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:

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

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

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

Alternatives to incarceration exist, but remain underfunded and underutilized.
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/⁠⁠

Want more Dr. Jhilam Biswas:
Dr. Biswas Website:
⁠https://psychexpertise.com/⁠
⁠https://www.neuroethicscollege.org/⁠

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Produced by Dr Glaucomflecken & Human Content
Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠

Chapters:

00:00 Understanding Mental Illness: A Medical Perspective
00:41 Introducing Dr. Jhilam Biswas: Forensic Psychiatry Expert
01:44 Forensic Psychiatry: Bridging Psychiatry and Law
06:04 Personal Journeys into Forensic Psychiatry
11:44 Challenges and Rewards in Forensic Psychiatry
18:42 Practicing Psychiatry in Correctional Settings
32:09 Ethical Considerations in Forensic Psychiatry
43:24 Substitution of Interests in Medical Ethics
44:10 Legal Processes and Patient Deterioration
45:34 Clinical Stories and System Failures
46:45 Freedom vs. Wellbeing in Psychiatry and Law
47:29 Homelessness and Incarceration Due to Untreated Mental Illness
49:22 Challenges in Medicating Psychotic Patients
50:32 Adversarial Hearings and Medication Delays
52:14 Stigma and Historical Context in Psychiatry
58:38 Advocacy and Legislative Efforts
01:08:53 Conclusion and Final Thoughts