10. S. Wakefield and C.J. Wildeman, Children of the Prison Boom.
11. T.A.L. Craigie, “The Effect of Paternal Incarceration on Early Childhood Behavioral Problems: A Racial Comparison,” Journal of Ethnicity and Criminal Justice 9, no. 3 (2011): 179–99; K. Turney and A.R. Haskins, “Falling Behind? Children’s Early Grade Retention After Paternal Incarceration,” Sociology of Education 87, no. 4 (2014): 241–58.
12. J. Hagan and H. Foster, “Children of the American Prison Generation: Student and School Spillover Effects of Incarcerating Mothers,” Law and Society Review 46, no. 1 (March 2012): 37–69.
13. M.E. Roettger and J.D. Boardman, “Parental Incarceration and Gender-Based Risks for Increased Body Mass Index: Evidence from the National Longitudinal Study of Adolescent Health in the United States,” American Journal of Epidemiology 175, no. 7 (2012): 636–44.
14. H. Foster and J. Hagan, “Maternal and Paternal Imprisonment in the Stress Process,” Social Science Research 42, no. 3 (2013): 650–69.
15. M.E. Roettger, R.R. Swisher, D.C. Kuhl, and J. Chavez, “Paternal Incarceration and Trajectories of Marijuana and Other Illegal Drug Use from Adolescence into Young Adulthood: Evidence from Longitudinal Panels of Males and Females in the United States,” Addiction 106, no. 1 (2011): 121–32). Foster and Hagan, “Maternal and Paternal Imprisonment.”
16. S. deVuono-Powell, C. Schweidler, A. Walters, and A. Zohrabi, Who Pays? The True Cost of Incarceration on Families (Oakland, CA: Ella Baker Center, 2015).
17. D.H. Dallaire, A. Ciccone, L.C. Wilson, “Teachers’ Experiences with and Expectations of Children with Incarcerated Parents,” Journal of Applied Developmental Psychology 31, no. 4 (2010): 281–90.
18. American Academy of Pediatrics, “Developmental Issues for Young Children in Foster Care: Committee on Early Childhood, Adoption, and Dependent Care,” Pediatrics 106, no. 5 (2000): 1146.
19. K. Zezima, “When Soldiers Go to War, Flat Daddies Hold Their Place at Home,” New York Times, September 30, 2006.
20. C. Boudin, “Children of Incarcerated Parents: The Child’s Constitutional Right to the Family Relationship,” Journal of Criminal Law and Criminology 101, no. 1 (2011).
21. Nell Bernstein, All Alone in the World: Children of the Incarcerated (New York: The New Press, 2005), 269–70.
22. Emani Davis is a nationally recognized advocate for children of incarcerated parents and also the daughter of Liz Gaynes.
23. See the website of Echoes of Incarceration, www.echoesofincarceration.org.
24. Beaty’s website is www.danielbeaty.com.
25. G. Puddefoot and L.K. Foster, Keeping Children Safe When Their Parents Are Arrested: Local Approaches That Work (Sacramento: California Research Bureau, 2007).
26. J. Lang and C. Bory, “A Collaborative Model to Support Children Following a Caregiver’s Arrest: Responding To Children Of Arrested Caregivers Together (REACT),” Connecticut Center for Effective Practice and Child Health and Development Institute of Connecticut, Inc., September 2012.
27. M. Defraites, “Lowering Incarceration Rates, Honoring Children of Incarcerated Parents,” June 12, 2013, https://obamawhitehouse.archives.gov/blog/2013/06/12/lowering-incarceration-rates-honoring-children-incarcerated-parents.
28. Office of Public Affairs, Department of Justice, “Department of Justice and the International Association of Chiefs of Police Release Groundbreaking Model Policy: Safeguarding Children of Arrested Parents,” press release, July 31, 2014.
29. International Association of Chiefs of Police and Department of Justice, Safeguarding Children of Arrested Parents: A Model Protocol, 2014, 11.
30. International Association of Chiefs of Police and Bureau of Justice Assistance, “Spotlight on Albany Police Department,” in Implementing a Parental Arrest Policy to Safeguard Children: A Guide for Police Executives, August 2016, 12.
31. Albany police chief Brendan Cox, personal communication, August 2, 2016.
32. The New York State Chief’s Chronicle (New York State Association of Chiefs of Police), June 2016.
33. The use of training videos during roll call when officers report for their shifts each day is not unprecedented. IACP also uses these tools to train officers on responding to other high-need groups, such as people living with Alzheimer’s and other dementias.
34. Senator Carol Liu SCR 20 Fact sheet, 2009. SCR20 can be accessed at http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb_0001-0050/scr_20_bill_20090901_chaptered.pdf; D.N. Newell, personal communication, April 11, 2012.
35. Oklahoma Statute Title §22-20.
36. Bernstein, All Alone in the World, 260.
37. A. Southall, “Jesse Jackson, Jr., Gets 30 Months, and His Wife 12, to Be Served at Separate Times,” New York Times, August 14, 2013.
38. D. Murphey and P.M. Cooper, Parents Behind Bars: What Happens to Their Children? (Bethesda, MD: ChildTrends, 2015).
39. M.T.Berg and B.M. Huebner, “Reentry and the Ties That Bind: An Examination of Social Ties, Employment and Recidivism,” Justice Quarterly 28, no.2 (2011): 382–410; C.Shapiro and M. Schwartz, “Coming Home: Building on Family Connections,” Corrections Management Quarterly 5, no. 3 (2001): 52–61.
40. G. Duwe and V. Clark, “Blessed Be the Social Tie That Binds: The Effect of Visitation on Offender Recidivism,” Criminal Justice Policy Review 24, no. 3 (2011): 271–96.
41. Ibid., 29.
42. DeVuono-Powell et al., Who Pays?
43. Ibid., 9.
44. Bernstein, All Alone in the World, 95.
45. C. Carr, personal communication, 2014.
46. The Osborne Association’s website is www.osborneny.org.
47. The Hour Children website is www.hourchildren.org.
48. DeVuono -Powell et al., Who Pays?, 9.
49. In 2017, the Osborne Association circulated a concept paper describing kinship reentry to city and state legislators. There was interest, but to date this has not been implemented.
9
Health and Decarceration
ROSS MACDONALD AND HOMER VENTERS
There can be no more compelling case for decarceration than a look inside the walls of American jails and prisons. Here there is ample evidence of failed management strategies, unmet community needs, and often a mismatch between the needs and abilities of almost everyone involved. While it is certainly true that jails and prisons house very sick and high-needs inmates, it is equally important to realize that these settings also create new health risks for the incarcerated. These risks are not spread evenly across the population, much like the risk of incarceration itself. The large disparities in class and race that play into arrest and conviction continue inside the walls of jails and prisons, with even less transparency. In addition, the inability of criminal justice systems to break the cycles of repeated incarcerations has created a cohort of high-needs people with substance use histories and housing problems that are largely unaddressed.
As these people repeatedly cycle through jails, homeless shelters, inpatient psychiatric settings, and street homelessness, the arc of their lives rarely is bent toward any improvement, despite the expenditure of enormous resources at every point of contact. This is in part because the considerable health services that are provided in jails and prisons lack consistent oversight or accountability in terms of access or quality.
The mandate to provide health care to the incarcerated makes prisoners the only group of American civilians who are guaranteed a “right” to health care. This right is linked to the Eighth Amendment of the U.S. Constitution via prohibition against “cruel and unusual” punishment, however, meaning that very common and broadly defined types of malpractice or unintentional lapses in care do not constitute a breach of this right. In addition, the funding of this care is local, as is the oversight, leading to many inconsistent and narrowly focused correctional health services.
Not all the examples of prison health care are negative. In some settings, efforts to establish teams that plan for an inmate’s discha
rge from prison have improved health and other outcomes after incarceration. In addition, data from prior incarcerations can be leveraged to divert people after arrest toward treatment and away from jail or prison.
Such examples notwithstanding, in the discussion of how to decarcerate the United States, an examination of the health risks of incarceration provides ample evidence of the specific failures of mass incarceration, as well as guidance about which groups of currently incarcerated people can be better served in alternate settings. In addition, the expansion of health insurance and coordinated case management created by the Affordable Care Act drew community health systems and insurance corporations into the discussion of the human and financial costs of mass incarceration. Prior to the 2016 election, there was some hope that this involvement could be leveraged for positive changes in correctional health care and coordination with aftercare upon reentry. But at the time of this writing (2017) no assumptions can be made about the future of most health care policies in America.
Health Risks of Incarceration
In the United States, we have come to accept the narrative that jails and prisons receive an increasingly sick and high-needs cohort of people. However, as incarceration has evolved to focus on those with nonviolent charges and with behavioral health problems, there has been relatively little analysis of the de novo health risks that these settings confer on the incarcerated. Adverse outcomes among the incarcerated, from missed medications to injury from violence or overdose death after release, reflect an interaction between inmates’ own characteristics and the risks that come from their surroundings. Understanding how these health issues interact is key to improving outcomes for the incarcerated, but also for designing alternatives that might improve community outcomes and avoid the need for incarceration.
The most reliably reported health outcome in jails and prisons is death, with the U.S. Department of Justice’s Bureau of Justice Statistics (BJS) receiving and aggregating basic death statistics. While most deaths in custody are linked to long-standing chronic illness, failures in provision of medications or other types of care can precipitate early death in jail or prison. Rates of suicide are far greater in jails, where people are typically held before they are convicted or for sentences of less than one year, than in prisons, and reflect the chaos of new criminal charges as well as the relative lack of knowledge about the people cycling through jail settings. In the most recent BJS report, covering 2000–2013, suicide was the leading cause of death in jails for every year of the reporting period, accounting for 34 percent of all jail deaths in 2013. In prison, natural causes of death predominate, with illness-related deaths such as heart and liver disease and cancer accounting for 89 percent of deaths in 2013. It is difficult to compare the rates of mortality between jail and prison because the data included by BJS are measured per 100,000 inmates and there are dramatic differences in length of stay and the age of inmates between the two types of settings.1
Another important health risk of incarceration is injury. Unlike deaths, injuries in jail and prison are not collected or analyzed in a standardized way, despite their extremely high prevalence. We conducted an analysis of injuries in the New York City jail system in 2011, which revealed that rates of injury among inmates were over 736 per 1,000 person-years, far in excess of community rates (which span approximately 90–300 per 1,000 person-years). In subsequent years, we have further refined our injury-tracking efforts to gather more information about the intentionality, cause, and circumstances of injuries to our patients. A major feature of this work has been to modify our electronic health record to allow for aggregate collection of health outcomes alongside variables that can be analyzed as part of these health outcomes, such as individual patient characteristics, environmental characteristics, mechanisms of injury, and so forth. For example, we are able to track injuries that include blows to the head and examine the percentage of inmate fights versus uses of force with security staff that cause this sort of injury.2
Table 9.1. Top Five Causes of Death, Overall Trend 2008–2013
Our analyses of injuries led us to examine the relationship between self-harm and potential predictive factors. We observed that the incidence of self-harm was increasing dramatically in 2011 and 2012. Clinical staff reported that this was often a function of the stress of being placed in solitary confinement, especially for adolescents and patients with mental illness. In order to better characterize these observations, we analyzed approximately 225,000 patient admissions in our electronic health record. We found that being adolescent, having serious mental illness, and exposure to solitary confinement were all risk factors that increased the likelihood of being in the group that self-harmed by six to eight times. Another way of looking at this data was that only about 7 percent of people who entered the jail ever went into solitary confinement. Nonetheless, more than half (53 percent) of all the self-harm occurred in this small group, as did almost half (45 percent) of the potentially lethal self-harm.3 We followed this analysis with another that examined approximately fifty thousand first-time jail admissions and revealed significant racial and age disparities in who received punishment (via solitary confinement) and who received treatment (in the jail mental health service). In this analysis, African American men were 2.4 times more likely to be confined in solitary than white men, even when adjusting for length of stay.4 These analyses reveal the physical harm and associated trauma that is a component of incarceration. They also reveal that the same racial disparities that are associated with incarceration may compound the adverse health consequences conferred by incarceration itself.
Aside from the human toll on individuals and their families, a great deal of expense is incurred by these health outcomes. For example, in our self-harm analysis, we calculated that every 100 acts of self-harm (there were more than 2,000 in this three-year analysis) entailed 36 transfers to a higher level of care and 3,760 hours of escort time by security staff, usually on overtime.
These data, along with favorable political circumstances and concerted collaboration between mental health and security staff, have led to virtual elimination in the use of solitary confinement for adolescents and people with serious mental illness in the New York City jail system. But few systems have the political will, the local resources, or the capital necessary to implement alternative models to safely house those with significant behavioral challenges.
Supportive Housing and Incarceration
Another aspect of the folly of mass incarceration involves those who cycle through jails repeatedly. In New York City, we have identified a group of eight hundred frequently incarcerated individuals who together accounted for more than eighteen thousand incarcerations over approximately six years, making up only 0.3 percent of the population incarcerated in New York City jails over that time but accounting for 3.5 percent of all incarcerations at an estimated cost of approximately $129 million.5 Incarcerations in this group were marked by their short duration and minor charges such as petty larceny, possession of trace amounts of controlled substances, trespassing, and jumping the subway turnstile. Assault charges are less common in this group than in a cross section of the jail population. With a mean age of forty-two years, this population was significantly older than the cross-sectional jail population.
Here we find a population for whom incarceration is serving no apparent purpose. They are not incapacitated, because they stay briefly and spend most of their time in the community. They are not deterred or rehabilitated, as evidenced by their repeated engagement in the same behavior that returns them to jail. And jailing does not represent retribution for their crimes because these are so minor as to not require retribution. The criminal justice system moves to release them from jail as soon as it becomes aware that they have been incarcerated again (median length of stay eleven days), but the cycle persists.
A look at the medical and mental health needs of these people sheds more light on this phenomenon. Significant substance use in this group was 97 percent prevalent, wi
th 19 percent meeting criteria for serious mental illnesses and 37 percent having ever been prescribed an antipsychotic in jail. The prevalence of chronic disease such as HIV, hepatitis C, diabetes, and epilepsy was higher in this group than in the cross-sectional jail population, which is already known to outpace the community in these measures.
More than half had evidence of homelessness in their medical charts, though the study design was not sensitive to this. Indeed, with a mean of twenty-three incarcerations per person over the approximately six-year study, the vast majority likely struggled with housing instability. We hypothesize that homelessness is the medium by which substance use disorders, often in conjunction with significant mental illness, come to the attention of the public and thus the criminal justice system. Living on the street leads this group to interact with the public in ways that are uncomfortable or unacceptable, such as public intoxication (leading perhaps to the trace possession charges), trespassing, or subsistence petty theft. Though they may be eligible for public services such as food stamps and even supportive housing, qualitative evidence suggests that they are profoundly disabled by substance use, limited bureaucratic literacy, mental illness, and frequent incarceration itself, such that they cannot consistently access these supportive services. In this framework, their minor charges can then be viewed more as a pretense to remove them from untenable public situations rather than as the actual target of policing efforts. The same degree of substance use or mental illness in a person with stable housing would more often be managed in the treatment arena without coming to the attention of the public, and thus the criminal justice system. Just as housing is known to be a key social determinant of health, here it represents a social determinant of incarceration.
Decarcerating America Page 23