Researcher: New approach needed for incarceration

PROVIDENCE – The current “epidemic of mass incarceration,” with more than 2.3 people behind bars and some 10 million Americans cycling in and out of correctional facilities each year, is being caused by inadequate treatment of addiction and mental illness, said Dr. Josiah D. Rich, director of the Center for Prisoner Health and Human Rights, a collaboration of The Miriam Hospital and Brown University.
In an article appearing in the June 2 issue of the New England Journal of Medicine, Rich says the epidemic is linked to policy changes over the last 30 years related to the nation’s “war on drugs.”
In the last 40 years, the number of people in U.S. prisons has increased by more than 600 percent, with one out of every 100 Americans currently in prison or jail, according to Rich and his co-authors Dr. Sarah E. Wakeman of Massachusetts General Hospital and Samuel L. Dickman of Harvard Medical School. Low-income and minority populations are disproportionately affected by this epidemic of mass incarceration.
“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,” said Rich. “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 country $50 billion annually.”
The largest facilities housing psychiatric patients in the U.S. are not hospitals but jails, the article said.
Major depression and psychotic disorders are four to eight times as prevalent among inmates as in the general population. However, only 22 percent of state prisoners and 7 percent of jail inmates receive mental health care while incarcerated.
In addition, as many as one quarter of all HIV-positive Americans and one in three individuals with hepatitis C pass through a correctional facility each year.