This week, Margaret and I sat down with Dr. Jhilam Biswas, psychiatrist and expert on the intersection of law and mental health, for one of the hardest—and most important conversations we’ve had on the show. Together, we take a close look at how our justice system responds to mental illness: what happens when people in crisis are incarcerated instead of cared for, and how the prison system has become a stand-in for mental health treatment in the U.S.

Dr. Biswas helps us unpack the reality of solitary confinement, forced treatment, and the impossible choices clinicians face when caring for patients inside a system built for punishment, not healing. Alongside Margaret, I reflect on the human cost—on families, on providers, and on the people trapped in cycles of crisis and incarceration.

This isn’t just a policy issue—it’s a deeply personal one. And it’s urgent.

Takeaways:

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  The prison system has become the de facto mental health provider—and it’s failing people in crisis.

  
  


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  Solitary confinement and punishment often substitute for care, especially when individuals are suicidal.

  
  


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  Clinicians face impossible ethical dilemmas, forced to provide care within systems that perpetuate harm.

  
  


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  Alternatives to incarceration exist, but remain underfunded and underutilized.

  
  


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  Reimagining justice requires reimagining care—building systems that prioritize treatment, not punishment.

  
  

Citations:

Biswas J, Drogin EY, Gutheil TG. Treatment Delayed is Treatment Denied. J Am Acad Psychiatry Law. 2018 Dec;46(4):447-453. doi: 10.29158/JAAPL.003786-18. PMID: 30593474.

Biswas J. Dignity restored: the power of treatment first. CNS Spectr. 2024 Dec 23;30(1):e11. doi: 10.1017/S109285292400052X. PMID: 39714025.

Advocacy: 

⁠https://www.psychiatry-mps.org/⁠

Jhilam Biswas:

Dr. Biswas Website:

https://psychexpertise.com/

https://www.neuroethicscollege.org/

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