Combating Global Warming Brings Population Back to the Agenda

Leiwen Jiang

In recent years, population has fallen off the international environment and development agenda. Could climate change refocus our attention on population growth?

Two landmark conferences of the 1990s really seemed to get the links between human population
and the environment. The 1992 Rio
Declaration
on Environment and Development noted that "human beings are the
centre of concern for sustainable development." Building on this two years
later, the Cairo Programme of Action included the objective "to reduce both
unsustainable consumption and production patterns as well as negative impacts
of demographic factors on the environment in order to meet the needs of current
generations without compromising the ability of future generations to meet
their own needs."

But in the following years, population started to fall off the map. In
2002, after several preparatory meetings for the Johannesburg
Summit
(the UN’s World Summit on Sustainable Development), population as a
key component of sustainable development was still absent from the agenda. As a
response, Wolfgang Lutz of the International
Institute for Applied Systems Analysis
(IIASA) and 34 other distinguished
scientists from various disciplines and regions organized the Global Science Panel on Population
and Environment
, calling for population to be included at the core of the
agenda. Though the panel successfully got the message out, participating
governments eventually decided to leave population out of the negotiation
process.

Population was at the center of public discussion, many national policies,
and almost all international conferences and agreements from the late 1950’s to
the early 1990’s. The sudden shift away from this issue was unexpected for many
people, and just as population, family planning, and reproductive health were
left out of the Millennium
Development Goals
, population has been largely absent from the response to
climate change, potentially the greatest environmental threat we have ever
faced.

Population has been overlooked by the Intergovernmental
Panel on Climate Change
(IPCC), which sets the gold standard in climate
research. Its 1995 report devoted only a few pages to the role of population in
this 2,000 page document; the companion summary for policymakers did not even
mention population. Population was also forgotten in the 1997 Kyoto Protocol,
aimed at limiting carbon dioxide emissions and reducing the threat of global
climate change.

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John Bongaarts, a leading demographer at the Population
Council
,
and Brian O’Neill, a scientist at the National Center for Atmospheric
Research
, argue that three common misconceptions can explain why population has been
pushed to the fringe: the beliefs that (1) the real problem is consumption, not population; (2)
not much can be done about population, and (3) strengthening population
policies leads to coercion.

Emphasizing the issue of consumption rightly points out the importance
of curbing rich countries’ consumption of fossil fuel in combating climate change. However, population
growth in both developed and developing nations is expected to play a very important
role in global greenhouse gas (GHGs) emissions. In a paper published in Population and Development Review,
Fred Meyerson, assistant professor at the University of Rhode Island, writes:

[For developed
countries,] per capita carbon emissions have stabilized or even decreased in
the last two decades. This means that emission increases in the developed world
are now primarily driven by population growth.

Richard York, a professor at the University of Oregon, has also found that

[developed] nations with higher expected population growth rates negotiated
higher carbon targets (in global GHGs emission treaties) than other nations and
were ultimately less likely to ratify the Kyoto Protocol.

Population matters to climate change,
in both developed and developing countries, for different reasons and to
different extent. It is not only because of total population size and fertility,
but also because of other demographic trends, particularly aging in the
developed nations and urbanization in the developing world.  First,
even though it is more important in the developing world, change of total
population size still plays a significant role in climate change in developed
countries where fertility rate reached or declined to below the replacement
level, due to population momentum and net immigration.

Second, in the developed world, the
more important demographic trend relevant to climate change is the changes
in population age structure.

Michael Dalton, economist at the National
Oceanic and Atmospheric Association
, and his co-authors have shown that
future changes of population age structure — the
comparative size of specific age groups relative to the population as a wholeunder
a scenario of low fertility, will drive U.S. carbon emissions down by 40
percent by the end of the century. This effect, under certain circumstances,
would be even more significant than technological advancements. While this does not imply that population
growth is more important than other factors for climate change, it surely
illustrates that demographic factors do affect environmental consequences and
the feasibility of social choices.

While it is important to be vigilant against them, coercive population
policies are highly criticized by the global community. Voluntary family
planning programs, on the other hand, have produced multiple benefits for society and the
environment. High quality voluntary services, along with efforts to improve
female education and promote gender equity, have already helped individuals
achieve their reproductive preferences and reduce the population size of less
developed countries by half a billion.

Recently, population issues have gradually regained the spotlight
— probably partially due to the pressing issue of global warming (the top 11
warmest years on record have occurred in the last 13 years
), the increasing
impact from emerging economies’ energy consumption (especially highly-populated
countries such as China and India), and the global food crisis.

The IPCC has been looking to population more as well. Its Fourth
Assessment Report, published in 2007, calls for greater focus on population
dynamics in future research, and the organization has founded a consortium to
develop new demographic and socioeconomic scenarios to help improve our
understanding of how demographic trends (such as aging, urbanization and
changes in household structure) will interact with economic growth and
technological improvement to determine the global climate future.

It is indisputable that economic development, improved standard of
living and energy poverty alleviation are necessary to improve the lives of the
global poor. Even though the poor still
account for a very small amount of overall GHGs emissions (disproportionately less than their population share), rapid economic development is
taking place in much of the developing world. The proportion of global
emissions originating in the developing world is growing as well, and is
anticipated to overtake that of the more developed nations in the next one or
two decades.

To fight global warming, international, collective actions are needed —
including financial support and technological transfer to developing countries.
It is acknowledged that rapid implementation of multiple strategies is needed
to curb global warming — the international community is working on multiple clean
and energy efficient technologies, carbon capture and storage, and prevention
of deforestation, among many others.

It is important that the scientific community also consider population
factors — in all their complexity — in climate change research. Moreover, the
sexual and reproductive health community needs to be aware of and engaged on
this issue
— to add their expertise, and to ensure that
these issues get back on the agenda, where they belong.

Analysis Law and Policy

Do Counselors-in-Training Have the Right to Discriminate Against LGBTQ People?

Greg Lipper

Doctors can't treat their patients with leeches; counselors can't impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Whether they’re bakers, florists, or government clerks, those claiming the right to discriminate against LGBTQ people have repeatedly sought to transform professional services into constitutionally protected religious speech. They have grabbed headlines for refusing, for example, to grant marriage licenses to same-sex couples or to make cakes for same-sex couples’ weddings-all in the name of “religious freedom.”

A bit more quietly, however, a handful of counseling students at public universities have challenged their schools’ nondiscrimination and treatment requirements governing clinical placements. In some cases, they have sought a constitutional right to withhold treatment from LGBTQ clients; in others, they have argued for the right to directly impose their religious and anti-gay views on their clients.

There has been some state legislative maneuvering on this front: Tennessee, for instance, recently enacted a thinly veiled anti-LGBTQ measure that would allow counselors to deny service on account of their “sincerely held principles.” But when it comes to the federal Constitution, providing medical treatment—whether bypass surgery, root canal, or mental-health counseling—isn’t advocacy (religious or otherwise) protected by the First Amendment. Counselors are medical professionals; they are hired to help their clients, no matter their race, religion, or sexual orientation, and no matter the counselors’ beliefs. The government, moreover, may lawfully prevent counselors from harming their clients, and universities in particular have an interest, recognized by the U.S. Supreme Court, in preventing discrimination in school activities and in training their students to work with diverse populations.

The plaintiffs in these cases have nonetheless argued that their schools are unfairly and unconstitutionally targeting them for their religious beliefs. But these students are not being targeted, any more than are business owners who must comply with civil rights laws. Instead, their universities, informed by the rules of the American Counseling Association (ACA)—the leading organization of American professional counselors—merely ask that all students learn to treat diverse populations and to do so in accordance with the standard of care. These plaintiffs, as a result, have yet to win a constitutional right to discriminate against or impose anti-LGBTQ views on actual or prospective clients. But cases persist, and the possibility of conflicting court decisions looms.

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Keeton v. Anderson-Wiley

The first major challenge to university counseling requirements came from Jennifer Keeton, who hoped to receive a master’s degree in school counseling from Augusta State University. As detailed in the 2011 11th Circuit Court of Appeals decision considering her case, Keeton entered her professional training believing that (1) “sexual behavior is the result of personal choice for which individuals are accountable, not inevitable deterministic forces”; (2) “gender is fixed and binary (i.e., male or female), not a social construct or personal choice subject to individual change”; and “homosexuality is a ‘lifestyle,’ not a ‘state of being.'”

It wasn’t those views alone, however, that sunk her educational plans. The problem, rather, was that Keeton wanted to impose her views on her patients. Keeton had told both her classmates and professors about her clinical approach at a university-run clinic, and it wasn’t pretty:

  • She would try to change the sexual orientation of gay clients;
  • If she were counseling a sophomore student in crisis questioning his sexual orientation, she would respond by telling the student that it was not OK to be gay.
  • If a client disclosed that he was gay, she would tell him that his behavior was wrong and try to change it; if she were unsuccessful, she would refer the client to someone who practices “conversion therapy.”

Unsurprisingly, Keeton also told school officials that it would be difficult for her to work with LGBTQ clients.

Keeton’s approach to counseling not only would have flouted the university’s curricular guidelines, but also would have violated the ACA’s Code of Ethics.

Her conduct would have harmed her patients as well. As a school counselor, Keeton would inevitably have to counsel LGBTQ clients: 57 percent of LGBTQ students have sought help from a school professional and 42 percent have sought help from a school counselor. Suicide is the leading cause of death for LGBTQ adolescents; that’s twice or three times the suicide rate afflicting their heterosexual counterparts. And Keeton’s preferred approach to counseling LGBTQ students would harm them: LGBTQ students rejected by trusted authority figures are even more likely to attempt suicide, and anti-gay “conversion therapy” at best doesn’t work and at worst harms patients too.

Seeking to protect the university’s clinical patients and train her to be a licensed mental health professional, university officials asked Keeton to complete a remediation plan before she counseled students in her required clinical practicum. She refused; the university expelled her. In response, the Christian legal group Alliance Defending Freedom sued on her behalf, claiming that the university violated her First Amendment rights to freedom of speech and the free exercise of religion.

The courts disagreed. The trial court ruled against Keeton, and a panel of the U.S. Court of Appeals for the 11th Circuit unanimously upheld the trial court’s ruling. The 11th Circuit explained that Keeton was expelled not because of her religious beliefs, but rather because of her “own statements that she intended to impose her personal religious beliefs on clients and refer clients to conversion therapy, and her own admissions that it would be difficult for her to work with the GLBTQ population and separate her own views from those of the client.” It was Keeton, not the university, who could not separate her personal beliefs from the professional counseling that she provided: “[F]ar from compelling Keeton to profess a belief or change her own beliefs about the morality of homosexuality, [the university] instructs her not to express her personal beliefs regarding the client’s moral values.”

Keeton, in other words, crossed the line between beliefs and conduct. She may believe whatever she likes, but she may not ignore academic and professional requirements designed to protect her clients—especially when serving clients at a university-run clinic.

As the court explained, the First Amendment would not prohibit a medical school from requiring students to perform blood transfusions in their clinical placements, nor would it prohibit a law school from requiring extra ethics training for a student who “expressed an intent to indiscriminately disclose her client’s secrets or violate another of the state bar’s rules.” Doctors can’t treat their patients with leeches; counselors can’t impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Ward v. Polite

The Alliance Defending Freedom’s follow-up case, Ward v. Polite, sought to give counseling students the right to withhold service from LGBTQ patients and also to practice anti-gay “conversion therapy” on those patients. The case’s facts were a bit murkier, and this led the appeals court to send it to trial; as a result, the student ultimately extracted only a modest settlement from the university. But as in Keeton’s case, the court rejected in a 2012 decision the attempt to give counseling students the right to impose their religious views on their clients.

Julea Ward studied counseling at Eastern Michigan University; like Keeton, she was training to be a school counselor. When she reviewed the file for her third client in the required clinical practicum, she realized that he was seeking counseling about a romantic relationship with someone of the same sex. As the Court of Appeals recounted, Ward did not want to counsel the client about this topic, and asked her faculty supervisor “(1) whether she should meet with the client and refer him [to a different counselor] only if it became necessary—only if the counseling session required Ward to affirm the client’s same-sex relationship—or (2) whether the school should reassign the client from the outset.” Although her supervisor reassigned the client, it was the first time in 20 years that one of her students had made such a request. So Ward’s supervisor scheduled a meeting with her.

Then things went off the rails. Ward, explained the court, “reiterated her religious objection to affirming same-sex relationships.” She told university officials that while she had “no problem counseling gay and lesbian clients,” she would counsel them only if “the university did not require her to affirm their sexual orientation.” She also refused to counsel “heterosexual clients about extra-marital sex and adultery in a values-affirming way.” As for the professional rules governing counselors, Ward said, “who’s the [American Counseling Association] to tell me what to do. I answer to a higher power and I’m not selling out God.”

All this led the university to expel Ward, and she sued. She claimed that the university violated her free speech and free exercise rights, and that she had a constitutional right to withhold affirming therapy relating to any same-sex relationships or different-sex relationships outside of marriage. Like Keeton, Ward also argued that the First Amendment prohibited the university from requiring “gay-affirmative therapy” while prohibiting “reparative therapy.” After factual discovery, the trial court dismissed her case.

On appeal before the U.S. Court of Appeals for the Sixth Circuit, Ward eked out a narrow and temporary win: The court held that the case should go to a jury. Because the university did not have a written policy prohibiting referrals, and based on a few troubling faculty statements during Ward’s review, the court ruled that a reasonable jury could potentially find that the university invoked a no-referrals policy “as a pretext for punishing Ward’s religious views and speech.” At the same time, the court recognized that a jury could view the facts less favorably to Ward and rule for the university.

And although the decision appeared to sympathize with Ward’s desire to withhold service from certain types of clients, the court flatly rejected Ward’s sweeping arguments that she had the right to stray from the school curriculum, refuse to counsel LGBTQ clients, or practice anti-gay “conversion therapy.” For one, it said, “Curriculum choices are a form of school speech, giving schools considerable flexibility in designing courses and policies and in enforcing them so long as they amount to reasonable means of furthering legitimate educational ends.” Thus, the problem was “not the adoption of this anti-discrimination policy, the existence of the practicum class or even the values-affirming message the school wants students to understand and practice.” On the contrary, the court emphasized “the [legal] latitude educational institutions—at any level—must have to further legitimate curricular objectives.”

Indeed, the university had good reason to require counseling students—especially those studying to be school counselors—to treat diverse populations. A school counselor who refuses to counsel anyone with regard to nonmarital, nonheterosexual relationships will struggle to find clients: Nearly four in five Americans have had sex by age 21; more than half have done so by the time they turn 18, while only 6 percent of women and 2 percent of men are married by that age.

In any event, withholding service from entire classes of people violates professional ethical rules even for nonschool counselors. Although the ACA permits client referrals in certain circumstances, the agency’s brief in Ward’s case emphasized that counselors may not refuse to treat entire groups. Ward, in sum, “violated the ACA Code of Ethics by refusing to counsel clients who may wish to discuss homosexual relationships, as well as others who fail to comport with her religious teachings, e.g., persons who engage in ‘fornication.'”

But Ward’s approach would have been unethical even if, in theory, she were permitted to withhold service from each and every client seeking counseling related to nonmarital sex (or even marital sex by same-sex couples). Because in many cases, the need for referral would arise well into the counseling relationship. And as the trial court explained, “a client may seek counseling for depression, or issues with their parents, and end up discussing a homosexual relationship.” No matter what the reason, mid-counseling referrals harm clients, and such referrals are even more harmful if they happen because the counselor disapproves of the client.

Fortunately, Ward did not win the sweeping right to harm her clients or otherwise upend professional counseling standards. Rather, the court explained that “the even-handed enforcement of a neutral policy”—such as the ACA’s ethical rules—”is likely to steer clear of the First Amendment’s free-speech and free-exercise protections.” (Full disclosure: I worked on an amicus brief in support of the university when at Americans United.)

Ward’s lawyers pretended that she won the case, but she ended up settling it for relatively little. She received only $75,000; and although the expulsion was removed from her record, she was not reinstated. Without a graduate counseling degree, she cannot become a licensed counselor.

Cash v. Hofherr

The latest anti-gay counseling salvo comes from Andrew Cash, whose April 2016 lawsuit against Missouri State University attempts to rely on yet murkier facts and could wind up, on appeal, in front of the more conservative U.S. Court of Appeals for the Eighth Circuit. In addition to his range of constitutional claims (freedom of speech, free exercise of religion, equal protection of law), he has added a claim under the Missouri Religious Freedom Restoration Act.

The complaint describes Cash as “a Christian with sincerely-held beliefs”—as opposed to insincere ones, apparently—”on issues of morality.” Cash started his graduate counseling program at Missouri State University in September 2007. The program requires a clinical internship, which includes 240 hours of in-person client contact. Cash decided to do his clinical internship at Springfield Marriage and Family Institute, which appeared on the counseling department’s list of approved sites. Far from holding anti-Christian bias, Cash’s instructor agreed that his proposed class presentation on “Christian counseling and its unique approach and value to the Counseling profession” was an “excellent” idea.

But the presentation itself revealed that Cash intended to discriminate against LGBTQ patients. In response to a question during the presentation, the head of the Marriage and Family Institute stated that “he would counsel gay persons as individuals, but not as couples, because of his religious beliefs,” and that he would “refer the couple for counseling to other counselors he knew who did not share his religious views.” Because discrimination on the basis of sexual orientation violates ACA guidelines, the university determined that Cash should not continue counseling at the Marriage and Family Institute and that it would be removed from the approved list of placements. Cash suggested, however, that he should be able to withhold treatment from same-sex couples.

All this took place in 2011. The complaint (both the original and amended versions) evades precisely what happened between 2012 and 2014, when Cash was finally expelled. You get the sense that Cash’s lawyers at the Thomas More Society are trying to yadda-yadda-yadda the most important facts of the case.

In any event, the complaint does acknowledge that when Cash applied for a new internship, he both ignored the university’s instructions that the previous hours were not supposed to count toward his requirement, and appeared to be “still very much defend[ing] his previous internship stating that there was nothing wrong with it”—thus suggesting that he would continue to refuse to counsel same-sex couples. He continued to defend his position in later meetings with school officials; by November 2014, the university removed him from the program.

Yet in challenging this expulsion, Cash’s complaint says that he was merely “expressing his Christian worldview regarding a hypothetical situation concerning whether he would provide counseling services to a gay/homosexual couple.”

That’s more than just a worldview, though. It also reflects his intent to discriminate against a class of people—in a manner that violates his program’s requirements and the ACA guidelines. Whether hypothetically or otherwise, Cash stated and reiterated that he would withhold treatment from same-sex couples. A law student who stated, as part of his clinic, that he would refuse to represent Christian clients would be announcing his intent to violate the rules of professional responsibility, and the law school could and would remove him from the school’s legal clinic. And they could and would do so even if a Christian client had yet to walk in the door.

But maybe this was just a big misunderstanding, and Cash would, in practice, be willing and able to counsel same-sex couples? Not so, said Cash’s lawyer from the Thomas More Society, speaking about the case to Christian news outlet WORLD: “I think Christians have to go on the offensive, or it’s going to be a situation like Sodom and Gomorrah in the Bible, where you aren’t safe to have a guest in your home, with the demands of the gay mob.” Yikes.

Although Cash seems to want a maximalist decision allowing counselors and counseling students to withhold service from LGBTQ couples, it remains to be seen how the case will turn out. The complaint appears to elide two years’ worth of key facts in order to present Cash’s claims as sympathetically as possible; even if the trial court were to rule in favor of the university after more factual development, Cash would have the opportunity to appeal to the U.S. Court of Appeals for the Eighth Circuit, one of the country’s most conservative federal appeals courts.

More generally, we’re still early in the legal battles over attempts to use religious freedom rights as grounds to discriminate; only a few courts across the country have weighed in. So no matter how extreme Cash or his lawyers may seem, it’s too early to count them out.

* * *

The cases brought by Keeton, Ward, and Cash not only attempt to undermine anti-discrimination policies. They also seek to change the nature of the counselor-client relationship. Current norms provide that a counselor is a professional who provides a service to a client. But the plaintiffs in these cases seem to think that counseling a patient is no different than lecturing a passerby in the town square, in that counseling a patient necessarily involves expressing the counselor’s personal and religious beliefs. Courts have thus far rejected these attempts to redefine the counselor-patient relationship, just as they have turned away attempts to challenge bans on “reparative therapy.”

The principles underlying the courts’ decisions protect more than just LGBTQ clients. As the 11th Circuit explained in Keeton, the university trains students to “be competent to work with all populations, and that all students not impose their personal religious values on their clients, whether, for instance, they believe that persons ought to be Christians rather than Muslims, Jews or atheists, or that homosexuality is moral or immoral.” Licensed professionals are supposed to help their clients, not treat them as prospective converts.

Analysis Human Rights

Erika Rocha’s Suicide Brings Attention to the Dire Need for Mental Health Care in Prison

Victoria Law

Erika Rocha's was the first suicide of the year at Corona's California Institution for Women (CIW), which is currently at 130 percent capacity. CIW's suicide rate, however, is more than eight times the national rate for women behind bars.

On April 14, 2016, one day before her parole hearing, Erika Rocha committed suicide. The 35-year-old had spent 21 years behind bars. But what should have been a day of hope for Rocha, her family, and her friends instead became a day of mourning.

Rocha’s was the first suicide of the year to rock Corona’s California Institution for Women (CIW), which is currently at 130 percent capacity. CIW’s suicide rate, however, is more than eight times the national rate for women behind bars. The prison had four suicides and 16 attempts in 2014. In 2015, it had two suicides and 35 attempts. And in the first two months of 2016, CIW had four additional suicide attempts.

These numbers, advocates say, display the consequences of the lack of mental health resources for women in prison, some of whom have been behind bars for decades.

The need for comprehensive mental health care has long plagued California prisons. In 1990, advocates filed Coleman vs. Wilson, a class-action civil rights lawsuit alleging unconstitutional medical care by the California Department of Corrections and Rehabilitation (CDCR). In 1995, a U.S. District Court ruled in Coleman that mental health-care access in the state prisons violated the Eighth Amendment prohibition against cruel and unusual punishment; the following year, it appointed a special master to review California’s prisons and to monitor mental health care. That special master is still monitoring CDCR’s mental health care.

In 2013, Lindsay Hayes, a suicide prevention expert, audited all of the state’s prisons for their suicide prevention plans. In 2015, he re-audited 18 of those prisons. In the report he released in January 2016, he noted that, while some prisons had made progress on the issue, “CIW continued to be a problematic institution that exhibited numerous poor practices in the area of suicide prevention.” These poor practices, Hayes wrote, included low completion of suicide risk evaluations, inadequate treatment planning, low compliance rates for annual suicide prevention training, and multiple suicides during the calendar year.

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“This Seemed To Be the Only Way”

No one will ever know what pushed Rocha over the edge. But others at CIW say that those who need mental health treatment there, both before and after their suicides, face a lack of preventive treatment, including counseling, and almost no follow-up.

Amber, who asked to be referred to by a pseudonym, noted that the prison lacks available mental health programming. She had already spent 14 years at another prison when she was transferred to CIW. There, she found that nearly every self-help and support group had a long waiting list.

In addition, mental health treatment was sparse. “I would only see mental health [staff] every 90 days, and that was only about five minutes,” she recalled in an interview with Rewire. “As time went on and I became more and more frustrated by the lack of anything to take my mind off my emptiness, I got more lonely and hopeless.” She stopped talking to her friends, stopped eating, lost interest in her appearance, and began losing weight. No one noticed these red flags. She told mental health staff that she wanted to stop taking medication. No one, she said, questioned her decision.

In July 2014, Amber and her friend Mindy (also a pseudonym) decided to end their lives together. Once they made their decision, Amber remembered feeling a sense of relief: “I was happy. I knew my misery and pain were ending. … This seemed to be the only way.” The two slit their throats, losing consciousness. But someone found them, alerted staff and they were transported to the hospital. How they were treated next, they said, didn’t make them feel any more hopeful about life.

After being released from the hospital, both women were placed in a mental health crisis bed, commonly referred to as “suicide watch” among people in prison. Amber described suicide watch as a place “where they strip you naked and put a hard gown on you, basically a life jacket. They give you a blanket made of the same material and have a bright light on with a nurse watching and recording [on paper] your every move. … You are not allowed anything for the first week. Then you can ‘earn’ a book. And maybe a muumuu gown if you are calm and cooperative. You aren’t even allowed a roll of toilet paper. When you need to use the toilet [in your cell], they hand you a tiny bit and watch you use it.”

Mindy spent 11 days in suicide watch; Amber was there for two weeks. Both were then placed in the prison’s specialty care unit, where they were able to have human interactions and access to group programming, which Amber described as 14 hours a week of coloring, watching movies, singing karaoke, and walking.

However, suicide watch is frequently full. In those cases, people are placed in an “overflow unit” in the prison’s Security Housing Unit (SHU), an isolation unit where people are locked in their cells for 23 to 24 hours each day. This kind of isolation can cause myriad mental health issues, including anxiety, panic, depression, agoraphobia, paranoia, aggression, and even neurological damage.

Krista Stone-Manista is an attorney with San Francisco-based Rosen Bien Galvan & Grunfeld, which co-litigated the Coleman case. She is also part of the team now monitoring compliance. She notes that, when a person reports feeling suicidal, she is supposed to be moved to a mental health crisis bed. But, because there aren’t enough mental health crisis beds, California prisons utilize what’s known as “alternative housing,” which might include isolation until a bed opens up. “What we’re seeing is that people are repudiating their suicidal ideation to get out of alternative housing,” she told Rewire. That means that they don’t receive counseling or any other type of mental health treatment.

But even when they are placed on suicide watch, the special master, in his 2015 review of CIW, found that “patients were discharged from the mental health crisis bed as soon as they reported they were no longer suicidal, with little effort to determine the underlying causes of their initial reports of suicidality.”

People incarcerated at CIW report that its environment has not improved in the two years since Amber and Mindy attempted to take their lives. In March 2015, Stephanie Feliz hung herself. Mindy, who was in the mental health unit at the time, said that Feliz walked in and requested services for a mental health crisis. Despite having a history of suicide attempts and self-mutilation, Mindy said staff told her that she had already been seen the day before. According to Mindy, Felix returned to her cell, where she was found dead two hours later. This treatment is not unusual, Mindy noted, writing to Rewire in a letter that she too has requested mental health services only to encounter delays and, at times, outright dismissal.

But no matter what changes the institution makes, Stone-Manista pointed out, “There’s only so much CIW can do for someone who is chronically suicidal. They’re not a hospital.”

CDCR did not respond to queries about the numbers of suicides and suicide attempts at CIW or about its suicide prevention practices.

Rocha’s Years in Prison

When Rocha was 14 years old, she and several older teens were arrested for an accidental shooting. Rocha was charged as an adult and, without a parent or guardian present, questioned by police and, according to advocates, pressured to plead guilty by the prosecutor. She did and was sentenced to 19 years to life. Rocha was initially sent to a juvenile prison, where she spent two years. At age 16, she was transferred to the adult Valley State Prison in Chowchilla. There, prison officials placed her in solitary, ostensibly for her own protection due to her age. She stayed in isolation for one year.

Windy Click is now program coordinator for the advocacy group California Coalition for Women Prisoners (CCWP). She was imprisoned at Valley State when Rocha arrived and met the girl shortly after she had turned 19. Rocha was looking for something positive to do and asked how to get to the prison library. While Click, then in her 30s, and Rocha never became close friends, each time Rocha was released from solitary, she sought the older woman out.

“She was a funny girl,” Click recalled in an interview with Rewire. “She liked to joke and be light-hearted.” One of the topics that Rocha frequently joked about was growing old in prison. “She’d say she would be an old lady in prison.”

Other times, however, the girl had a hard time coping with prison. “She would be very shaky, trembling almost,” Click recalled. “‘I can’t do this no more,’ she’d tell me.” During those times, Click said, Rocha would tell prison staff that she was afraid for her life and request to be placed in administrative segregation, a form of isolation commonly known as ad-seg, where she would be locked in a cell for 23 to 24 hours each day. Prison staff obliged and Rocha would be placed in isolation. When she returned to general population, Click remembered that the girl would seem better but “after a day or so, she’d be back to that shakiness.”

Click recalled one conversation in which she told Rocha, “This place isn’t the last place you’ll ever be.” But, she remembered, the younger woman couldn’t see the light at the end of the tunnel.

It didn’t help that Rocha spent more than a decade without seeing her family, who lived nearly 300 miles in the Los Angeles area. Lacking a car, they could not make the trek to Central Valley. It was not until Rocha was moved to CIW, 15 minutes from their home, that they could visit. By then, Rocha’s father had died; her stepmother Linda Reza brought her three daughters as soon as Rocha was allowed to receive visits.

“She was still the same little kid that left us,” Reza remembered of that first visit in an interview with Rewire.

That was how Geraldine, Rocha’s half-sister, saw it as well: “She’s nine years older than me. But it was like I was the big sister.”

Rocha got along best with her teenage sister Freida, who was born after her incarceration and whom she met for the first time in the CIW visiting room. When the family visited, Reza remembered that Rocha and Freida would head to the visiting room’s play area and play on the swings. Reza recalled that, when Rocha received news of her upcoming hearing, she and Freida made plans to share a room at Reza’s house, clipping magazine pictures and envisioning how to decorate the room.

Colby Lenz, a volunteer legal advocate with CCWP, saw a different, more vulnerable side, one that Rocha did her best to keep from her family. “She was the most fragile and traumatized person I had ever met in prison,” Lenz recalled about their first meeting less than two years ago. It was only partway through the legal visit that Rocha began to open up. “She went back to [age] 14 or 15 and talked about her early years—how much time she had done in solitary, how they treated her.”

Under California’s SB 260, which passed in 2013 and went into effect in January 2014, Rocha became eligible for a youth parole hearing for youth sentenced as adults to long prison sentences. As part of the hearing process, she was given a psychiatric evaluation. But, said Lenz, no one explained to her why she was undergoing a psychiatric evaluation. The process brought her back to the police interrogations she had gone through at age 14 without a parent or guardian present. Frightened and retraumatized, Rocha not only waived her hearing, but also attempted to take her own life.

In 2015, Rocha learned she was scheduled for another youth parole hearing on April 15, 2016. In the weeks before, Reza recalled that Rocha was excited. The last time she called, Reza wasn’t able to answer her phone. The message Rocha left was hopeful. “Tell my sisters I know they’re going to kick my ass when I get home,” she said. “But that’s okay, I’ll take it.”

“In a Hopeless Place, Most Don’t Make It”

Since Rocha’s death, CCWP has reported that at least 22 people in CIW have been placed on suicide watch for attempting suicide or stating that they felt suicidal.

Mariposa, who asked to go by her stage name, is one of those 22 placed on suicide watch. She is the co-author of the one-woman play Mariposa and the Saint about her own time in solitary. She was also Rocha’s cellmate and fiancée. After Rocha was found hanging in their shared cell, Mariposa was immediately placed in suicide watch, where she was not allowed regular visits, phone calls, or mail. She was, however, allowed a legal visit with CCWP, but, advocates told Rewire, kept in a treatment cage the entire time.

Those inside the prison report that the lack of programs and activities contributes to the feeling of hopelessness. “People have way too much time to think and be in their heads,” wrote another woman at CIW to Rewire one month before Rocha’s death. “A lot of us are only hanging on by hope alone. In a hopeless place, most don’t make it.”

Krista Stone-Manista noted that CDCR is working on new policies and procedures to move people who need more care or longer-term care to inpatient care rather than keeping them inside the prisons, which are often inadequately staffed with mental health professionals. She also pointed to CDCR’s reduction of the use of solitary confinement, noting that studies have shown the damage to mental health and that suicides and suicide attempts often occur in segregation. In addition, she says, CDCR is working on how to respond to reports of suicidal thoughts before they become attempts or actual suicides.

All of these efforts are too late for Rocha. “When I get out, I want you to take me to the park,” Reza remembered her stepdaughter telling her and her sisters during one visit. “I want to play on the swings and the slide and run in the grass.”

Reza plans to honor that wish. “After her cremation, we’re going to have a reception in the park,” she said. “We’re going to put her on the swings.”