Treating an "epidemic of mass incarceration" —Physicians in NJEM

Everybody from Serpico to Richard Branson and even the U.S. Senate says the War on Drugs has failed and we should stop locking up so many people. Now physicians weigh in.

ScienceDaily, 1 June 2011, U.S. Physicians Call for New Approach to Address National 'Epidemic of Mass Incarceration'

With 2.3 million people behind bars and an estimated 10 million Americans cycling in and out of correctional facilities each year, the United States is in the midst of an "epidemic of mass incarceration," say researchers from the Center for Prisoner Health and Human Rights, a collaboration of The Miriam Hospital and Brown University.

In a Perspective article to appear in the June 2 issue of the New England Journal of Medicine (NEJM), the authors argue that much of this epidemic is due to inadequate treatment of addiction and mental illness in the community, which they say can be linked to policy changes over the last 30 years, such as severe punishment for drug users as a result of the nation's "War on Drugs."

"More than half of all inmates have a history of substance use and dependence or mental illness, yet they are often released to the community without health insurance or access to appropriate medical care and treatment," says Josiah D. Rich, M.D., M.P.H., director of the Center for Prisoner Health and Human Rights, which is based at The Miriam Hospital.

"Sadly, without these linkages to transitional care in the community, the majority of these individuals will re-enter the revolving door of the criminal justice system, which already costs our county $50 billion annually," he adds.

What is to be done?

Start with diagnosis and treatment of diseases, mental and physical, and follow up with re-entry programs:

There are tremendous medical and public health opportunities that can be created by addressing the health care needs of prisoners and former prisoners, the authors note. "For some inmates, incarceration may represent their first intersection with the medical community, offering an invaluable opportunity to diagnose and treat the overrepresented rates of infectious and chronic diseases, addiction and mental illness," says Wakeman.

Partnerships between correctional facilities and community health care providers -- especially community health centers and academic medical centers -- also can capitalize on health gains made during incarceration and improve the continuity of care for former inmates during the critical post-release period.

"Health care reform, with the Affordable Care Act, has the potential to improve access to much needed health care, which in turn, could redirect many people with serious illnesses away from the revolving door of the criminal justice system," the authors write, adding that this could avoid costs, re-incarceration and other adverse outcomes related to untreated addiction and mental illness.

Oh, and stop locking up so many people:

Rich concludes that a new evidence-based approach is desperately needed. "Locking up millions of people for drug-related crimes has failed as a public-safety strategy and has harmed public health in the communities to which these men and women return," he says. "The medical community and policymakers must advocate for alternatives to imprisonment, drug-policy reform and increased public awareness in order to reduce the consequences of mass incarceration."

Here's the actual NJEM article, Medicine and the Epidemic of Incarceration in the United States, Josiah D. Rich, M.D., M.P.H., Sarah E. Wakeman, M.D., and Samuel L. Dickman, A.B. N Engl J Med 2011; 364:2081-2083June 2, 2011. Someone has helpfully posted a PDF.

Since locking up so many people is a public health problem, we don't need to make it worse by using tax dollars to profit private prison companies. We don't need a private prison in Lowndes County, Georgia. Spend those tax dollars on rehabilitation and education instead.

-jsq