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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 (at least) one former inmate, we will develop a novel line of bioethics research to examine ethics and policy questions in correctional mental health care.

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



More From ScattergoodEthics

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Research In the News

Here & Now's Jeremy Hobson talks about the state of mental health hospitals in the U.S. with Dominic Sisti (@domsisti), a medical ethicist at the University of Pennsylvania. | November 30, 2017 | Listen

The Washington Post | "He’s in prison for life for a violent carjacking. His mother says he belongs in a mental hospital." | September 24, 2017 | Read Article

The Atlantic | "Who Decides Where Autistic Adults Live?" | May 26, 2015 | Read Article

VICE | "The Life, Death, and Possible Resurrection of the Asylum" | April 27, 2015 | Read Article

The New York Times | "The Modern Asylum" | February 18, 2015 | Read Article

Nature | "Rave drug holds promise for treating depression fast" | January 7, 2015 | Read Article

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Who Decides Where Autistic Adults Live?

Amy Lutz | The Atlantic | May 26, 2015

"We were trying to rehabilitate the term [asylum], bring it back to its original meaning, which is a place of sanctuary and healing,” Sisti said. “But it turned out to be too distracting. Everyone focused on that instead of the ethical imperative, which is clear: We need settings that match up with each individual’s needs.

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Assent as an Ethical Imperative in the Treatment of ADHD

Anson Koshy & Dominic Sisti | The Journal of Medical Ethics

Ethical debates about the origins, status, and treatment of ADHD have been happening for decades.  We argue that assent for ADHD related treatment can be a valuable clinical tool for clinicians in promoting aspects of shared decision making, family centered care and supporting the transition of care to adulthood. Meaningful assent requires an ongoing process and dialogue between all parties involved in the medical decision-making of a child’s health. 

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Seeking Common Ground in Very Different Views of Mental Illness

February 27, 2015

Dominic Sisti, Joseph Rogers, Michael Brody, Andrea Segal | The Public's Health

Mental health care in the United States continues to be under-resourced, plagued by fragmentation, subjected to ever-changing political forces, and influenced by public misunderstanding and controversy. Consensus on how to best serve people with mental health conditions remains elusive. 

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Applied Ethics in Mental Health Care: An Interdisciplinary Reader (MIT Press, 2013)

Dominic Sisti, Arthur Caplan, Hila Rimon-Greenspan, eds.

"In this superb volume, Sisti, Caplan, and Rimon-Greenspan have gathered in one place some of the most thoughtful and incisive thinkers about the difficulties of caring for people with mental illness. Applied Ethics in Mental Health Care is an important and timely contribution to this ongoing ethical conversation."—Paul Root Wolpe, Asa Griggs Candler Professor of Bioethics and Director of the Center for Ethics, Emory University


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Immune to Addiction: The Ethical Dimensions of Vaccines Against Substance Abuse

Michael J. Young, Dominic A. Sisti, Hila Rimon-Greenspan, Jason L. Schwartz, and Arthur L. Caplan.  Nature Immunology 13, no. 6 (2012): 521-524.

Promising advances have been made in recent years for a unique class of immunotherapies that use vaccination to combat substance-use disorders. Although such vaccines are potentially useful for addictions, they raise a variety of ethical and social questions.

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Drug Therapy for Alcohol Dependency: What's the Issue? 

Arthur Caplan

Naltrexone, which is sold under the trade names Depade and Revia and in an extended release version called Vivitrol, has been shown in many studies by many groups in the United States and other nations to be a very safe drug that is highly effective in treating alcoholism. Yet, relatively few programs that treat chronic alcoholics use the drug. Why?

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Mental Health Reform in America: Thomas Scattergood (1748 – 1814)

David Roby 

The personal disposition of Thomas Scattergood combined with the timing of his visit to the York Retreat were profoundly fortuitous in the founding of Friends Hospital. “To Thomas Scattergood, a minister in the Society of Friends, it is generally believed that we are indebted for the inception of the institution.”

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