b'Mental health Salud mentalChristine Montross, M.d.Psychiatrist, author of Waiting for an EchoThe Madness of American Incarceration, USAMdica especialista en Psiquiatra, autora de Waiting for an EchoThe Madness of American Incarceration, Estados Unidos de amricaWhat solutions for the mentally ill caught in the web of a broken criminal justice system?Qu soluciones para los enfermos mentales atrapados en la red de una justicia penal rota?JT: What made you embark on exploring incarceration and how theJT: Qu le hizo embarcarse en la exploracin del encarcelamiento American legal system manages mental health? y de cmo el sistema legal estadounidense gestiona la salud mental?CM: I am an inpatient psychiatrist. I work in a psychiatric hospital onCM: Soy psiquiatra para pacientes hospitalizados. Trabajo en un hospital the intensive treatment unitsthe mental health equivalents of medicalpsiquitrico en las unidades de tratamiento intensivo, los equivalentes de intensive care units. The patients who are hospitalized there are the mostsalud mental de las unidades de cuidados intensivos mdicos. Los pacientes severely ill patients in our facility. They actively hear voices or see visions;que estn hospitalizados all son los pacientes que estn ms gravemente they are profoundly depressed, really trying to hurt themselves or otherenfermos de nuestras instalaciones. Estn escuchando activamente voces people; very manic; or grandiose or delusional. My patients are reallyo viendo visiones; estn profundamente deprimidos; realmente tratando de suffering from their severe mental illnesses.hacerse dao a s mismos o a otras personas; con episodios muy manacos; What I found in that role was that over and over again, I was hearing fromgrandiosos o delirantes. Mis pacientes estn sufriendo realmente debido my patients that they were coming in contact with the police. Sometimesa sus enfermedades mentales graves. Lo que descubr al desempear ese the police encounter led them to the hospital. But oftentimes, the policepapel fue que, una y otra vez, mis pacientes me decan que estaban en encounter ended up with them going to jail. And I thought about howcontacto con la polica. A veces el encuentro con la polica los llevaba al difficult it was for my patients to comply with instructions, even withinhospital. Pero a menudo el encuentro con la polica terminaba con ellos a therapeutic environment like a hospital, and I began to wonder whatyendo a la crcel. Y pens en lo difcil que era para mis pacientes cumplir it must be like for them to be in a punitive environment that demandedcon las instrucciones, incluso dentro de un ambiente teraputico como un compliance, like a jail or a prison.hospital, y empec a preguntarme cmo debe ser para ellos estar en un To understand this more, I started doing competency to stand trialentorno punitivo que exiga obediencia, como una crcel o una prisin. Para evaluations. In the US, if a defence attorney or a judge has a concernentender mejor esto, empec a hacer evaluaciones de prueba de capacidad about a defendant\'s ability to understand their charges, or how the courtpara comparecer en juicio. En los EE. UU., si un abogado defensor o un works, or whether they can work with their attorney, then the judge canjuez estn preocupados por la capacidad del acusado para comprender sus order a competency evaluation so that a mental health provider can assesscargos, o cmo funciona el tribunal, o si pueden trabajar con su abogado, whether or not that person is competent to stand trial.entonces el juez puede ordenar una evaluacin de competencia para que Through this work, I began really seeing firsthand that the people I wasun proveedor de salud mental pueda determinar si esa persona es o no evaluating in our country\'s jails were often no different from the people thatcompetente para ser juzgada. I was seeing in my hospital. And, often, the men and women I evaluatedFue a travs de este trabajo que empec a ver de primera mano que las in jail were incarcerated for reasons that had very little to do with criminalpersonas que estaba evaluando en las crceles de nuestro pas a menudo no intent and very much to do with their psychiatric symptomatology. Foreran tan diferentes de las personas que estaba viendo en mi hospital. Y, a example, they may have been shouting at their hallucinations in the coffeemenudo, los hombres y mujeres que evalu en la crcel fueron encarcelados shop or may have charged through security at an airport because they hadpor razones que tenan muy poco que ver con la intencin criminal y a delusion about needing to get on a particular flight. In those moments,mucho que ver con su sintomatologa psiquitrica. Por ejemplo, pueden police are called, and the legal system takes over.haber estado gritando a sus alucinaciones en la cafetera, o pueden haber I was a writer before I was a doctor; I was a poet before I ever went toembestido a personas en el control de seguridad de un aeropuerto porque medical school. I started writing as a child as a way of making sense oftenan un delirio acerca de la necesidad de subirse a un vuelo en particular. the world. And, when I started my career in medicine, I really leaned onEn esos momentos, se llama a la polica y el sistema judicial se hace cargo. writing to make sense of the things that I was encountering: as a first- Antes de ser mdica fui escritora, fui poeta antes de estudiar Medicina. year medical student, I wrote a book about the experience of dissectingEmpec a escribir cuando era una nia, como una forma de dar sentido a cadaver; I wrote a book about the most difficult and most compellingal mundo. Y, cuando comenc mi carrera en Medicina, realmente me cases that I had as a novice psychiatrist. And then this became one ofapoy en la escritura para dar sentido a las cosas a las que me estaba those questions that really was burning for me: "What was happening toenfrentando: como estudiante de primer ao de Medicina, escrib un libro my patients when they were in these punitive environments?"sobre la experiencia de diseccionar un cadver; escrib un libro sobre los I began talking to my patients about what their experiences were like withcasos ms difciles y convincentes que tuve como psiquiatra novata. Y police and in jail. I was performing competency evaluations in correctionalentonces esta se convirti en una de esas preguntas que realmente me facilities. And I also started visiting several jails and prisons around theardan: Qu les estaba pasando a mis pacientes cuando estaban en estos country. I went to Cook County Jail in Chicago, which is the largestentornos punitivos? psychiatric facility in our country. Even though it is not a psychiatricEmpec a hablar con mis pacientes sobre cmo eran sus experiencias con hospital, Cook County Jail holds more psychiatrically ill people than anyla polica y en la crcel. Realic evaluaciones de competencia en centros other facility in America.penitenciarios y tambin empec a visitar varias crceles y prisiones I spent a lot of time at Northern Correctional Institution (a supermaxde todo el pas. Fui a la crcel del condado de Cook en Chicago, que state prison in Connecticut) where men are held in solitary confinementes el centro psiquitrico ms grande de nuestro pas. Aunque no es un Semester / Semestre 12021JUSTICE TRENDS // 1 1 3'