By Bernice Yeung By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
California prisons saw 246 additional AIDS/HIV cases between 2007 and 2008, the largest percentage jump of any prison system in the nation, according to a recently released federal report.
The number of inmates infected with the disease has climbed steadily in California over the past few years, from 1,155 in 2006 to 1,402 in 2008, although questions regarding prisoner tracking and follow-through upon their release may have influenced the data.
"Part of the underlying problem is that there's a concentration of HIV/AIDS among those who are the most disenfranchised," says Dr. George Lemp, director of the University of California's Universitywide AIDS Research Program.
"Those who are least likely to receive services and seek care are those persons who are more likely to find themselves in the prison system," he says. "As HIV becomes more concentrated in disenfranchised populations, I'd assume that this would be reflected in who is showing up in prison."
This growth in California cases, however, may reflect changes to prison health policy rather than an escalation in cases.
"There was no outbreak but merely increased effort to identify patients with HIV and get them into treatment," says Dr. Lori Kohler, a UCSF professor and the director of Correctional Medicine Consultation Network, which provides HIV services to California prisons.
"Patients with HIV are getting excellent care through a network of HIV providers in CPHCS and at UCSF," Dr. Kohler adds.
(As part of the ongoing federal oversight of prison medical care, the California Office of Inspector General will soon release a summary of its evaluations of prison medical facilities.)
Additionally, the percentage of inmates with the disease clocks in at only one-tenth of one percent, compared to nearly six percent of New York's HIV/AIDS-positive inmates. Nationwide, inmates are 2.5 times more likely to have the disease than the general public, the federal report notes.
"The subset of people who are HIV positive and who are incarcerated are the people who are least likely to be tested and more likely to have other significant health problems like hepatitis C or mental illnesses," says Dr. Josiah Rich, a professor at the Warren Alpert Medical School of Brown University. "This is a tremendous public health opportunity to find the hardest to reach people while they're incarcerated and get them access to health care."
Rich says that prisons "generally do a good job" providing health care for infected inmates, but "we fall flat on our face after people are released."
Rich co-authored a 2009 study that looked at 2,115 HIV-positive parolees in Texas and found that 90 percent did not refill their medications in time to safely continue treatment.
Another recent study tracked 512 HIV-positive repeat offenders from the San Francisco County Jail over nine years and found that only 15 percent continued medical treatment for the virus between incarceration and release.
"This population is at high risk for spreading the virus because they don't know they have it, they can be incarcerated for reasons related to mental illness or addiction, and they are not receiving treatment in the community," says Rich. "Connecting them to care when they are released is a public health argument. It's not a moral argument about whether they are more or less deserving of care."
Sources:
All interviews cited above conducted by Bernice Yeung
"HIV in Prisons, 2007-08"
U.S. Department of Justice, Dec. 1, 2009
California HIV/AIDS Research Program
California Prison Health Care Services
"Treatment for Individuals With HIV/AIDS Following Release From Prison"
Journal of the American Medical Association, July 8, 1009
"The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail"
PLoSONE Journal, September 22, 2009
By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
Despite a year of legal sanctions and budget cuts, the California Department of Corrections and Rehabilitation takes an upbeat tone in its new annual report.
Inspirationally titled "Corrections Moving Forward" [25 mb PDF], the report opens with a letter from the CDCR secretary Matthew Cate, who writes that "in the midst of significant challenges, the California Department of Corrections and Rehabilitation (CDCR) has quietly had a remarkable string of successes in the last year. While it is easy to focus on the negative, there have been many positive developments at our agency."
One such positive development, according to the report, is improvements to prison health care, with a new collaboration between the state and federal Medical Receiver Clark Kelso, who was appointed by a judge to oversee prison medical-care reform, and whose office the state previously tried to shut down.
As a result of the new cooperation, the report states, preventable deaths are down, medical position vacancies have increased, and the agency is working on a "comprehensive plan to improve medical facilities."
For a deeper look, we spoke with Hadar Aviram, a criminal law professor at the University of California's Hastings School of the Law and founder of the California Corrections Crisis blog.
BERNICE YEUNG: The CDCR annual report notes that there's been improvements to prison health care. Is this true?
HADAR AVIRAM: You have to pay attention to exactly what the report says. It specifically names Clark Kelso, the federal receiver, and he didn't come from nowhere. He was appointed because the state was deemed incapable of providing Constitutionally adequate care. They have made progress, but the CDCR and the governor have been fighting the receiver for years -- they've said that [Kelso's] proposals cost too much and that it's coddling prisoners.
But once the three-judge panel order came down this summer and it cited overcrowding as the cause of the substandard care, one thing that happened is that the state begin to make the argument that we do have a receiver and that he's doing a great job.
It'd be unfair to say that the state has not cooperated with the receiver at all. They are certainly working in conjunction with the receiver. One good thing that is happening is that they are overhauling the pharmaceutical system. They have made progress in construction so that there's more space for more people. They have made attempts to hire more staff -- prisons can be a difficult area of practice because they are in remote locations and it can be a difficult population to work with.
The receiver files quarterly reports on its Web site with information about improvements they've made.
BY: The annual report has an interesting breakdown of the CDCR's $9 billion budget. What are your thoughts on the budget for healthcare, which will cost about $2 billion in 2009-2010?
HA: The report says that we spend $48,000 a year on every inmate, which is 50 percent more than it costs to study at UC Hastings for a year. And of that amount, $16,000 is for medical expenses.
So how come the medical service is so poor? It's because we're looking at an average of expenditures on medical services. The "Three Strikers" and older inmates don't make up a large number of inmates, but they cost the state more in health care. Inmates that are 50 years or older, their medical costs double; those that are 60 years or older triple their medical costs.
And these numbers also include mental health care. And not everyone is getting preventative health care and eating organic salmon prior to incarceration. They didn't necessarily come in with the health and well being of an average citizen.
BY: Any other notable takeaways from the annual report?
HA: Well, overcrowding is the result of a variety of things and the assumption has always been that [the state's "three strikes" law] is the parent of all evil, but as the report shows, that's not true. Three Strikes is problematic because it means you are housing people who are getting old and who are getting sick. And what good is it to lock up people after their peak of criminal propensity?
The report shows that the bulk of people are in prison for short prison terms -- four to eight months or a year. They have short sentences or they are parole violators -- that makes up quite a chunk of the pie. [Read Aviram's detailed analysis.]
So then we have to ask: What are we doing when we let people in and when we let people out that is causing this?
Perhaps we are criminalizing behavior that shouldn't be criminalized and prosecuting for things that shouldn't be prosecuted for, like simple possession of small amounts of drugs. What about alternatives to incarceration? Why do we have inconsistent sentencing?
On the way out, you have to ask, why do we have universal parole?
Currently, everyone who comes out is under parole supervision. Do low-risk, nonviolent people all need to be monitored? The CDCR is currently looking into parole reform for parolees that are not dangerous, for those where it's perhaps a waste of time and resources to supervise them so closely.
There are various stations in the process where you could implement evidence-based practices, but that would require politicians not being in political and panic mode.
Posted by Spot. Us on 11/23/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
(See the posting at NewsDesk.org for the comments. There is a good conversation going there).
With his first proposal rejected by a federal court, Gov. Arnold Schwarzenegger last week submitted a new, 130-page plan to cut California prisons' inmate population by 42,000 in two years.
The proposal (PDF) would build new prisons and transfer inmates out of state, but comes amid a hefty budgetary slash to drug treatment programs that lawmakers had previously identified as an effective way of in keeping people out of prison.
Indeed, rehabilitation -- treatment, counseling or education programs -- does not figure into the new prison plan. It adopts similar strategies outlined in the document that Schwarzenegger filed with the courts in September -- including house arrest for elderly and ill inmates, transferring inmates out of state, and building new prisons.
The plan would waive environmental laws to expedite prison construction, and forgo restrictions on transferring inmates with serious medical and mental health problems to out-of-state prisons.
As mandated by the court, the state also included comments on the effects of $250 million in state cuts to adult rehabilitation programs -- a 40 percent reduction in the overall rehabilitation and treatment budget.
The cuts could have an "adverse impact" on some health services for prisoners, and would also target 5,000 slots in the state's substance-abuse programs for parolees.
The new plan does not mention that cuts to rehab will mean that drug treatment will close outright at eight prisons, and scaled-down versions will continue operating at 12 of its 33 prisons, as reported by the Los Angeles Times.
Cuts have already forced the shuttering of a substance abuse program at Donovan State Prison that's hailed for cutting recidivism from 71 to 21 percent.
Two years ago, an independent review of California's prison system commissioned by state legislators found that rehab programs could eliminate 48,000 prison beds, saving taxpayers $561 million to $684 million per year.
Schwarzenegger has championed rehabilitation in the past. He was responsible for changing the name of the state's corrections department to the California Department of Corrections and Rehabilitation four years ago and in 2007, he told reporters that when it comes to rehabilitation services for prisoners, "We have to heal them. We have to get them ready to go out so they can get a job, connect with society and never commit a crime again."
Schwarzenegger continues to challenge the legality of the federal court's August 2009 order mandating California's prison population reduction. The case is currently before the U.S. Supreme Court.
Posted by Spot. Us on 11/20/09Check out Bernice Yeung's latest coverage from her "Prisons & Public Health" hard-news blog on Newsdesk.org, and pass this email along if you think the topic is worthy:
"A Pound of Cure: On Prisons and National Health Care Reform"
http://www.newsdesk.org/
(Will be re-published on Spot.Us soon).
Can health-care reform keep people out of jail? Bernice Yeung digs into the question in an interview with Tracy Velazquez of the Justice Policy Institute.
You can also use Spot.Us to support of her ongoing coverage of the issue:
Help Crowdfund "Prisons & Public Health"
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BACKGROUND
Bernice Yeung's hard-news blog, "Prisons & Public Health," has been running on Newsdesk.org since July, and tracks how incarceration and parole affect people and communities struggling with chronic health problems -- from AIDS and STDs to addiction, wellness, family health, and more.
"Prisons & Public Health": A Hard-News Blog by Bernice Yeung
http://www.newsdesk.org/
Often, those most affected by these issues are from low-income and minority demographics that are overlooked by mass media. Bernice's coverage is filling a gap in the mainstream news agenda -- and has been getting GREAT comments from readers.
The project is crowdfunded by Spot.Us -- our goal is $1,500, and we're just shy of the 50% mark. Your small donation can help fund her ongoing coverage through the end of the year, and enable Newsdesk.org to continue publishing her diverse mix of interviews, legislative updates, topic roundups and formal reportage.
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Posted by Spot. Us on 10/22/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
Facing a court-ordered deadline to reduce overcrowded state prison populations, Gov. Arnold Schwarzenegger released a plan last Friday (PDF) that would revisit a previously rejected "early release" program, along with other measures.
Early release would place elderly, medically infirm inmates and some prisoners with less than 12 months left to serve on their sentence under house arrest with GPS monitoring. Thus, an elderly or ill inmate could be "housed" in a hospital or treatment center.
Previously, Newsdesk.org reported that California's underfunded public health systems are already struggling to absorb existing parolees, and that local officials fear that situation will worsen as the state tries to meet the court-imposed mandate to lower the prison population by 40,000 over the next two years.
The state estimates that early release, also known as "alternative custody," could reduce the prison population by 4,800 inmates, but the measure was rejected by the California assembly earlier this month due to public-safety concerns.
"You do have a lot of hysteria that was whipped up," California Assembly Speaker Karen Bass (D-Los Angeles) told reporters in late August. "We were going to release all these people, and that scares folks."
Gov. Schwarzenegger emphasized that the proposal is tough on crime by calling it a "comprehensive public safety plan."
Other components of the proposal include:
* Building, re-purposing or renovating 21 prisons by using $6.4 billion set aside through Assembly Bill 900.
* Expanding California's out-of-state correctional facility program by an additional 5,000 inmates.
* Forming a 13-member sentencing commission to create sentencing guidelines based on research and empirical data.
* Changing the threshold for a felony property crime (grand theft) from $400 in stolen goods to $950.
Debate about whether the governor's plan is tough or even smart on crime will continue, but it also doesn't take a mathematician to see that for all of its potential strengths and weaknesses, the plan doesn't meet the court mandate 40,000 fewer prisoners by 2011.
Under the current proposal, it would take five years to meet the court's reduction goals.
Gov. Schwarzenegger's plan also relies on the uncertain cooperation of the state legislature; the state assembly has already abandoned some of his proposed reforms -- such as the early-release program -- that he reintroduced last Friday.
Posted by Spot. Us on 09/22/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
How will California resolve its chronic prison overcrowding problems? With court-imposed deadlines ahead, the answer is as murky as ever.
Sept. 18 Deadline Looms
In August, following class-action litigation filed by California inmates, a federal court found that the state's prisoners were receiving Constitutionally sub-par health and mental health care because of overcrowding, and issued an order requiring the inmate population to be lowered by more than 40,000 over the next two years.
Gov. Arnold Schwarzenegger filed a motion to delay the order, which the district court denied; a further appeal filed with the U.S. Supreme Court was also turned down last week.
California is now out of appeals, and has no choice but to come up with a plan for reducing the prison population by Friday, September 18.
Budget Battles
Simultaneously, there's been a lot of back-and-forth on efforts to trim the prison budget by $1.2 billion.
The state senate bill, which Mr. Schwarzenegger supported, would have cut the prison population by 27,000 inmates, by re-categorizing some nonviolent felonies as misdemeanors, and releasing elderly and sick inmates early, among other strategies.
Last week, citing concerns about public safety, the state assembly passed a modified version of the bill that did away with its most controversial portions, including early release (although some nonviolent inmates will still be eligible for early release if they complete rehabilitation programs).
The assembly bill would reduce the prison population by 17,000 and tighten the prison budget by less than $1 billion.
Though last-minute negotiations threatened to derail the bill, California lawmakers agreed to adopt the assembly's prison bill on Friday, the last day of this year's legislative session.
The prison bill falls short of the 40,000-inmate reduction required of the state, and how the state plans to meet the federal court order remains to be seen.
Posted by Spot. Us on 09/16/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
As the state of California grapples with overcrowded prisons, its counties struggle with the flip side of the problem -- a lack of support for the increasing number of people returning from prison who need reentry services.
For example, a recent survey by prisoner advocates found that most shelters and services for women parolees in San Francisco and Alameda counties have long waiting lists, and many are unreachable by the phone numbers in official resource guides published by the state.
Budget Cuts Deepening
"There are not nearly enough services and what services do exist are not coordinate optimally," says Darryl Stewart, a constituent liaison and organizer for Alameda County Supervisor Nate Miley, and a member of the Alameda County Reentry Network.
State budget cuts have drastically affected "any program that deals with the safety net for low-income individuals," he said, "Cuts to social services, food stamps, general assistance and health care -- this is the safety net that people are talking about, and that safety net has been shredded."
Factor in the pending release of state prisoners, he says, and the result is "a tsunami coming at us, not just with the potential of early release, but because about 7,000 people are paroled to Alameda County each year."
In Hayward, Calif., the 14-year-old Women on the Way Recovery Center provides addiction treatment services primarily to formerly incarcerated women.
Currently, the organization has 36 women on the waiting list for its 10-bed residential treatment program, while an additional 56 women are waiting for space at the center's eight-bed transitional housing.
Once they become clients of the program, these women face additional challenges to accessing services, said Barbara Quintero, the center's director of operations.
"The barriers to reentry are medical, dental, mental health and housing," Quintero said. "There are barriers to these women getting health care consistently. There is a system, but it takes weeks to get in. So it's not that we don't have a system, it's just that the system is broken down, especially with the budget cuts."
Women's Services Struggle
When the nearby Central Health Clinic in Fairmont Hospital closed due to budget cuts several years ago, Women on the Way clients were lucky to receive most of their health care, dental work and mental-health prescriptions through an Alameda County program called Health Care for the Homeless.
Quintero, whose clients include women with stomach cancer and diabetes, said that without Health Care for the Homeless's last-minute suport, "these women would get no care."
Not all returning prisoners have such a fallback, however.
This August, All of Us or None, a national advocacy organization of ex-prisoners, teamed with the California Coalition for Women Prisoners to survey the East Bay and San Francisco housing programs for women listed in the parolee resource guide given to inmates upon release.
They found that of the 17 East Bay housing options listed in the resource guide, 10 weren't reachable by phone; in San Francisco, four of the 11 housing options were unreachable.
Of the housing services that All of Us or None was able to contact, most of them had waiting lists; there were no beds available in the East Bay and only five beds in San Francisco (two beds required a one- to two-week process to become eligible, two beds were for single women without children only, and one bed required a referral from a social service agency).
The results were announced at the Alameda County Reentry Network's meeting last month, said Linda Evans, an organizer with All of Us or None, and "what became really clear from this presentation is that this is an ongoing crisis."
In other words, the early release of inmates from California state prisons is only going to make an existing problem worse.
"[W]hat came out from the research and the discussion afterward is that the services that people need aren't there now for the people who are normally coming home," Evans said. "And that is a crisis in and of itself."
The sparse reentry services for women will be re-visited at the next Coordinating Council meeting, which is coming up on September 17.
Posted by Spot. Us on 09/16/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
The Sacramento Bee has posted some new online maps in advance of the potential release of 27,000 California inmates due to budget cuts, and another 40,000 thanks to a federal court order to curb prison overcrowding.
Last week's map, "An overview of California prisons," reveals the capacity of prisons throughout the state, as well as prisoner demographics and stats on their crimes, simply by rolling your mouse over each facility listed.
According to the map, the California Medical Facility in Vacaville is the least overcrowded, at 118 percent of capacity.
Meanwhile, the Deuel Vocational Institution in Tracy is the most overcrowded, operating at 233 percent above capacity.
Earlier this month, the Bee also published the interactive map, "Counties with the most residents in prison," which notes that Kings County has highest ratio of its residents in prison with 9.4 inmates per 1,000 county residents.
Read more Prisons & Public Health blog entries.
Posted by Spot. Us on 08/31/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
In a recent New York Times op-ed, columnist Nicholas Kristof cites the case of Curtis Wilkerson as an example of lopsided budget priorities ("Priority Test: Health Care or Prisons?"), wherein health care is considered too expensive, yet long and costly prison terms are the norm.
Wilkerson, you see, is a California inmate who became entangled in the state's three-strikes laws; he's now serving a life sentence for stealing a $2.50 pair of socks (strike one and two both involved abetting a robbery in 1981 when he was 19).
California doles out $49,000 a year on each inmate housed in a state prison, and $216,000 a year on each young person incarcerated through the juvenile justice system, Kristof notes, while in contrast, the Bay Area's Urban Strategies Council has found that only $8,000 is spent on each Oakland public school student.
Prison spending has been growing for decades in California and across the country [PDF], along with incarceration rates, under the "tough on crime" banner.
Yet as many public-policy makers are beginning to realize, being tough on crime doesn't mean that they're being safer or smarter about it.
Consider illegal drugs and public health.
According to the FBI, most people are serving time behind bars because they've committed a drug crime. The agency notes that "law enforcement made more arrests for drug abuse violations (an estimated 1.8 million arrests, or 13 percent of the total number of arrests) than for any other offense in 2007 (the most recent year that official statistics are available)."
On top of that, federal statistics from 2004 show that 17 percent of state prisoners and 18 percent of federal inmates say that they landed in lock-up committing a crime to get money for drugs.
In other words, a notable number of non-violent criminals -- who are also disproportionately black [PDF] -- are being sent to prison because they are drug addicted and unhealthy.
And then a good majority of them are released.
As I have reported in the past, many parolees are often released battling the same drug addiction that landed them in prison in the first place, which only makes it easier to commit another drug crime or violate their parole.
And then the incarceration cycle begins anew.
So in the end, is our choice really between spending tax dollars on health care and prisons? If we prioritized health care (including mental health and addiction services), how would that impact our prison spending?
Let me know your thoughts, and stay tuned as this blog continues to explore the issue.
Posted by Spot. Us on 08/26/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
With 40,000 inmates slated for release in the next two years due a federal court order targeting overcrowding in California prisons, what to do with all those convicts re-entering society is at the top of peoples' minds.
(In fact, the state has to come up with a plan of action by mid-September, although it will likely appeal the order.)
This is on top of the nearly 140,000 inmates released annually to California communities. Gov. Arnold Schwarzenegger has also indicated that he'd consider the early release of even more inmates to help cut $1.2 billion from the state budget.
For years, the state's more savvy cities and counties have convened reentry task forces to improve public safety by helping parolees transition more smoothly.
One of the most proactive efforts comes out of Alameda County -- which receives about 7,000 parolees a year -- and which has paid particular attention to the health and mental health needs of the formerly incarcerated.
In 2007, the county's then-director of the Department of Public Health, Arnold Perkins, helped create the Alameda County Reentry Network, which includes elected officials and representatives from a variety of local social-service and law-enforcement agencies.
At their meeting in July, the group discussed a plan to direct health and social-service funding toward inmates who are supposedly scheduled for early release, creating a better system for parolees to access their medical records, and handle the many health issues that women and the elderly face when they are released from prison.
The Reentry Network's coordinating council takes up the issue once again in Oakland on Thursday, August 20, from 1:00 p.m. to 3:00 pm, at the California Endowment Oakland Conference Center at 1111 Broadway, 7th Floor, Oakland.
Stay tuned for an update on their next move ...
Posted by Spot. Us on 08/21/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
Fresh from lockup and battling a host of health problems -- including chronic illness, addiction and mental illness -- a majority of California parolees wind up in a handful of cities like Los Angeles, Oakland and San Diego.
But here's the rub: Parolees often can't get the services they need because they're going back to low-income communities where health services are "severely strained," according to a recent RAND Corporation study.
The study also says that access to care for minority parolees also tends to be uneven. For example, African Americans living in Los Angeles and Alameda counties had less access to hospitals than Latino or white parolees, while in Kern and San Diego counties, Latino parolees had the least access.
I spoke with Lois Davis, the lead researcher on the RAND study, which mapped where parolees go after they're released, and analyzed -- for the first time -- California's safety net of medical, mental health and addiction services available to parolees in their communities.
Bernice Yeung: Why should we care about the health of parolees?
Lois Davis: A lot of people ask that question--why does this matter?--and they are usually fairly unsympathetic. But California is in the top five states in terms of the sheer number of prisoners and the truth is, they all return to communities.
[T]hey should care because [parolees] become a part of a larger set of public health and social problems that California will have to deal with. They become part of the medically indigent population, those suffering from mental illness, homelessness and those having drug problems.
It has affects on our public safety, since those conditions can be associated with property crimes. This population also brings with them infectious diseases, which can have an impact on the communities that they're returning to. So policy makers need to make sure that they are getting the service and the medications that they need.
How would you summarize the major findings of this study?
Certain California counties and communities are disproportionately impacted by reentry. They are often returning to disadvantaged communities where the medical and health safety nets are already restrained and where they have limited resources to help those individuals returning from prison. So some communities are disproportionately impacted.
Also, these individual tend to be in poorer health. They have higher rates of chronic health conditions such as asthma and hypertension, higher rates of infectious diseases and conditions that require rigorous use of health care to keep them in check. Two-thirds of California inmates report having drug-abuse or -dependency problems, and one-third report having mental health problems. So they are disproportionately sicker than the average citizen in California.
The key message is that certain counties and communities are disproportionately affected by reentry and if we want to think about how to target resources, we should take that into account.
How is this study unique?
The innovation of this study is not in mapping where parolees return to and the location of healthcare facilities; it's in trying to define, for the first time, the safety net for these individuals and figuring out what the capacity of that system is in terms of being able to meet the needs of these individuals.
We are beginning to recognize that access to services varies from community to community and it varies in terms of types of service. And this impacts parolees by race and ethnicity--it's important for people to understand that mental health services for African Americans and Latinos in Los Angeles or Alameda County, for example, reside in areas with lower access to these services ...
What was surprising to me was that in the mental health area, there is a patchwork of two small networks for parolees. But in truth, they need to rely on country resources [Something we'll explore in future posts--Ed.]. It's often hard for parolees and their advocates to navigate this patchwork.
We need, fundamentally, for policy makers to ask themselves about what reentry looks like in their community. What capacity do they have to meet the health care needs of people returning from prison? As reentry plans are getting more attention, how do we design strategies to target the resources to these individuals?
What policy recommendations would you make based on your research?
My specific recommendations are that policymakers have to realize that nonprofit community organizations--in Los Angles they're called public-private partnership clinics--fill an important role in the medical safety net. So if a county is thinking about how to target their resources, they should think about the possibility of funding more of these clinics in places where there are gaps in services for this population.
They also need to look at the patchwork of mental health and drug treatment for parolees because this is an area where parolees have the greatest need, and it will have an impact on whether they reoffend or violate their parole, whether they can find housing or a job. There is a real need to look at how we can better rationalize these services so that people have better access to the resources that they need.
Is California somehow different in terms of reentry and health care?
We have to recognize that we are one of the states with a large number of people coming out of prison, so this is not an issue that we can ignore. The sheer size of the prison population is not trivial in terms of the public health and public safety impacts.
And as the state is trying to find reductions in health care and corrections costs, they are considering cutting out rehabilitative services in prisons. For example, they are thinking of cutting substance-abuse counseling unless it is court ordered, or they are thinking of releasing individuals without parole. So we could have more people coming back out but at the same time, rehabilitative services are potentially being cut while they are incarcerated. And the state is also trying to trim funding to the medical and mental health safety net when they come out. What does this mean for the medically indigent? This population will essentially push the costs to a local level. So there are impacts of reentry on public health.
Why is health not often been discussed in terms of reentry?
We know that this population is sicker on average, but when people think of people that are coming out of prison, they think about how they need housing and a job. And they do. But what some people do not appreciate is the impact that health has on the ability of people to do these things.
This population has a higher burden of disease, whether you're talking about mental health, drug abuse or chronic illness. And the public-health community has not traditionally seen prisoners, or those returning from prison, as important when they're dealing with things like infectious diseases. But [it] does have a role to play in meeting these individuals needs; these individuals are part of the population that they need to worry about ...
We need to understand this population as part of the homeless and medically indigent population, which often needs alcohol and drug treatment.
As Jeremy Travis, the former director of the National Institute of Justice, said, "They all come back," and that's true. This is not an issue that we can ignore. And this impacts certain communities in a profound way. This goes back to the question of why we should care.
Posted by Spot. Us on 08/12/09By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog
Ron Sanders, a community-health worker serving former prisoners at San Francisco's Transitions Clinic, struggles to keep his clients from being among the 66 percent of parolees who eventually return to prison.
No easy task, as many are dealing with addiction, chronic illness, mental health problems -- or all of the above. I first became interested in these issues when writing for the San Francisco Chronicle about Sanders, himself a former prisoner who is all to aware of the challenges parolees face.
But why should Californians care about chronically ill prisoner and parolee health? What's the connection between prison reentry, medical care and our communities?
In fact, there's a growing awareness of the public health and safety implications of ignoring this population. About 95 percent of the people in prisons or jails will eventually be released. Nationwide, that's roughly 13 million releases each year -- and when they get back home, these men and women aren't exactly paragons of health.
More than 80 percent of 1,100 parolees from Texas and Ohio reported a chronic illness, according to a 2008 Urban Institute study, and more than 60 percent had no health insurance for nearly a year after release. A third sought medical care in emergency rooms, and 20 percent were hospitalized at one point during their first year out, creating costs that are passed on to taxpayers.
In Rhode Island, a program called Project Bridge connects the dots between parolees and public health, by hooking up HIV-positive parolees with medical care once they're released.
Writing for Miller-McCune magazine about the program, I note that the moral issue of providing ex-inmates with health care is also a public health imperative:
In February, the Journal of the American Medical Association published the results of a four-year study of 2,000 HIV-positive Texas inmates and found that only 5 percent of parolees filled their prescription soon enough to avoid interrupting their treatment regime. The lack of medical continuity had dire consequences."If people are not getting their meds when they get out of prison, there's a greater risk of medical complications for the patient, that the virus will spread and that drug-resistant strains will develop," said Josiah Rich, the Project Bridge doctor and one of the authors of the study.
As one physician argued, connecting parolees to care is simply good public policy:
"The strongest argument at the moment (for post-incarceration health care) is not a humanitarian one, it's an economic one," said Dr. Robert Greifinger, a distinguished research fellow at John Jay College of Criminal Justice and the editor of the 2007 book "Public Health Behind Bars.""If we're going to drive change in the costs of criminal justice and health care systems," he said, "one very substantial area to look at is by providing through care for inmates."
These are the issues I'll be looking at through this blog, by telling the human stories behind the research, policy and news on inmate reentry and health care in California.
For a conversation around this blog post - see it at NewsDesk.org
Posted by Bernice Yeung on 07/15/09California Gov. Arnold Schwarzenegger is bagging a plan to improve his state’s prison health-care system, which is known to be a mess, because of the $1.9 billion price tag.
San Quintin Quarantine for H1N1 - CBS-5
A limited quarantine imposed at San Quentin State Prison last week because of four probable cases of the H1N1 virus, or swine flu, has now been expanded to quarantine 2,100 inmates, a prison health care spokesman said Monday.
Governor dumps plan to build prison hospitals. SF Chronicle
Gov. Arnold Schwarzenegger disowned a tentative agreement Thursday to build prison hospitals to settle lawsuits over shoddy health care for inmates, saying the state won't borrow $1.9 billion for the effort while it's slashing other services.
Posted by Spot. Us on 07/07/09
