content note: this post talks about eugenics, incarceration and institutionalization, and violent ableism
tangent from that post because i didn't want to start writing an essay on someone else's post and this is about a conversation i had irl this month, not intended as a reply to that post. but i actually feel very complicated about the idea of whether or not we should be pushing for more "accessibility" in jails and prisons and psych wards and institutions. i put that word in quotes because i don't think there is ever a way that being incarcerated is actually accessible to our bodies and minds; it is a disabling experience on so many levels. i'm not going to list out all the reasons why on this post; i've made so many posts talking explicitly about the harms of institutionalization before and i don't want to do that again right now. Talila Lewis has given several interviews about ableism, incarceration, and disability that are really worth reading and go more in depth into what that violence looks like. Liat Ben Moshe has also given another interview about disability and incarceration that goes over many of the same topics. given that these places are intense sites of violence towards disabled people, it feels difficult for me to claim that they could ever truly be accessible in any meaningful sense of the word.
what's also true right now is that institutions and prisons are incredibly inaccessible for physically disabled people in particular. i've been arrested with a wheelchair, i've been institutionalized with a feeding tube on top of that as well, i've been held on medical floors for psych treatment before, and i know very well exactly how bad it is. i've watched myself and so many other physically disabled people almost die in these places because of sheer neglect. i have physically disabled neighbors who were killed in these places. it is so dangerous for physically disabled people who are locked up in these places, yet at the same time, often psych wards are so inaccessible that physically disabled people just can't even be admitted because wards refuse to take people with mobility aids, medical devices, specific types of medication or care needs, if you have some kinds of terminal illness, and on and on and on.
what's also true is that when these places are so inaccessible that many physically disabled people are excluded and unable to even access them in the first place, it doesn't mean that we then somehow access other types of care instead. it just means that we're also discarded and left to die. this also is a really similar dynamic for a ton of other marginalized groups that get excluded from psych care--many of my comrades who are people of color have also experienced this same type of denial of care. initially i think that can seem like a confusing contradiction--how is it that psych wards are locking up some people up against their will but refusing to take in other people? but when you start thinking about the underlying logic at the core of these systems, it makes sense.
psych wards operate under this idea that madness must be cured by any means possible, up to and including eradication. institutions are a way of disappearing madness from the world--hiding us away so that we don't disturb a sane society, and not letting us free again until we either die in there or are able to appear like we've sufficiently eradicated madness from our mind. preventing physically disabled people from accessing inpatient treatment is operating under the same assumptions--except that this particularly violent convergence of ableism is happy to just let us die, both because it eradicates madness from the world and because they view our lives as unworthy of living in the first place. eugenics is still alive and well in the united states and it's still fucking killing us; both inside institutions and outside of them.
i would never tell someone that they're privileged for getting institutionalized--i think that would be a cruel thing to say to someone who has just survived a lot of violent ableism. and at the same time, our current systems of mental health care are set up in a way where not being able to access inpatient care can be a deadly logistical nightmare. there are some partial hospitalization programs that have such a long waiting list that you can only really get in if you just got an urgent referral because you're getting discharged from inpatient care--how the fuck are physically disabled people supposed to access those programs? if you need meal support for your eating disorder 6 times a day and the only places that offer that are residential treatment in a house with stairs, what the fuck are you supposed to do? if noncarceral outpatient forms of treatment like therapy, support groups, PHP programs, peer support funding, etc etc etc are often prioritizing people who have recently been discharged from inpatient care, how are you supposed to access any type of mental health care at all? (to be clear i know that not all forms of outpatient care operate in this way, but a lot of state run/low cost programs that accept Medicaid/Medicare operate in that way, and i've seen it cause enough barriers that i know this is a very real problem.)
so when i think about what it would take to actually ensure that physically disabled people can access mental healthcare, there's a lot that comes up for me. on one hand, so much of my work is about tearing down institutions and ensuring that no one is forced into these places to face that type of violence. on the other hand, so many physically disabled people need care right now, and we have to figure out some way of making that happen given the current systems we have in place. i will never be okay with just discarding physically disabled people as collateral damage, and any world that we're building needs to be one that embraces disability from the beginning.
i keep thinking about the concept of non-reformist reforms that gets talked about a lot in the prison abolition movement. the idea behind non-reformist reforms is that usually, reforms work to reinforce the status quo. they're usually talked about in liberal language of "improvement" and "human rights", but when it comes down to it, they're still giving more power to harmful institutions and reinforcing state power. an example of a reformist reform is building a new jail that is bigger and has "nicer" services. or when the cops in my city tried to get funding for more wheelchair accessible cop vans. these are reformist reforms because when it comes down to it, it's still giving more money and legitimacy to the prison system and increasing the capacity to keep people locked up--even when people talk about it using language about welfare for prisoners, that's not actually what's happening. having more wheelchair accessible cop vans would be dangerous for the disabled people in my city--it's helped us out a LOT that it's so difficult for the cops to arrest multiple wheelchair users at once.
non-reformist reforms are the opposite of that--they're reforms that work to dismantle systems, redistribute power, and set the stage for more even more dramatic transformations. They're sort of an answer to the question of "what do we do right now if we can't go out and burn down all the prisons overnight?" Examples of a nonreformist reform are defunding prisons, getting rid of paid administrative leave for cops, shutting down old prisons and not building new ones, etc. they're steps we can take right now that don't fully abolish prisons, but still work to dismantle them, rather than making it easier for the system to keep going.
so, when we apply this to the psych system, what are some nonreformist reforms that could help make sure that all disabled people are having their needs met right now? Some ideas I'm having include fixing the problem of PHP/outpatient care requiring referrals from inpatient, increasing the amount of Medicaid/Medicare funding for outpatient mental health care, building physically accessible peer respites that allow caregivers to stay with you if needed, increasing SSI/SSDI to an actually liveable rate, creating more disability specific mental health resources, support groups, care webs, and a million other things we'd probably need to actually get our needs met. non-reformist reforms for people in psych wards right now might look like ensuring everyone has 24/7 access to phones and internet, ensuring that disabled people have access to mobility aids in these spaces, making sure that there's accessible nutrition for people with dietary restrictions and/or feeding tubes, and more.
when i see people saying that we need to ensure that psych wards or prisons are made accessible it makes me feel nervous. i worry that the changes required to do that wouldn't actually provide care to disabled people, i worry it would just make it easier for increasing numbers of disabled people to get locked up and harmed all while people claimed it was a success story of "inclusion." i worry that it would just continue to cement carceral treatment as the only option for existing as a disabled person, and that it would make it harder for us to live in our communities, with the services and adaptations we need. when i think about abolition, i'm always thinking about what can we do right now, what do disabled people who are incarcerated and institutionalized need right now, what can we do right now to ensure that everyone is surviving and getting their needs met. i'm not willing to ignore or discard my incarcerated disabled comrades in the moment because of my dreams for an abolitionist future, i'm always going to support our organizing in these places as we try to survive them.
overall i guess what i'm saying is that i think making inpatient psych care accessible would require dismantling and fundamentally destroying the whole system. I can't imagine a way of doing that within the current system that wouldn't just continue to harm disabled people. and that as a psych abolitionist i think that means we have a responsibility to each other right now to fight for that, to understand that physically disabled people not being able to access mental health care is an incredibly urgent need. I refuse to treat my MadDisabled comrades as disposable: our lives are valuable and worth fighting for.
i'm also going to link to the HEARD organization on this post. They're one of the few abolitionist organizations that does direct advocacy and support for deaf and disabled people in prisons. if you or one of your disabled community members ever gets incarcerated in jail/prison, they have a lot of resources. donate to support their work if you can.
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