The U.S. incarcerates a higher percentage of its citizens than any other country in the world.
There’s little doubt among researchers that mass incarceration is wreaking havoc on our society, in particular on people of color, LGBTQ and the poor. What’s often overlooked in this discussion is the damage that prisons and jails do to our health — from those who are incarcerated to their family members waiting at home to those who work in detention settings.
As researchers and advocates, we have studied mass incarceration issues and started discussions on the ethics of this practice. To us, the evidence is clear: Mass incarceration is a public health scourge in the U.S.
The only reasonable response is to limit the unnecessary use of incarceration across the board — as lawmakers in New Jersey and Maryland are attempting to do.
Incarceration and health
Each year, an estimated 1,000 people die while incarcerated in local jails.
A majority of those who died were not convicted of any crimes and were being held pretrial, often because they were too poor to afford bail. Those awaiting trial in jail have nearly twice the mortality rate of people who have been convicted and are serving their sentence. This appears to be a testament to the stress associated with being held pretrial.
Perhaps not surprisingly, suicide is the leading cause of mortality in U.S. jails, accounting for 34 percent of all deaths. Again, the vast majority of these individuals have not been convicted of any crime. Suicide rates among incarcerated individuals are three to four times higher than the general public.
Many individuals in jail and prison suffer from mental illness. A majority of sentenced people in jail and prison meet the criteria for drug dependence and abuse.
Even though incarceration often forces individuals to remain sober, being incarcerated generally exacerbates mental health disorders. Research has shown that those with mental illness and substance use disorders have better treatment outcomes outside of correctional facilities. When individuals who have been receiving mental health care end up in correctional facilities, they often experience a large disruption in their care. They might lose access to medication or be forced to switch to entirely different ones. Their relationship with a mental health provider might also be severed.
The food — which tends to be high-calorie and high-fat — often has poor nutritional value. This, combined with restrictions on physical movement and the stress of incarceration and overcrowding, can have adverse effects on both mental and physical health. Lack of privacy, poor sanitation and poor ventilation often only make matters worse.
Incarceration also puts individuals at risk for physical and sexual assault.
Furthermore, the U.S. faces the burgeoning crisis of a geriatric incarcerated population. According to the Federal Bureau of Prisons, almost 19 percent of inmates are over 50 years of age. To make matters worse, several states — including Massachusetts, where we are based — do not have compassionate release procedures for terminally ill or medically incapacitated people who are sick and dying in our prisons.
Family and employees
It’s not just the incarcerated individual who suffers.
Over half of people behind bars are parents. Most incarcerated mothers were primary caregivers to minor children before their incarceration.
An estimated 2.7 million U.S. children have an incarcerated parent. Having a parent incarcerated is considered to be an “adverse childhood experience.” This is linked to multiple negative health outcomes throughout life, including poor mental health, substance abuse, disease, disability and even early death.
Children with an incarcerated household member are also likelier to experience poor mental and physical health in adulthood.
Since prisons and jails are high stress environments to work in and are often overcrowded and understaffed, correctional officers too can experience serious mental and physical health problems.
A recent survey of 8,300 correctional officers found that 10 percent have seriously considered or attempted suicide. That’s three times the rate of the general population. Correctional workers also experience higher levels of hypertension from elevated stress levels and higher levels of obesity than the national average.
Addressing the problem
So how do we reduce mass incarceration?
The humane treatment of drug users is a step in the right direction. In the face of the opioid epidemic, some policymakers have pushed to redirect resources away from incarceration and toward substance abuse treatment and social services.
But to curb the unhealthy effects of incarceration, we believe that policymakers should extend this compassion to all individuals convicted of crimes. This means reducing the unnecessary use of incarceration across the board, not just when dealing with drug users.
Research indicates that the repeal of mandatory minimum sentencing laws would help; that overzealous and unaccountable prosecutors must be reined in; and that our system of cash bail, which punishes the poor, must be overhauled.
As practitioners based in Massachusetts, we welcomed the passing of the omnibus criminal justice reform bill last October. The bill would retroactively reduce mandatory minimum sentences and would establish a process to permit the medical parole of incapacitated people from prison who pose no public safety risk.
What’s more, the bill’s proposed reforms to cash bail — which would be replaced by a risk assessment system — could reduce the use of pretrial detention, as it has in New Orleans and New Jersey. Similar reforms to reduce cash bail have also been adopted in Alaska, Illinois, New Mexico and Kentucky.
As momentum continues to gain for reform efforts in the U.S. penal system, we believe policymakers across the country should take action to ameliorate the adverse health effects of incarceration and help make our society more just.
Emily Nagisa Keehn, Associate Director, Human Rights Program, Harvard Law School, Harvard University and J. Wesley Boyd, Faculty, Center for Bioethics and Associate Professor of Psychiatry, Harvard Medical School, Harvard University
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