The Hunger Games, Corrections            Style   Jeffrey E. Keller MD FACEP CCHP
Faculty Disclosure• “I do not have any relevant financial  relationships with any commercial interests.”
Objectives• Describe the historical roots and modern  definition of a “Hunger Strike.”• Identify reasons inmates may refus...
“Hunger Strike”• The term “Hunger Strike” is often used  inappropriately for any inmate who refuses to  eat
Bobby Sands• Member of the Irish Republican Army• Wanted to be considered a Prisoner of War  rather than a common criminal...
Criteria for a true Hunger Strike• The person intends to commit suicide• The suicide is done for a political or religious ...
Suicide by Starvation?• Buddhist monk setting himself on fire to  protest totalitarian rule in Myanmar.• Al Qaida “suicide...
Most Inmates Who are Fasting are not         “Hunger Strikers.”•   Religious fasts•   Extreme dieting•   Manipulative inma...
The Approach to Each of These is             Different• Housing. Special housing. Monitoring.  Audience• Mental Health. Su...
Step by Step Approach•   Initial interview•   Initial Physical Exam•   Setting up a care plan•   What about inmates who ac...
Initial interview--Questions•   Are you expecting to die?•   Are you protesting something?•   Total fast or will you eat s...
Initial Interview--Education– You can fast for awhile– We cannot allow you to harm yourself– Court ordered feeding if nece...
Initial Interview Results• Suicide by starvation  – True Hunger Strikers  – Impulsive• Those who deny suicidal intent  – D...
The Physical Exam•   Weight•   Fat reserves•   Overall health•   Labs?
Care plan--Housing• Suicide precautions• Who can Remain in the Dorms?• Separate from support group  – Psychological suppor...
Care Plan—Mental Health Evaluation•   Suicidal•   Psychotic•   True Hunger Strikers•   Protestors
Medical Monitoring• Repeat medical evaluations  – Weights  – Food logs  – Vitals• Do not be an Enabler  – “I don’t want a ...
Care Plan--Legal• Psychotic inmates  – Commitment• Hunger strikers  – Timing is important  – Aggressive interventions must...
Case 1—Extreme Dieter•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
Case 2—Religious Fast•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
Case 3--Protester•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
Case 4--Manipulator•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
Case 5--Psychotic•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
Case 6—True Hunger Strike•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
True Hunger Strike—Week 2•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
True Hunger Strike—Week 4•   Housing?•   Medical monitoring?•   Mental Health?•   Legal?
True Hunger Strike          Involuntary Feeding• WHO• Guatanamo experience• How it is done
Summary• “Hunger Strike” = “Suicide by Starvation”• Hunger Games Response  – Housing  – Medical monitoring  – Mental Healt...
Questions? Comments?
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Hunger games

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Transcript of "Hunger games"

  1. 1. The Hunger Games, Corrections Style Jeffrey E. Keller MD FACEP CCHP
  2. 2. Faculty Disclosure• “I do not have any relevant financial relationships with any commercial interests.”
  3. 3. Objectives• Describe the historical roots and modern definition of a “Hunger Strike.”• Identify reasons inmates may refuse to eat and the appropriate assessment, diagnosis and treatment for each.• Outline a step-by-step approach applicable to all types of fasting inmates that incorporates medical monitoring, housing, mental health and legal considerations.
  4. 4. “Hunger Strike”• The term “Hunger Strike” is often used inappropriately for any inmate who refuses to eat
  5. 5. Bobby Sands• Member of the Irish Republican Army• Wanted to be considered a Prisoner of War rather than a common criminal• Announced fast on March 1, 1981• Died 66 days later• Generated international publicity for his cause
  6. 6. Criteria for a true Hunger Strike• The person intends to commit suicide• The suicide is done for a political or religious reason• A goal is to generate maximum publicity
  7. 7. Suicide by Starvation?• Buddhist monk setting himself on fire to protest totalitarian rule in Myanmar.• Al Qaida “suicide bombers”• Easier to push a button detonating a bomb than to not eat for 66 days.
  8. 8. Most Inmates Who are Fasting are not “Hunger Strikers.”• Religious fasts• Extreme dieting• Manipulative inmates who are secretly eating.• Tantrum throwers• Mentally ill inmates• Protesters (but not suicidal)• True Hunger striker.
  9. 9. The Approach to Each of These is Different• Housing. Special housing. Monitoring. Audience• Mental Health. Suicidal? Psychotic?• Medical monitoring? Weights, Vital signs, labs• Legal. Commitment? Involuntary feeding?
  10. 10. Step by Step Approach• Initial interview• Initial Physical Exam• Setting up a care plan• What about inmates who actually fast for a long time?
  11. 11. Initial interview--Questions• Are you expecting to die?• Are you protesting something?• Total fast or will you eat something?• How long will you fast?
  12. 12. Initial Interview--Education– You can fast for awhile– We cannot allow you to harm yourself– Court ordered feeding if necessary
  13. 13. Initial Interview Results• Suicide by starvation – True Hunger Strikers – Impulsive• Those who deny suicidal intent – Dieters – religious fasts• Psychotic and delusional
  14. 14. The Physical Exam• Weight• Fat reserves• Overall health• Labs?
  15. 15. Care plan--Housing• Suicide precautions• Who can Remain in the Dorms?• Separate from support group – Psychological support – Surreptitious feeding
  16. 16. Care Plan—Mental Health Evaluation• Suicidal• Psychotic• True Hunger Strikers• Protestors
  17. 17. Medical Monitoring• Repeat medical evaluations – Weights – Food logs – Vitals• Do not be an Enabler – “I don’t want a tray. I won’t eat it anyway.” – Don’t feed attention seeking more than necessary.
  18. 18. Care Plan--Legal• Psychotic inmates – Commitment• Hunger strikers – Timing is important – Aggressive interventions must be court ordered
  19. 19. Case 1—Extreme Dieter• Housing?• Medical monitoring?• Mental Health?• Legal?
  20. 20. Case 2—Religious Fast• Housing?• Medical monitoring?• Mental Health?• Legal?
  21. 21. Case 3--Protester• Housing?• Medical monitoring?• Mental Health?• Legal?
  22. 22. Case 4--Manipulator• Housing?• Medical monitoring?• Mental Health?• Legal?
  23. 23. Case 5--Psychotic• Housing?• Medical monitoring?• Mental Health?• Legal?
  24. 24. Case 6—True Hunger Strike• Housing?• Medical monitoring?• Mental Health?• Legal?
  25. 25. True Hunger Strike—Week 2• Housing?• Medical monitoring?• Mental Health?• Legal?
  26. 26. True Hunger Strike—Week 4• Housing?• Medical monitoring?• Mental Health?• Legal?
  27. 27. True Hunger Strike Involuntary Feeding• WHO• Guatanamo experience• How it is done
  28. 28. Summary• “Hunger Strike” = “Suicide by Starvation”• Hunger Games Response – Housing – Medical monitoring – Mental Health – Legal
  29. 29. Questions? Comments?

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