Earlier this year, Jerome Murdough—a homeless veteran charged with trespassing—died after being left unchecked for hours in a sweltering cell in New York City’s Rikers Island Jail mental observation unit. His death showed us what can occur when medical, social service, and criminal justice systems fail to meet the needs of vulnerable individuals. Stories like Murdoch’s, or those of other inmates with mental illnesses who are featured in the New York Times series “Locked In”—cast in high relief the challenges we face when reconciling punishment and the treatment of those who are incarcerated, especially people with mental illness.
This is not an issue unique to New York City. Across the country, people with mental health needs are too often warehoused in overcrowded, chaotic, and violent correctional facilities rather than treated in the community.
The Affordable Care Act (ACA), however, presents a tremendous opportunity to address this national crisis and ensure that patients like Murdough don’t end up on Rikers Island. The ACA provides one of the largest expansions of mental health coverage in U.S. history—extending it to 27 million people who previously lacked health insurance—and a wider range of benefits to 62 million U.S. citizens overall. Millions of uninsured, undertreated, and destitute people cycling through correctional systems will be covered for the first time.
This expansion of treatment opportunities, coupled with bipartisan agreement that we need a comprehensive overhaul of the criminal justice system, presents a rare opportunity for reform that we can and must seize.
The criminal justice system has expanded to such a degree that mass incarceration is now one of the major public health concerns facing poor communities, according to a new report from the Vera Institute of Justice. Since the 1970s, state prison populations in the U.S. have grown by 700 percent. Yet the nation’s overuse of incarceration succumbed to the law of diminishing returns long ago—creating more harm than good—with widening disparities in health as one of the results.
The concentration of incarceration and the omnipresence of the criminal justice system in the lives of residents in poor communities of color are well documented. Now research is starting to reveal the extent to which mass incarceration impacts community health. For example, decades of disparate exposure to incarceration among communities of color has fractured families and exacerbated socioeconomic inequities in ways that have contributed to wider gaps in infant mortality rates between black and white Americans.
The criminalization of addiction and mental illness is a core driver of overall health disparities in the criminal justice system. The War on Drugs in essence delegated to criminal justice agencies what should be the responsibility of our community health system. As a result, people coping with serious clinical conditions are gravely overrepresented in correctional facilities. Yet the traditional punitive tactics that corrections departments too frequently turn to—such as solitary confinement—tend to promote the very behavioral problems that lead to incarceration.
There are signs that the social and political climate is changing. U.S. Senators Rand Paul (R-KY) and Cory Booker (D-NJ) have reached across the aisle to work on federal legislation that aims to remove the stigma and legal barriers that prevent millions of Americans with a drug conviction from securing employment and public benefits. Additionally, state officials are pursing legislative and programmatic solutions to trim their prison populations: A recent Vera study found that more than 29 states have amended, scaled down, or repealed laws that mandated lengthy prison sentences for drug and other crimes.
But undoing mass incarceration’s public health crisis will require more than changing sentencing laws and providing people with health insurance. We also need state and local investments to establish a robust network of community health centers and a culturally competent workforce in neighborhoods where mass incarceration is most entrenched. These investments are needed in order to stop relying on jails and courts as default healthcare providers.
This strategy is being pursued in New York City, where Mayor Bill DeBlasio announced a sweeping plan to prevent people with mental health needs from ending up at Rikers Island when they encounter law enforcement. The plan includes the opening of a Public Health Diversion Center, under the auspices of the New York City Department of Health and Mental Hygiene. It would redirect people to community-based services—in lieu of arrest and prosecution—in communities where health disparities and incarceration are most prevalent. The diversion center would include a 24-hour drop-off location where people accused of low-level crimes could receive health services, withdrawal treatment, case management, overnight shelter, and food.
Finally, we need our political leaders to repeal unjustly harsh policies that deprive individuals who have served their time—and their families—of a fair chance at finding secure housing, entering the labor market, and rising out of poverty.
Momentum is building in the right direction. Ending mass incarceration and restoring the health of our communities is a mission that we all must get behind.