prisoners were new immigrants. As a result of a tour of prisons in 18 states, Enoch Wines and Theodore Dwight produced a monumental report describing the flaws in the existing system and proposing remedies. Their critical finding was that not one of the state prisons in the United States was seeking the reformation of its inmates as a primary goal. They set out an agenda for reform which was endorsed by a National Congress in Cincinnati in 1870. These ideas were put into practice in the Elmira Reformatory in New York in 1876 run by Zebulon Brockway. At the core of the design was an educational program which included general subjects and vocational training for the less capable. Instead of fixed sentences, prisoners who did well could be released early.

But by the 1890s, Elmira had twice as many inmates as it was designed for and they were not only the first offenders between 16 and 31 for which the program was intended. Although it had a number of imitators in different states, it did little to halt the deterioration of the country's prisons which carried on a dreary life of their own. In the southern states, in which blacks made up more than 75% of the inmates, there was ruthless exploitation in which the states leased prisoners as chain gangs to entrepreneurs who treated them worse than slaves. By the 1920s drug use in prisons was also becoming a problem. 

At the beginning of the twentieth century, psychiatric interpretations of social deviance were gaining a central role in criminology and policy making. By 1926, 67 prisons employed psychiatrists and 45 had psychologists. The language of medicine was applied in an attempt to "cure" offenders of their criminality. In fact, little was known about the causes of their behavior and prescriptions were not much different from the earlier reform methods. A system of probation was introduced, but often used simply as an alternative to suspended sentences, and the probation officers appointed had little training, and their caseloads numbered several hundred making assistance or surveillance practically impossible. At the same time they could revoke the probation status without going through another trial or other proper process.

In 1913, Thomas Mott Osborne became chairman of a commission for the reform of the New York prison system and introduced a Mutual Welfare League at Auburn with a committee of 49 prisoners appointed by secret ballot from the 1400 inmates. He also removed the striped dress uniform at Sing Sing and introduced recreation and movies. Progressive reform resulted in the "Big House" by the late twenties – prisons averaging 2,500 men with professional management designed to eliminate the abusive forms of corporal punishment and prison labor prevailing at the time. 

The American prison system was shaken by a series of riots in the early 1950s triggered by deficiencies of prison facilities, lack of hygiene or medical care, poor food quality, and guard brutality. In the next decade all these demands were recognized as rights by the courts. In 1954, the American Prison Association changed its name to the American Correctional Association and the rehabilitative emphasis was formalized in the 1955 United Nations Standard Minimum Rules for the Treatment of Prisoners. 

Since the 1960s the prison population in the US has risen steadily, even during periods where the crime rate has fallen. This is partly due to profound changes in sentencing practices due to a denunciation of lenient policies in the late sixties and early seventies and assertions that rehabilitative purposes do not work. As a consequence sentencing commissions started to establish minimum as well as maximum sentencing guidelines, which have reduced the discretion of parole authorities and also reduced parole supervision of released prisoners. Another factor that contributed to the increase of incarcerations was the Reagan administration's "War On Drugs" in the 1980s. This War increased money spent on lowering the number of illegal drugs in the United States. As a result, drug arrests increased and prisons became increasingly more crowded. By 2010, the United States had more prisoners than any other country and a greater percentage of its population was in prison than in any other country in the world. "Mass incarceration" became a serious social and economic problem, as each of the 2.3 million American prisoners costs an average of about $25,000 per year. Recidivism remained high, and useful programs were often cut during the recession of 2009–2010. In 2011, the U.S. Supreme Court in Brown v. Plata upheld the release of thousands of California prisoners due to California's inability to provide constitutionally mandated levels of healthcare. 

In 2015 a bipartisan effort was launched by Koch family foundations, the ACLU, the Center for American Progress, Families Against Mandatory Minimums, the Coalition for Public Safety, and the MacArthur Foundation to more seriously address criminal justice reform in the United States. The Kochs and their partners, are combating the systemic over-criminalization and over-incarceration of citizens from primarily low-income and minority communities. The group of reformers is working to reduce recidivism rates and diminish barriers faced by rehabilitated persons seeking new employment in the work force. In addition they have a goal in ending Asset forfeiture practices since law enforcement often deprives individuals of the majority of their private property.

Europe

The first public prison in Europe was Le Stinch in Florence, constructed in 1297, copied in several other cities. The more modern use grew from the prison workhouse (known as the Rasphuis) from 1600 in Holland. The house was normally managed by a married couple, the 'father' and 'mother', usually with a work master and discipline master. The inmates, or journeymen, often spent their time on spinning, weaving and fabricating cloths and their output was measured and those who exceeded the minimum received a small sum of money with which they could buy extras from the indoor father.

An exception to the rule of forced labor were those inmates whose families could not look after them and paid for them to be in the workhouse. From the later 17th century private institutions for the insane, called the beterhuis, developed to meet this need. 

In Hamburg a different pattern occurred with the spinhaus in 1669, to which only infamous criminals were admitted. This was paid by the public treasury and the pattern spread in eighteenth-century Germany. In France the use of galley servitude was most common until galleys were abolished in 1748. After this the condemned were put to work in naval arsenals doing heavy work. Confinement originated from the hôpitaux généraux which were mostly asylums, though in Paris they included many convicts, and persisted up till the revolution. 

The use of capital punishment and judicial torture declined during the eighteenth century and imprisonment came to dominate the system, although reform movements started almost immediately. Many countries were committed to the goal as a financially self-sustaining institution and the organization was often subcontracted to entrepreneurs, though this created its own tensions and abuse. By the mid nineteenth century several countries initiated experiments in allowing the prisoners to choose the trades in which they were to be apprenticed. The growing amount of recidivism in the latter half of the nineteenth century led a number of criminologists to argue that "imprisonment did not, and could not fulfill its original ideal of treatment aimed at reintegrating the offender into the community". Belgium led the way in introducing the suspended sentence for first-time offenders in 1888, followed by France in 1891 and most other countries in the next few years. Parole had been introduced on an experimental basis in France in the 1830s, with laws for juveniles introduced in 1850, and Portugal began to use it for adult criminals from 1861. The parole system introduced in France in 1885 made use of a strong private patronage network. Parole was approved throughout Europe at the International Prison Congress of 1910. As a result of these reforms the prison populations of many European countries halved in the first half of the twentieth century.

Exceptions to this trend included France and Italy between the world wars, when there was a huge increase in the use of imprisonment. The National Socialist state in Germany used it as an important tool to rid itself of its enemies as crime rates rocketed as a consequence of new categories of criminal behavior. Russia, which had only started to reform its penal and judicial system in 1860 by abolishing corporal punishment, continued the use of exile with hard labor as a punishment and this was increased to a new level of brutality under Joseph Stalin, despite early reforms by the Bolsheviks.

Postwar reforms stressed the need for the state to tailor punishment to the individual convicted criminal. In 1965, Sweden enacted a new criminal code emphasizing non-institutional alternatives to punishment including conditional sentences, probation for first-time offenders and the more extensive use of fines. The use of probation caused a dramatic decline in the number women serving long-term sentences: in France the number fell from 5,231 in 1946 to 1,121 in 1980. Probation spread to most European countries though the level of surveillance varies. In the Netherlands, religious and philanthropic groups are responsible for much of the probationary care. The Dutch government invests heavily in correctional personnel, having 3,100 for 4,500 prisoners in 1959.

However, despite these reforms, numbers in prison started to grow again after the 1960s even in countries committed to non-custodial policies.

Theories

Retribution, vengeance and retaliation

This is founded on the "eye for an eye, tooth for a tooth" incarceration philosophy, which essentially states that if one person harms another, then an equivalent harm should be done to them. One goal here is to prevent vigilantism, gang or clan warfare, and other actions by those who have an unsatisfied need to "get even" for a crime against them, their family, or their group. It is, however, difficult to determine how to equate different types of "harm". A literal case is where a murderer is punished with the death penalty, the argument being "justice demands a life for a life". One criticism of long term prison sentences and other methods for achieving justice is that such "warehousing" of criminals is rather expensive, this argument notwithstanding the fact that the multiple incarceration appeals of a death penalty case often exceed the price of the "warehousing" of the criminal in question. Yet another facet of this debate disregards the financial cost for the most part. The argument regarding warehousing rests, in this case, upon the theory that any punishment considered respectful of human rights should not include caging humans for life without chance of release—that even death is morally and ethically a higher road than no-parole prison sentences.

Deterrence

The criminal is used as a "threat to themselves and others". By subjecting prisoners to harsh conditions, authorities hope to convince them to avoid future criminal behavior and to exemplify for others the rewards for avoiding such behavior; that is, the fear of punishment will win over whatever benefit or pleasure the illegal activity might bring. The deterrence model frequently goes far beyond "an eye for an eye", exacting a more severe punishment than would seem to be indicated by the crime. Torture has been used in the past as a deterrent, as has the public embarrassment and discomfort of stocks, and, in religious communities, excommunication. Executions, particularly gruesome ones (such as hanging or beheading), often for petty offenses, are further examples of attempts at deterrence. One criticism of the deterrence model is that criminals typically have a rather short-term orientation, and the possibility of long-term consequences is of little importance to them. Also, their quality of life may be so horrific that any treatment within the criminal justice system (which is compatible with human rights law) will only be seen as an improvement over their previous situation.There used to be many European Monks who disagreed with the containment of the mentally ill, and their ethics had a strong influence towards Dix's mission to find a proper way to care for the challenged people.

Rehabilitation, reform and correction

("Reform" here refers to reform of the individual, not the reform of the penal system.) The goal is to "repair" the deficiencies in the individual and return them as productive members of society. Education, work skills, deferred gratification, treating others with respect, and self-discipline are stressed. Younger criminals who have committed fewer and less severe crimes are most likely to be successfully reformed. "Reform schools" and "boot camps" are set up according to this model. One criticism of this model is that criminals are rewarded with training and other items which would not have been available to them had they not committed a crime. 

Prior to its closing in late 1969, Eastern State Penitentiary, then known as State Correctional Institution, Philadelphia, had established a far reaching program of voluntary group therapy with the goal of having all inmates in the prison involved. From 1967 when the plan was initiated, the program appears to have been successful as many inmates did volunteer for group therapy. An interesting aspect was that the groups were to be led by two therapists, one from the psychology or social work department and a second from one of the officers among the prison guard staff.

Removal from society

The goal here is simply to keep criminals away from potential victims, thus reducing the number of crimes they can commit. The criticism of this model is that others increase the number and severity of crimes they commit to make up for the "vacuum" left by the removed criminal. For example, incarcerating a drug dealer will result in an unmet demand for drugs at that locale, and an existing or new drug dealer will then appear, to fill the void. This new drug dealer may have been innocent of any crimes before this opportunity, or may have been guilty of less serious crimes, such as being a look-out for the previous drug dealer.

Restitution or repayment

Prisoners are forced to repay their "debt" to society. Unpaid or low pay work is common in many prisons, often to the benefit of the community. In some countries prisons operate as labour camps. Critics say that the repayment model gives government an economic incentive to send more people to prison. In corrupt or authoritarian regimes, such as the former Soviet Union under the control of Joseph Stalin, many citizens are sentenced to forced labor for minor breaches of the law, simply because the government requires the labor camps as a source of income. Community service is increasingly being used as an alternative to prison for petty criminals.

Reduction in immediate costs

Government and prison officials also have the goal of minimizing short-term costs.

In wealthy societies:

This calls for keeping prisoners placated by providing them with things like television and conjugal visits. Inexpensive measures like these prevent prison assaults and riots which in turn allow the number of guards to be minimized. Providing the quickest possible parole and/or release also reduces immediate costs to the prison system (although these may very well increase long term costs to the prison system and society due to recidivism). The ultimate way to reduce immediate costs is to eliminate prisons entirely and use fines, community service, and other sanctions (like the loss of a driver's license or the right to vote) instead. Executions at first would appear to limit costs, but, in most wealthy societies, the long appeals process for death sentences (and associated legal costs) make them quite expensive. Note that this goal may conflict with a number of goals for criminal justice systems.

In poor societies:

Poor societies, which lack the resources to imprison criminals for years, frequently use execution in place of imprisonment, for severe crimes. Less severe crimes, such as theft, might be dealt with by less severe physical means, such as amputation of the hands. When long term imprisonment is used in such societies, it may be a virtual death sentence, as the lack of food, sanitation, and medical care causes widespread disease and death, in such prisons.

Some of the goals of criminal justice are compatible with one another, while others are in conflict. In the history of prison reform, the harsh treatment, torture, and executions used for deterrence first came under fire as a violation of human rights. The salvation goal, and methods, were later attacked as violations of the individual's freedom of religion. This led to further reforms aimed principally at reform/correction of the individual, removal from society, and reduction of immediate costs. The perception that such reforms sometimes denied victims justice then led to further changes.

Examples

John Howard is now widely regarded as the founding father of prison reform, having travelled extensively visiting prisons across Europe in the 1770s and 1780s. Also, the great social reformer Jonas Hanway promoted "solitude in imprisonment, with proper profitable labor and a spare diet". Indeed, this became the popular model in England for many decades.

United Kingdom

Within Britain, prison reform was spearheaded by the Quakers, and in particular, Elizabeth Fry during the Victorian Age. Elizabeth Fry visited prisons and suggested basic human rights for prisoners, such as privacy and teaching prisoners a trade. Fry was particularly concerned with women's rights. Parliament, coming to realize that a significant portion of prisoners had come to commit crimes as a result of mental illness, passed the County Asylums Act (1808). This made it possible for Justice of the Peace in each county to build and run their own pauper asylums.

Whereas the practice of confining such lunatics and other insane persons as are chargeable to their respective parishes in Gaols, Houses of Correction, Poor Houses and Houses of Industry, is highly dangerous and inconvenient.

There is contemporary research on the use of volunteers by governments to help ensure the fair and humane detention of prisoners. Research suggests that volunteers can be effective to ensure oversight of state functions and ensure accountability, however, they must be given tasks appropriately and well trained.

United States

Johnny Cash advocated prison reform at his July 1972 meeting with United States President Richard Nixon.

 

In the 1800s, Dorothea Dix toured prisons in the U.S. and all over Europe looking at the conditions of the mentally handicapped. Her ideas led to a mushroom effect of asylums all over the United States in the mid-19th-century. Linda Gilbert established 22 prison libraries of from 1,500 to 2,000 volumes each, in six states. 

In the early 1900s Samuel June Barrows was a leader in prison reform. President Cleveland appointed him International Prison Commissioner for the U.S. in 1895, and in 1900 Barrows became Secretary of the Prison Association of New York and held that position until his death on April 21, 1909. A Unitarian pastor, Barrows used his influence as editor of the Unitarian Christian Register to speak at meetings of the National Conference of Charities and Correction, the National International Prison Congresses, and the Society for International Law. As the International Prison Commissioner for the U.S., he wrote several of today's most valuable documents of American penological literature, including "Children's Courts in the United States" and "The Criminal Insane in the United States and in Foreign Countries". As a House representative, Barrows was pivotal in the creation of the International Prison Congress and became its president in 1905. In his final role, as Secretary of the Prison Association of New York, he dissolved the association's debt, began issuing annual reports, drafted and ensured passage of New York's first probation law, assisted in the implementation of a federal Parole Law, and promoted civil service for prison employees. Moreover, Barrows advocated improved prison structures and methods, traveling in 1907 around the world to bring back detailed plans of 36 of the best prisons in 14 different countries. In 1910 the National League of Volunteer Workers, nicknamed the "Barrows League" in his memory, formed in New York as a group dedicated to helping released prisoners and petitioning for better prison conditions. 

Zebulon Brockway in Fifty Years of Prison Service outlined an ideal prison system: Prisoners should support themselves in prison though industry, in anticipation of supporting themselves outside prison; outside businesses and labor must not interfere; indeterminate sentences were required, making prisoners earn their release with constructive behavior, not just the passage of time; and education and a Christian culture should be imparted. Nevertheless, opposition to prison industries, the prison-industrial complex, and labor increased. Finally, U.S. law prohibited the transport of prison-made goods across state lines. Most prison-made goods today are only for government use—but the state and federal governments are not required to meet their needs from prison industries. Although nearly every prison reformer in history believed prisoners should work usefully, and several prisons in the 1800s were profitable and self-supporting, most American prisoners today do not have productive jobs in prison.

Kim Kardashian-West has fought for prison reform, notably visiting the White House to visit President Donald Trump in on May 30th, 2018. 

Musician Johnny Cash performed and recorded at many prisons and fought for prison reform.

Community health

From Wikipedia, the free encyclopedia

 

Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities. It is a distinct field of study that may be taught within a separate school of [public health] or [environmental health]. The WHO defines community health as:

...environmental, social, and economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment.

Community health tends to focus on a defined geographical community. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as InfoShare or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries.

Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. Each category focuses on a different level and approach towards the community or population group. In the United States, community health is rooted within primary healthcare achievements. Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.

The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (mass communication). The latest shift is towards health marketing.

Measuring community health

Community health is generally measured by geographical information systems and demographic data. Geographic information systems can be used to define sub-communities when neighborhood location data is not enough. Traditionally community health has been measured using sampling data which was then compared to well-known data sets, like the National Health Interview Survey or National Health and Nutrition Examination Survey. With technological development, information systems could store more data for small scale communities, cities, and towns; as opposed to census data that only generalizes information about small populations based on the overall population. Geographical information systems (GIS) can give more precise information of community resources, even at neighborhood levels. The ease of use of geographic information systems (GIS), advances in multilevel statistics, and spatial analysis methods makes it easier for researchers to procure and generate data related to the built environment.

Social media can also play a big role in health information analytics. Studies have found social media being capable of influencing people to change their unhealthy behaviors and encourage interventions capable of improving health status. Social media statistics combined with geographical information systems (GIS) may provide researchers with a more complete image of community standards for health and well being.

Categories of community health

Primary healthcare and primary prevention

Community based health promotion emphasizes primary prevention and population based perspective(traditional prevention). It is the goal of community health to have individuals in a certain community improve their lifestyle or seek medical attention. Primary healthcare is provided by health professionals, specifically the ones a patient sees first that may refer them to secondary or tertiary care.

Primary prevention refers to the early avoidance and identification of risk factors that may lead to certain diseases and disabilities. Community focused efforts including immunizations, classroom teaching, and awareness campaigns are all good examples of how primary prevention techniques are utilized by communities to change certain health behaviors. Prevention programs, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up. This finding also applies to all groups and classes of people. Prevention programs are one of the most effective tools health professionals can use to greatly impact individual, population, and community health.

Secondary healthcare and secondary prevention

Community health can also be improved with improvements in individuals' environments. Community health status is determined by the environmental characteristics, behavioral characteristics, social cohesion in the environment of that community. Appropriate modifications in the environment can help to prevent unhealthy behaviors and negative health outcomes.

Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient, since it's too late to prevent them from their current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case.

Chronic disease self management programs

Chronic diseases has been a growing phenomena within recent decades, affecting nearly 50% of adults within the US in 2012. Such diseases include asthma, arthritis, diabetes, and hypertension. While they are not directly life-threatening, they place a significant burden on daily lives, affecting quality of life for the individual, their families, and the communities they live in, both socially and financially. Chronic diseases are responsible for an estimated 70% of healthcare expenditures within the US, spending nearly $650 billion per year.

With steadily growing numbers, many community healthcare providers have developed self-management programs to assist patients in properly managing their own behavior as well as making adequate decisions about their lifestyle. Separate from clinical patient care, these programs are facilitated to further educate patients about their health conditions as a means to adopt health-promoting behaviors into their own lifestyle. Characteristics of these programs include:

• grouping patients with similar chronic diseases to discuss disease-related tasks and behaviors to improve overall health
• improving patient responsibility through daily disease-monitoring
• inexpensive and widely-known

Chronic Disease self-management programs are structured to help improve overall patient health and quality of life as well as utilize less healthcare resources, such as physician visits and emergency care. Furthermore, better self-monitoring skills can help patients effectively and efficiently make better use of healthcare professionals' time, which can result in better care. Many self-management programs either are conducted through a health professional or a peer diagnosed with a certain chronic disease trained by health professionals to conduct the program. No significant differences have been reported comparing the effectiveness of both peer-led versus professional led self-management programs.

The distribution of rural CDSME program participantsvaried across the US. Analysis across rurality indicated that approximately 22.1% (using county-level rurality) to24.4% (using ZCTA/ZIP Code-level rurality) of CDSME programparticipants resided in rural areas.

 

There has been a lot of debate regarding the effectiveness of these programs and how well they influence patient behavior and understanding their own health conditions. Some studies argue that self-management programs are effective in improving patient quality of life and decreasing healthcare expenditures and hospital visits. A 2001 study assessed health statuses through healthcare resource utilization and self-management outcomes after 1 and 2 years to determine the effectiveness of chronic disease self-management programs. After analyzing 800 patients diagnosed with various types of chronic conditions, including heart disease, stroke, and arthritis, the study found that after the 2 years, there was a significant improvement in health status and fewer emergency department and physician visits (also significant after 1 year). They concluded that these low-cost self-management programs allowed for less healthcare utilization as well as an improvement in overall patient health. Another study in 2003 by the National Institute for Health Research analyzed a 7-week chronic disease self-management program in its cost-effectiveness and health efficacy within a population over 18 years of age experiencing one or more chronic diseases. They observed similar patterns, such as an improvement in health status, reduced number of visits to the emergency department and to physicians, shorter hospital visits. They also noticed that after measuring unit costs for both hospital stays ($1000) and emergency department visits ($100), the study found the overall savings after the self-management program resulted in nearly $489 per person. Lastly, a meta-analysis study in 2005 analyzed multiple chronic disease self-management programs focusing specifically on hypertension, osteoarthritis, and diabetes mellitus, comparing and contrasting different intervention groups. They concluded that self-management programs for both diabetes and hypertension produced clinically significant benefits to overall health.

On the other hand, there are a few studies measuring little significance of the effectiveness of chronic disease self-management programs. In the previous 2005 study in Australia, there was no clinical significance in the health benefits of osteoarthritis self-management programs and cost-effectiveness of all of these programs. Furthermore, in a 2004 literature review analyzing the variability of chronic disease self-management education programs by disease and their overlapping similarities, researchers found "small to moderate effects for selected chronic diseases," recommending further research being conducted.

Some programs are looking to integrate self-management programs into the traditional healthcare system, specifically primary care, as a way to incorporate behavioral improvements and decrease the increased patient visits with chronic diseases. However, they have argued that severe limitations hinder these programs from acting its full potential. Possible limitations of chronic disease self-management education programs include the following:

• under representation of minority cultures within programs
• lack of medical/health professional (particularly primary care) involvement in self-management programs
• low profile of programs within community
• lack of adequate funding from federal/state government
• low participation of patients with chronic diseases in program
• uncertainty of effectiveness/reliability of programs

Tertiary healthcare

In tertiary healthcare, community health can only be affected with professional medical care involving the entire population. Patients need to be referred to specialists and undergo advanced medical treatment. In some countries, there are more sub-specialties of medical professions than there are primary care specialists. Health inequalities are directly related to social advantage and social resources.

Aspects of care that distinguish conventional health care from people-centered primary care

Conventional ambulatory medical care in clinics or outpatient departments	Disease control programs	People-centered primary care
Focus on illness and cure	Focus on priority diseases	Focus on health needs
Relationship limited to the moment of consultation	Relationship limited to program implementation	Enduring personal relationship
Episodic curative care	Program-defined disease control interventions	Comprehensive, continuous and person-centered care
Responsibility limited to effective and safe advice to the patient at the moment of consultation	Responsibility for disease-control targets among the target population	Responsibility for the health of all in the community along the life cycle; responsibility for tackling determinants of ill-health
Users are consumers of the care they purchase	Population groups are targets of disease-control interventions	People are partners in managing their own health and that of their community

Challenges and difficulties with community health

Summary of Governance Issues, Strategies, and New/Lingering Problems

 

The complexity of community health and its various problems can make it difficult for researchers to assess and identify solutions. Community-based participatory research (CBPR) is a unique alternative that combines community participation, inquiry, and action. Community-based participatory research (CBPR) helps researchers address community issues with a broader lens and also works with the people in the community to find culturally sensitive, valid, and reliable methods and approaches.

Other issues involve access and cost of medical care. A great majority of the world does not have adequate health insurance. In low-income countries, less than 40% of total health expenditures are paid for by the public/government. Community health, even population health, is not encouraged as health sectors in developing countries are not able to link the national authorities with the local government and community action.

In the United States, the Affordable Care Act (ACA) changed the way community health centers operate and the policies that were in place, greatly influencing community health. The ACA directly affected community health centers by increasing funding, expanding insurance coverage for Medicaid, reforming the Medicaid payment system, appropriating $1.5 billion to increase the workforce and promote training. The impact, importance, and success of the Affordable Care Act is still being studied and will have a large impact on how ensuring health can affect community standards on health and also individual health.

Academic resources

• Journal of Urban Health, Springer. ISSN 1468-2869 (electronic) ISSN 1099-3460 (paper).
• International Quarterly of Community Health Education, Sage Publications. ISSN 1541-3519 (electronic), ISSN 0272-684X (paper).
• Global Public Health, Informa Healthcare. ISSN 1744-1692 (paper).
• Journal of Community Health, Springer. ISSN 1573-3610.
• Family and Community Health, Lippincott Williams & Wilkins. ISSN 0160-6379 (electronic).
• Health Promotion Practice, Sage Publications. ISSN 1552-6372 (electronic) ISSN 1524-8399 (paper).
• Journal of Health Services Research and Policy, Sage Publications. ISSN 1758-1060 (electronic) ISSN 1355-8196 (paper).
• BMC Health Sciences Research, Biomed Central. ISSN 1472-6963 (electronic).
• Health Services Research, Wiley-Blackwell. ISSN 1475-6773 (electronic).
• Health Communication and Literacy: An Annotated Bibliography, Centre for Literacy of Quebec. ISBN 0968103456.