Late-Night Committee Votes Yield Success for Sex Ed Programs within Health Care Reform

Jodi Jacobson

Advocates for evidence-based, comprehensive sex education realized two major gains in the health care reform process last night, defeating an amendment to the House Energy and Commerce Committee Affordable Health Choices Act that would have extended discredited abstinence-only-until-marriage programs, and passing another amendment introduced by Congresswman Lois Capps creating a Healthy Teen Initiative.

Last night, as part of the broader process of health care reform in the House of Representatives, the House Energy and Commerce Committee, chaired by California Congressman Henry Waxman, met to continue debate and consideration of amendments to the Affordable Health Choices Act of 2009, a copy of the House version of and amendments to which can be found here (including votes on each amendment).

Two important amendments to the bill were introduced in Committee.  One of these, submitted by Nebraska Congressman Lee Terry, would have extended Title V abstinence-only-until-marriage progams through 2012.  The Title V abstinence-only program, which provided funding for now-widely discredited programs, expired this year.  Terry’s attempt to extend it failed by a 3-vote margin, 29 to 26, mostly along party lines.  Three Democrats, Michigan Congressman Bart Stupak, Louisiana Congressman Charlie Melancon, and Georgia Congressman John Barrow voted in favor of extending Title V.

Congresswoman Lois Capps introduced an amendment intended to create a Healthy Teen Initiative, expanding on the narrower teen pregnancy prevention initiative originally proposed in President Obama’s budget.  This amendment, which passed 33 to 23 on a recorded vote, alloacates $50 million dollars in funding for a new program through which states can fund
evidence-based interventions to reduce teen pregnancy, reduce the spread of sexually transmitted infections, and comprehensively address a range of teen sexuality issues, and build life-long skills to promote good sexual and reproductive health throughout a person’s life-cycle. 

A large coalition of public health and human rights advocacy groups have been working for the past 3 months to expand on the President’s proposal and they have focused their efforts on both appropriations bills and health reform proposals to establish the policy framework and lock in more funding for comprehensive programs.  Last night’s votes were hailed by many. "This is a major step forward and will get the states the money they need to improve adolescent sexual health outcomes across the board," says Bill Smith, Vice President for Public Policy at the Sexuality Information and Education Council of the United States (SIECUS), one of the coalition’s leading groups. "And now this program is solidly part of the healthcare reform package making its way
through the House."

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James Wagoner, president of Advocates for Youth and another leader of the coalition, stated: "This was a vote to bring science back into government.  By promoting evidence-based teen pregnancy and STI prevention
programs, the Committee, under the leadership of Representative Waxman,
has taken an important step toward ensuring young people get the
critical sexual health information they need to make responsible
decisions about their lives."

 

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.”

News Sexual Health

Alaska Republican’s Campaign Against Sex Ed Reaches ‘Peak Desperation’

Nicole Knight Shine

Gonorrhea and chlamydia rates have surged in the state. Alaska reported 808 cases of chlamydia per 100,000 people in 2011—the nation’s highest rate, according to the Centers for Disease Control and Prevention.

Alaska state Sen. Mike Dunleavy (R-Wasilla) practically pulled an all-nighter this week to write legislation designed to dismantle school sexual health education in a state with the nation’s highest chlamydia rate.

No friend to sexual health curricula, Dunleavy crafted his newest measure one day after his bill to restrict sex education in Alaska schools, SB 89, met defeat in the House Health and Social Services Committee. The measure would have prohibited Planned Parenthood and other abortion providers from teaching sexual health courses in Alaska schools.

The committee rejected it 5 to 2 amid public outcry from parents and the state union representing 13,000 teachers.

Then on Wednesday, Dunleavy introduced an amendment to an education bill that, in essence, bars anyone who isn’t a certificated teacher from providing sexual health instruction in schools.

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Dunleavy on Wednesday told the Senate Education Committee, which he chairs, that he “stayed up most of last night” to craft the newest attempt to gut sex education.

Dunleavy’s amendment requires the school board to vet and approve sex education curricula and allows parents to review the lessons. It includes language barring anyone who isn’t a teacher in the school where the instruction takes place from teaching about sexual health.

The provision has the effect of banning nearly all doctors, public health nurses, pharmacists, teenage peer educators, and Planned Parenthood instructors from teaching.

The bill, with Dunleavy’s amendment, now heads to the Senate Finance Committee.

Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education. The state senator insists that teachers are best equipped to offer sexual health instruction in a state where advocates say evidence-based health education is sorely needed.

“We’ve been clear that sex education should be taught, reproduction education should be taught and the new concept that I think a lot of us are learning about—sexuality—probably should also be touched upon,” Dunleavy told the Alaska Senate Education Committee on Wednesday, as the Juneau Empire reported. “Sex education is the biology. Sexuality is now the new view of sex. I think we’ve got to be very careful, very careful that we have the right people in there.”

Gonorrhea and chlamydia rates have surged in the state. Alaska reported 808 cases of chlamydia per 100,000 people in 2011—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is also higher than the national average.

Explaining his rationale for SB 89 on the Senate floor in February, Dunleavy said, “Most parents don’t send their kids to school to be trained by abortion providers. They don’t want their children indoctrinated in public schools, and that’s what’s happening. This is a process of indoctrination.”

“Mike Dunleavy has reached peak desperation, staying up all night to come up with his worst idea yet,” Jessica Cler, Alaska public affairs manager for Planned Parenthood Votes Northwest and Hawaii, said Thursday in an emailed statement. “Make no mistake: this amendment may be a different method from SB 89, but it has the same result of barring Planned Parenthood’s sexual health educators from Alaska schools and making it harder for youth to access the information they need.”

Dunleavy recently inserted language in another bill, SB 191, to penalize teachers who use sexual health materials from abortion care providers. The legislation is awaiting committee action.

2014 study in the Journal of School Health, which examined Massachusetts’ Planned Parenthood sex education programs, showed that 16 percent fewer boys and 15 percent fewer girls had sex between the sixth and eighth grades in schools that taught the programs, compared to students in schools without them.