Decarcerating America Read online

  In “Minimizing the Impact of Parental Incarceration,” Elizabeth Gaynes and Tanya Krupat of the Osborne Association discuss the impact of parental incarceration on children, arguing that a campaign that humanizes parents and all people involved in the justice system must be a key component of decarceration. They warn of the dangers of classifying people based only on their crime, as this ensures the continued poverty, stigmatization, and social marginalization of entire families. And they remind us that the harms associated with incarceration are extended to the health and well-being of both the incarcerated and their families; the costs of institutional support for addressing and healing trauma during and after periods of a family member’s incarceration must all be factored into decarceration efforts.

  In “Health and Decarceration,” physicians Ross MacDonald and Homer Venters, who worked together to provide medical care at Rikers Island in New York City for many years, discuss the provision of health care in jails and prison. For decarceration to succeed, they argue, the scope of correctional health services must be expanded. In particular, we must provide support for diversion efforts before incarceration and also include medication-assisted therapy (e.g., opiate maintenance treatment with methadone or buprenorphine) during incarceration. In the case of diversion, health information for frequently incarcerated people inside jail and prisons can help formulate an alternative to detention. This includes reducing the dramatically increased risk of death immediately after release from prison—ten to twelve times the usual death rate for this population—mostly due to drug overdoses in the two weeks after release.9

  In “Release Aging People in Prison,” Mujahid Farid, director of the Release Aging People in Prison Campaign, and activist Laura Whitehorn advocate for the release of aging people from prison. In New York State, the number of people over fifty years of age confined in prisons increased by more than 84 percent between 2004 and 2014, even as the total number of people locked up fell by 23 percent during the same period. Farid and Whitehorn make the case for accelerating campaigns and initiatives that can lead to the release of greater numbers of elderly prisoners, who are routinely denied parole, compassionate release, and clemency, even though they are the population posing the lowest risk to public safety. Attention has been paid to the elderly prison population, but it has taken only the form of creating geriatric prison wards, hospices, and other ways to accommodate elders behind bars. Ending mass incarceration requires radical reforms that attack the idea of permanent, lifelong punishment and enable the release of many elders serving long sentences, including for violent crimes. Even if it were possible to release all of the nonviolent drug offenders in the next ten to fifteen years, meaningful reductions would have to include the release of people convicted of violent offenses, many of whom are now over fifty-five years of age and have served long periods in prison for offenses they committed when they were young.

  Finally, tertiary interventions broaden our focus from incarcerated individuals themselves to the impact of mass incarceration upon entire communities and populations by focusing on the difficult process of reentry that a former prisoner must undergo upon his or her release from prison. The tertiary approach addresses the very large population of nearly seventy million Americans with criminal records, about 50 percent of whom cycle back through the prison system within the first three years after their release because of parole violations and new arrests; it looks at treatment programs that can reduce recidivism and help reintegrate formerly incarcerated individuals into their families and communities.

  In “Health Care as a Vehicle for Decarceration,” Daliah Heller, former New York City assistant commissioner of health, shows how broad health care reform is a tool for supporting successful decarceration. Heller outlines harm reduction programs that originated at the peak of the HIV and drug epidemic in the South Bronx, and shows how, if continued as it was conceived, President Obama’s much-disputed Affordable Care Act could function to reduce the likelihood of reimprisonment, often for violations related to continued drug use. Heller argues for supportive services to address the social determinants of health, for universal health insurance coverage, and for targeted enrollment and retention for justice-involved individuals and their families, as well as for mental health and substance use disorder care and treatment, all as a means to reduce the number of people we feel a need to lock up.

  In “Come Close In,” Kathy Boudin shares the personal tale of her own twenty-three years of imprisonment and its role in developing her leadership role within the Bedford Hills Correctional Facility for Women and, subsequently, in the creation of Columbia University’s groundbreaking Justice Program, focused on how former prisoners can become powerful assets in decarceration. Boudin argues eloquently for a fundamental shift in how we see former long-term prisoners who may have served sentences for violent crimes, including homicide. A long-term prison experience often creates practical and social expertise that, when combined with a passion for change, can make a huge difference in movements against mass incarceration. For years, lawyers, advocates, activists, policy makers, service providers, health workers, and others have devoted themselves to improving the lives of people impacted by incarceration. Boudin makes a compelling case for including people who were imprisoned, together with those who are supporting loved ones inside, in the national conversation.

  In “Dealing with Drug Use After Prison,” a group of clinicians with decades of experience in the treatment of drug use—Jeannie Little, Jenifer Talley, Scott Kellogg, Maurice Byrd, and Sheila Vakharia—present a new harm reduction model designed to effectively manage drug problems after release from prisons. People with substance use disorders also have very high rates of other mental health disorders—approximately 50 percent of respondents with a substance use disorder also meet criteria for at least one mental health disorder in their lifetimes. Individuals with co-occurring disorders also tend to have more severe and enduring symptoms, are less likely to engage in treatment, are more likely to be homeless, and are at greater risk for being victimized. The harm reduction approach is specifically intended to work with this population, instead of turning to prisons and jails as a first-line defense against drug use. Harm reduction therapy treats substance misuse as a health concern, not a legal issue. It prioritizes safety and employs strategies to keep people alive and healthy. Once people have reduced their risk-taking behaviors, these mental health experts argue, they are in a better position to stabilize their mental, emotional, and socioeconomic conditions. Only then are they likely to be ready to consider changing their relationship with drugs in the more profound ways that will allow them to avoid repeated arrest and incarceration.

  In “From Prisons to Ploughshares,” Eric Lotke discusses ways to develop new economies for prison towns, a critical component of decarceration. Lotke explores the role of rural prisons in local economies and how alternative uses of abandoned prisons must become a positive basis for supporting the decommissioning of prisons and jails. As Patrick Mulhern, mayor of Cresson, Pennsylvania, noted regarding the closure of Cambria State Prison near Pittsburgh in 2013, “It’s going to hurt the restaurants, the hardware store, every business place here is going to be affected. Five hundred employees in one fell swoop—that’s an awful lot.”10 Lotke offers numerous examples of “repurposed” prisons across the country that continue to be a source of jobs and economic vitality, making the transition away from prisons and jails less contentious. Giving prison towns more economic alternatives, Lotke argues, will strengthen the case for decarceration.

  Any conclusions we can draw from this book are, of course, limited by the uncertainties we now face in the United States. The Donald Trump administration has threatened and has now begun to impose massive cuts in public health and social programs, and the U.S. attorney general, Jeff Sessions, has called for reinstatement of long mandatory sentences and a resumption of the failed war on drugs. For decarceration to proceed, both as a concept and as a practical strategy, it will have to surmou
nt the obstacles put up by the current administration, relying on the momentum of decades of reform work at the local, state, and national levels.

  Decarceration will also have to address two linked challenges: reducing the size of the prison population and minimizing the many well-documented harms of the system’s punitive policies. For the many millions of people who have come through our prisons and jails, these harms continue even after release, both in terms of psychological damage and in terms of the array of collateral consequences faced by former prisoners (so memorably described by Michelle Alexander as “the new Jim Crow”). In addition to the 2.2 million individuals behind bars, at the end of 2014, an estimated 4.7 million adults were under community supervision in the U.S. Approximately 1 in 52 adults in the United States was under the control of the criminal justice system, with more than 45,000 offenders newly placed on parole that year.11 The result was the perpetuation of a vast, state-based control apparatus, employing more than 40,000 parole officers, with thousands more in the federal system. Our bloated criminal justice system (which itself employs over 2 million people)12 must be redesigned and reconfigured to one based on the science of public health and on the goals of social justice and human rights.

  The range of topics covered in this book demonstrate the many perspectives and disciplines that will be required to address the specific issues of public health and justice needed to end mass incarceration. The current rise of interest in and support for this public health approach has produced some very useful work in several vital areas directly related to the odds of survival in prison and the possibility for productive lives for the ten to twelve million adult prisoners who have been released in the last twenty years (though about 40 percent of these are currently expected to be reincarcerated within three years after release from prison). These millions of former prisoners, including many (the majority) who do not get rearrested, now live in local communities. They have been called “invisible men” in an important new book of that title by Flores Forbes, a former leader in the Black Panther Party and now vice president for community programs at Columbia University, who himself has been freed from prison for twenty-five years. Forbes is one of a large group of black men in America who are “without constituency” and “all but invisible in society”—men who have served their time and not gone back to prison and who have the potential (largely untapped) to become an important part of efforts to decarcerate America.

  In addition to including the voices of those most affected by mass incarceration in the conversation about ending it, we must pay attention to lessons from an earlier era of deinstitutionalization: that of mental hospitals in the second half of the twentieth century. It is crucial that we not repeat the experiences of the dismantling of that system—a system that at peak was of a scale on par with mass incarceration, affecting about 700 per 100,000 adults in the U.S. population. Deinstitutionalization of millions of mental hospital patients took place beginning in the 1950s and lasting through the 1970s, by which time more than 95 percent of all U.S. mental hospital patients had been discharged, and most of the large institutions that warehoused them had been shut down. That earlier process (also called “decarceration” at the time) was publicly presented as a progressive initiative to get people out of the medieval conditions of many old mental hospitals. At the time, the plan was for mental health services and care to be rendered through community-based programs. Unfortunately, those programs never materialized due to the budgetary demands of the Vietnam War and the death of President John F. Kennedy, who had driven the initiative from the start. This earlier failure of public policy affected many of the same populations we see in prisons today, where about 50 percent of inmates carry major mental health diagnoses. We must certainly insist that prison decarceration not repeat the wholesale abandonment of follow-up care that occurred after the earlier decarceration.

  A special area of new services is also needed to help secure the freedom of the many elderly prisoners who have served decades behind bars. This can be accomplished only with the creation of networks of support from the local communities to which they return.

  The many educational and health service programs required by former prisoners must be concentrated in “reentry communities”—those communities from which most prisoners come and to which they return after release. In New York State, for example, 80 percent of all state prisoners come from six New York City communities. Because decarceration is about both getting people out of prison and the ongoing task of “getting prison out of people,” these concentrations of former prisoners, even though now freed, will require a broad range of services to heal the many wounds of brutal prisons and jails. We must offer compassionate care as former prisoners strive to build new lives after release from prison.

  While decreasing the prison and jail population is a key component of decarcerating America, perhaps even more consequential is addressing the long-term trajectory of the many prisoners who have reentered society and returned to the communities from which they came. Both their families and their networks of social contacts will play a key role as this population struggles to meet their most pressing needs: home, family, education, and a job. And we must provide services in the form of health care, higher education, better employment, and psychological assistance with the many problems, including drug dependence, that they face.

  The good news is that we now have many new advocacy organizations and individual leaders working in the communities of reentry. It is at the community level that these new agents of change and support can make a huge difference in the fates of those communities that account for such a large portion of former prison inmates.

  Among the leading groups offering this type of support is Just Leadership USA, a group founded and led by former prisoner and public policy leader Glenn Martin. Martin has tapped into the large stream of former prisoners who have had extensive experience in the criminal justice system and who after release have advocated for the provision of life-saving services and education for the population inside prison and for community supports after release.

  Just Leadership’s program enables more than two hundred well-trained former prisoners to become a tangible asset in the communities they come from. During periods of parole, former prisoners continue to be accountable to the criminal justice system and little else. One focus of Just Leadership is therefore on providing support for parolees that is based on community reintegration and restorative justice models, rather than the continued punitive surveillance of the criminal justice system. One specific program of this group in New York City is the campaign to close New York City’s notorious Rikers Island, an effort that has generated significant support and gained the commitment by New York City mayor Bill de Blasio to eventually close down the jail.

  On the primary prevention side are restorative justice programs such as the one pioneered by Common Justice and led by Danielle Sered for the Vera Institute. These programs also create and operate vital community-based services to intervene at the time of arrest with violent youthful offenders, the group that everyone agrees is the most difficult for the criminal justice system to address. But these cases are also proving most amenable to high-impact restorative justice and reconciliation methods at the community level, with crime victims and their families recognizing the value of these programs and offering impressive levels of support. By creating a new space in the criminal justice system for meaningful contact between offender and victims, these restorative programs achieve the aims of effective reconciliation and healing at the community level.

  Some of the other intervention models discussed in the book include harm-reduction approaches to drug addiction and its treatment. Two important areas to address are HIV/AIDS and drug overdoses, a set of public health issues that are newly urgent because of the increase in people injecting opiates. With the United States having seen more than 65,000 overdose deaths in 2016 alone and several outbreaks of AIDS cases in states that had not experienced them in the last decade,
a new area of public health and prevention programs has arisen. These include the wide employment of lifesaving naltrexone, a narcotic antagonist medication that reverses opioid overdose and saves many lives. In this area of public health an important role has emerged for law enforcement personnel.

  We now also see a growing and very progressive role for the police in decarceration. At the front end—in terms of primary interventions—there is a role for police working with early diversion programs to prevent arrest and jail time. Law Enforcement Assisted Diversion (LEAD) is a partnership between local police and mental health organizations and personnel that operates pre-booking diversion programs. These were first developed in the United States in Seattle, where the community used this approach to address low-level drug and prostitution crimes in King County. These pre-booking, community-based diversion programs are designed to divert those suspected of low-level drug and prostitution offenses away from the courts and jail and to replace prosecution with case management and other supportive services. Follow-up studies show that intervention groups are significantly less likely to have been arrested compared with the control groups.

  This work has spawned a new international movement, with the Center for Law Enforcement and Public Health (CLEPH), founded in Melbourne, Australia, in 2011, working globally to identify and support examples of progressive initiatives on the part of local police in the United States and abroad. The hallmarks of the center’s program are the partnership with law enforcement and its emphasis on the translation of research and knowledge into action and practice. CLEPH’s vision ranges from the very local to the global. In collaboration with others around the world, the center is building capacity, interest, and activities across the whole range of investigation and influence: research, teaching, advocacy, networking (including peer support and education), and engagement with other sectors/disciplines.